Section 01
Antiepileptics
Seizure & Epilepsy Medications
37 AGENTS
Levetiracetam
KeppraSV2A ligand
- Forms
- Tab: 250, 500, 750, 1000mg | XR: 500, 750mg | Sol: 100mg/mL | IV: 100mg/mL
- Dose
- 1000-3000mg/day
- MOA
- Binds synaptic vesicle protein SV2A
Valproate
DepakoteBroad-spectrum AED
- Forms
- DR tab: 125, 250, 500mg | Sprinkle: 125mg | ER: 250, 500mg | IV: 100mg/mL
- Dose
- 500-1500mg/day
- MOA
- ↑GABA; blocks Na+/T-type Ca2+ channels
Lamotrigine
LamictalNa+ channel blocker
- Forms
- Tab: 25, 100, 150, 200mg | Chew: 2, 5, 25mg | XR: 25-300mg | ODT: 25-200mg
- Dose
- 200-400mg/day
- MOA
- Blocks voltage-gated Na+ channels
Carbamazepine
TegretolNa+ channel blocker
- Forms
- Tab: 200mg | Chew: 100mg | XR: 100, 200, 400mg | Susp: 100mg/5mL
- Dose
- 400-1200mg/day
- MOA
- Blocks voltage-gated Na+ channels
Oxcarbazepine
TrileptalNa+ channel blocker
- Forms
- Tab: 150, 300, 600mg | Susp: 300mg/5mL
- Dose
- 600-2400mg/day
- MOA
- Blocks voltage-gated Na+ channels
Eslicarbazepine
AptiomNa+ channel blocker
- Forms
- Tab: 200, 400, 600, 800mg
- Dose
- 400-1600mg once daily
- MOA
- Blocks voltage-gated Na+ channels
Phenytoin
DilantinNa+ channel blocker
- Forms
- ER cap: 30, 100mg | Chew: 50mg | Susp: 125mg/5mL | IV: 50mg/mL
- Dose
- 300-400mg/day
- MOA
- Blocks voltage-gated Na+ channels
Fosphenytoin
CerebyxNa+ channel blocker (prodrug)
- Forms
- IV/IM: 50mg PE/mL (100mg PE & 500mg PE vials)
- Dose
- load 15-20 PE/kg, then maint.
- MOA
- Converted to phenytoin
Phenobarbital
LuminalBarbiturate
- Forms
- Tab: 15, 30, 60, 100mg | Elixir: 20mg/5mL | IV: 65, 130mg/mL
- Dose
- 60-200mg/day
- MOA
- ↑GABA-A Cl- channel open duration
Primidone
MysolineBarbiturate (prodrug)
- Forms
- Tab: 50, 250mg
- Dose
- 750-1500mg/day divided
- MOA
- Metabolized to phenobarbital
Topiramate
TopamaxMulti-mechanism AED
- Forms
- Tab: 25, 50, 100, 200mg | Sprinkle: 15, 25mg
- Dose
- 200-400mg/day
- MOA
- Na+ blockade, ↑GABA, ↓AMPA/kainate
Zonisamide
ZonegranMulti-mechanism AED
- Forms
- Cap: 25, 50, 100mg
- Dose
- 100-400mg/day
- MOA
- Na+ and T-type Ca2+ blockade
Lacosamide
VimpatNa+ channel modulator
- Forms
- Tab: 50, 100, 150, 200mg | Sol: 10mg/mL | IV: 10mg/mL
- Dose
- 100-400mg/day
- MOA
- Enhances slow Na+ inactivation
Gabapentin
NeurontinGabapentinoid
- Forms
- Cap: 100, 300, 400mg | Tab: 600, 800mg | Sol: 250mg/5mL
- Dose
- 900-3600mg/day
- MOA
- Binds α2δ Ca2+ channel subunit
Pregabalin
LyricaGabapentinoid
- Forms
- Cap: 25, 50, 75, 100, 150, 200, 225, 300mg | Sol: 20mg/mL
- Dose
- 150-600mg/day
- MOA
- Binds α2δ Ca2+ channel subunit
Perampanel
FycompaAMPA antagonist
- Forms
- Tab: 2, 4, 6, 8, 10, 12mg | Susp: 0.5mg/mL
- Dose
- 4-12mg qHS
- MOA
- Noncompetitive AMPA receptor blockade
Brivaracetam
BriviactSV2A ligand
- Forms
- Tab: 10, 25, 50, 75, 100mg | Sol: 10mg/mL | IV: 10mg/mL
- Dose
- 50-200mg/day
- MOA
- High-affinity SV2A binding
Cenobamate
XcopriNa+/GABA-A modulator
- Forms
- Tab: 12.5, 25, 50, 100, 150, 200mg
- Dose
- 200-400mg/day
- MOA
- Na+ blockade + GABA-A positive modulation
Clobazam
OnfiBenzodiazepine
- Forms
- Tab: 5, 10, 20mg | Susp: 2.5mg/mL
- Dose
- 10-40mg/day
- MOA
- ↑GABA-A Cl- channel frequency
Clonazepam
KlonopinBenzodiazepine
- Forms
- Tab: 0.5, 1, 2mg | ODT: 0.125, 0.25, 0.5, 1, 2mg
- Dose
- 0.5-4mg/day divided
- MOA
- ↑GABA-A Cl- channel frequency
Diazepam
Valium / DiastatBenzodiazepine
- Forms
- Tab: 2, 5, 10mg | Sol: 5mg/5mL | IV: 5mg/mL | Rectal gel: 2.5, 10, 20mg
- Dose
- status/rescue dosing, weight-based
- MOA
- ↑GABA-A Cl- channel frequency
Ethosuximide
ZarontinT-type Ca2+ blocker
- Forms
- Cap: 250mg | Syrup: 250mg/5mL
- Dose
- 500-1500mg/day (absence sz.)
