O

Table 8. Continued

Oral

Levels and

Protein Adverse

Interactions

Drug Mechanism

Indications

Dose

Absorption

Metabolism

Binding Effects

with other AEDs

Benzodiazepines Potentiates GABA (Clonazepam, inhibition by

Lorazepam, Nitrazepam)

Valproic Acid (Depakote®)

increasing rate of chloride channel opening

Enhances GABA, raising seizure threshold

Clonazepam: myoclonic, absence, atonic, akinetic seizures Diazepam

(Valium): status Lorazepam

(Ativan): status Chlorazepate:

partial seizures N itratrazepam: myoclonic, infantile spasms Lorazepam: status

Broad: partial and generalized seizures

Clonazepam: 0.01-0.03

mg/kg/day

15-80 mg/kg/day

Rapidly Trough and concentration:

completely 50-1 50 mcg/mL absorbed

Sedation, behavioral changes (hyperactivity in children)

Gl distress, sedation, weight gain

Caution with other

CNS depressants

Don't use under age 2 (Reye's syndrome) Don't use with salicylates Avoid polytherapy in children on valproic acid Inhibits metabolism of Phenytoin, carbama-zepine and phénobarbital

Table 8. Continued

Oral

Levels and

Protein

Adverse

Interactions

Drug

Mechanism

Indications

Dose

Absorption

Metabolism

Binding Effects

with other AEDs

Ethosuximide

Blocks calcium

Absence

10-40

Rapid and

Trough

0%

Gl distress,

With valproic acid,

(Zarontin®)

channels

seizures

mg/kg/day

completely

concentration:

nausea and

ethosuximide

(T-type)

absorbed

40-100 mcg/mL

vomiting,

clearance is

dizziness

reduced; ethosux

imide will increase

phenytoin levels

Gabapentin

Increases regional

Add-on therapy

10-50

Rapid,

Trough

0%

Sedation,

Negligible

(Neurontin®)

brain GABA

for partial and

mg/kg/day

40-60%

concentration:

dizziness,

concentration

generalized

absorbed;

12-20 mcg/mL*

headache,

seizures

decreased

weight gain,

absorption

behavioral

with increas

changes

ing dose

Lamotrigine

Blocks sodium

Broad: partial

1-10

Rapid and

Trough

55%

Dizzines, skin

Cyp450 inducers

(Lamictal®)

channels

and generalized

mg/kg/day

completely

concentration:

rash, headache,

enhance lamotrigine

seizures

absorbed

2-18 mcg/mL*

diplopia

metabolism; valproic

acid inhibits lamotri

gine metabolism

Topiramate

Blocks sodium

Broad: partial

1-6

80%

Trough

15%

Somnolence,

Phenytoin and

(Topamax)

channels and

and generalized

mg/kg/day

absorbed

concentration:

language and

carbamazepine

increases

seizures

5-20 mcg/mL*

higher cognitive

reduces topiramate

GABA induced

function impair

levels

choride flux

ment, 1.5%

incidence of

kidney stones

continued on next page continued on next page

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