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Table 239. Guide to Pediatric Antiepileptic Drug (AED) Therapy.

Drug/Target Dose Carbamazepine

Target Serum Levels

Idiosyncratic Reactions

Dose-Related Toxicity

Other Effects

412 Dermatologic (rash, Vertigo, visual mcg/mL including Stevens- disturbance Adult: 1000 Johnson syndrome), (diplopia), leukopenia 2000 mg/d rare hematologic, Pediatric: 1030 hepatic mg/kg/d

Hyponatremia in adults; leukopenia; liver induction; myoclonus in patients with general spike-wave discharges, increased bone metabolism Behavioral changes

Ethosuximide Adult: 1000 mg/d Pediatric: 1540 mg/kg/d Felbamate Adult: 2400 3600 mg/d Pediatric: 4560 mg/kg/d; has been used up to 200 mg/kg/d Gabapentin Adult: 1800 3600 mg/d Pediatric: 30 100 mg/kg/d

40100 Leukopenia, SLE, Sedation, GI upset mcg/mL nephrotic syndrome, rash

30100 Aplastic anemia Anorexia, insomnia, mcg/mL (adults only?), headache, irritability hepatic failure, rash (rare)

Aplastic anemia (postpubertal?); drug interactions

420 Rash (rare) mcg/mL

Somnolence, irritability, weight gain

Renal excretion, no drug interactions

320 Rash, mcg/mL hypersensitivity Adult: 300500 reaction mg/d Lamotrigine Pediatric: 115 mg/kg/d; dose depends on concomitant medication Levetiracetam 550 None reported to

Ataxia, diplopia, GI upset, headache

Rash (probably 5%, especially in children), StevensJohnson syndrome

Somnolence, ataxia

Agitation,

Adult: 1200 2400 mg/d Pediatric: 40 100 mg/kg/d Oxcarbazepine Adult: 1200 2400 mg/d Pediatric: 1545 mg/kg/d Phenobarbital Adult: 60120 mg/d Pediatric: 26 mg/kg/d

mcg/mL date

aggression, depression (510%?)

MHD: Rash (25% cross1045 reactivity with mcg/mL carbamazepine)

CNS effects, diplopia Hyponatremia (3% of adults) behavior, ?weight gain

1540 Rash, Stevensmcg/mL Johnson syndrome, SLE

Somnolence, irritability

Possible irreversible cognitive effects, liver induction, increased bone metabolism Elevated LFTs, induction; reduced vitamin D levels; ?cerebellar degeneration; increased bone metabolism Similar to phenobarbital

1020 Rash (510%), mcg/mL hematologic, Adult: 200600 hepatic, mg/d lymphadenopathy Pediatric: 48 others mg/kg/d; may need higher does in infants Phenytoin Primidone Adult: 750 2000 mg/d Pediatric: 520 mg/kg/d Tiagabine Adult: 3256 mg/d Pediatric: 0.25 1.25 mg/kg/d 325 Rash (rare), acute mcg/mL glaucoma (rare) Adult: 100400 mg/d Topiramate Pediatric: 525 mg/kg/d; can increase if side effects are tolerated 570 Psychiatric effects mcg/mL 412 Rash mcg/mL

Cosmetic, CNS, ataxia, nystagmus

Sedation, irritability, GI upset

CNS, tremor, weakness, gastroesophageal reflux, gait difficulty

Somnolence, language disturbance, renal stones anorexia, paresthesias

Language disturbance (especially with polytherapy); avoid ketogenic diet; oligohidrosis

Valproic acid Adult: 750 1500 mg/d Pediatric: 2060 mg/kg/d

50150 Hepatic failure; mcg/mL pancreatitis

Tremor, weight gain, alopecia, sedation and cognitive changes, thrombocytopenia, prolonged bleeding time

Hepatic failure (in 1:500 children < age 2 y receiving polytherapy), elevated LFTs; GI upset with syrup; incidence of PCOS unknown, liver enzyme inhibition

Vigabatrin Adult: maximum 3000 mg/d Pediatric: 40 150 mg/kg/d

Visual field constriction, sedation, CNS effects

Psychiatric symptoms Especially effective (rare), visual field for infantile spasms constriction and tuberous sclerosis

1030 Rash, hematologic, mcg/mL hepatic Adult: 200600 mg/d Zonisamide Pediatric: 410 mg/kg/d
Current pediatric diagnosis 19th ed

Renal stones, Oligohidrosis in anorexia, somnolence children; crosssensitivity with sulfa drugs