AAN GUIDELINES Bundle

Table 4. Drug Table Agent (Brand) Dose* Indications* Warnings* carbamazepine (CBZ) Tegretol , Carbatrol , Equetro Initial: 200 mg bid Maximum: 1200 mg/d • partial seizures with complex symptomatolog y (psychomotor, temporal lobe) • generalized tonic-clonic seizures (grand mal) • mixed seizure patterns • trigeminal neuralgia • serious dermatologic reactions • aplastic anemia and agranulocytosis ethosuximide (ESM) Zarontin Initial: 250 mg/d PO Maximum: 1500 mg/d PO • absence (petit mal) epilepsy • blood dyscrasias • effects on liver and kidneys • systemic lupus erythematosus • suicidal behavior and ideation gabapentin (GBP) Neurontin Initial: 300 mg tid Maximum: 1800 mg/day • partial seizures • postherpetic neuralgia • suicidal behavior and ideation • withdrawal seizures lamotrigine (LTG) Lamictal Initial: 25 mg/d Maximum: 200 mg/d • partial seizures • primary generalized tonic-clonic seizures • generalized seizures of Lennox-Gastaut syndrome • bipolar disorder • serious skin rashes • hypersensitivity reactions • acute multiorgan failure • blood dyscrasias • suicidal behavior and ideation • withdrawal seizures • status epilepticus levetiracetam (LVT) Keppra Initial: 1 gm/d Maximum: 3 gm/d • adjunctive Rx for partial onset, myoclonic and primary generalized tonic-clonic seizures • suicidal behavior and ideation • neuropsychiatric adverse events • withdrawal seizures oxcarbazepine (OXC) Trileptal Initial: 600 mg/d Maximum: 1200 mg/d • partial seizures • adjunctive Rx for epilepsy • hyponatremia • anaphylactic reactions and angioedema • serious dermatological reactions • withdrawal seizures phenobarbital (PB) generic, Solfoton 50-100 mg bid-tid • generalized tonic-clonic and cortical local seizures • habit forming • withdrawal seizures phenytoin (PHT) Dilantin Initial: 100 mg tid Maximum: 600 mg/d • generalized tonic-clonic (grand mal) and complex partial (psychomotor, temporal lobe) seizures • withdrawal seizures • lymphadenopathy • status epilepticus primidone (PRM) Mysoline Initial: 100 to 125 mg at bedtime Maximum: 500 mg qid • grand mal, psychomotor, and focal epileptic seizures • withdrawal seizures • suicidal behavior and ideation • status epilepticus topiramate (TPM) Topamax Initial: 25 mg bid Titrate up to maximum: 200 mg bid • partial onset or primary generalized tonic-clonic seizures • migraine • metabolic acidosis • acute myopia and secondary angle closure glaucoma • oligohidrosis and hyper thermia • withdrawal seizures • cognitive neuropsychiatric disturbances • psychiatric/behavioral problems • somnolence/fatigue valproate (VPA) Depakene, Depakote, Stavzor Initial: 5-15 mg/kg/day Maximum: 60 mg/kg/day • complex partial seizures • simple and complex absence seizures • bipolar disorder • migraine • hepatotoxicity • teratogenicity • pancreatitis • suicidal ideation * See PI for details

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