- MOA
- Blocks thalamic T-type Ca2+ channels
Methsuximide
CelontinT-type Ca2+ blocker
- Forms
- Cap: 150, 300mg
- Dose
- 600-1200mg/day divided
- MOA
- Blocks thalamic T-type Ca2+ channels
Felbamate
FelbatolNMDA antagonist
- Forms
- Tab: 400, 600mg | Susp: 600mg/5mL
- Dose
- 1200-3600mg/day divided
- MOA
- NMDA blockade + GABA-A potentiation
Vigabatrin
SabrilGABA-transaminase inhibitor
- Forms
- Tab: 500mg | Powder packet: 500mg
- Dose
- 1-3g/day divided BID
- MOA
- Irreversibly inhibits GABA-T
Tiagabine
GabitrilGABA reuptake inhibitor
- Forms
- Tab: 2, 4, 12, 16mg
- Dose
- 4-56mg/day divided
- MOA
- Blocks GAT-1 GABA transporter
Rufinamide
BanzelNa+ channel modulator
- Forms
- Tab: 200, 400mg | Susp: 40mg/mL
- Dose
- up to 3200mg/day divided BID
- MOA
- Prolongs Na+ channel inactive state
Stiripentol
DiacomitGABA-A modulator
- Forms
- Cap: 250, 500mg | Powder packet: 250, 500mg
- Dose
- 50mg/kg/day divided (Dravet)
- MOA
- Potentiates GABA-A + CYP inhibition
Fenfluramine
FinteplaSerotonergic agent
- Forms
- Sol: 2.2mg/mL
- Dose
- 0.2-0.7mg/kg/day (Dravet/LGS)
- MOA
- ↑Serotonin release, sigma-1 agonist
Cannabidiol
EpidiolexCannabinoid
- Forms
- Sol: 100mg/mL
- Dose
- 5-20mg/kg/day divided BID
- MOA
- Unclear; TRPV1/GPR55 modulation
Ganaxolone
ZtalmyNeuroactive steroid
- Forms
- Susp: 50mg/mL (110mL bottle)
- Dose
- Weight-based TID with food; titrate to max 21mg/kg TID (28kg or less) or 600mg TID (over 28kg) - CDKL5 seizures, age 2+
- MOA
- Positive allosteric modulator of GABA-A receptors
Midazolam
Nayzilam / SeizalamBenzodiazepine · rescue
- Forms
- NS: 5mg/spray (Nayzilam) | IM: 5mg/mL (Seizalam)
- Dose
- Nayzilam 5mg intranasal, may repeat x1 after 10 min | Seizalam 10mg IM (adult status epilepticus)
- MOA
- ↑GABA-A Cl- channel frequency
Diazepam nasal
ValtocoBenzodiazepine · rescue
- Forms
- NS: 5, 7.5, 10mg/0.1mL devices (5-20mg doses)
- Dose
- Age-based: 0.2mg/kg (12+), 0.3mg/kg (6-11), 0.5mg/kg (2-5); may repeat x1 after 4h
- MOA
- ↑GABA-A Cl- channel frequency
Lorazepam
AtivanBenzodiazepine
- Forms
- Tab: 0.5, 1, 2mg | IV/IM: 2, 4mg/mL
- Dose
- Status epilepticus: 4mg IV slowly; may repeat once in 10-15 min
- MOA
- ↑GABA-A Cl- channel frequency
Clorazepate
Tranxene T-TabBenzodiazepine
- Forms
- Tab: 3.75, 7.5, 15mg
- Dose
- Adjunct partial seizures: start 7.5mg TID, increase 7.5mg weekly, max 90mg/day
- MOA
- ↑GABA-A Cl- channel frequency
Everolimus
Afinitor DisperzmTOR inhibitor
- Forms
- Tab for susp: 2, 3, 5mg
- Dose
- TSC seizures: 5mg/m² once daily, titrate to trough 5-15ng/mL
- MOA
- Inhibits mTORC1 (TSC-related seizure pathway)
Corticotropin (ACTH)
Acthar GelHormone (ACTH)
- Forms
- Inj: 80 units/mL (5mL vial)
- Dose
- Infantile spasms: 150 units/m²/day IM divided BID x2wk, then taper
- MOA
- Stimulates adrenal steroidogenesis; melanocortin receptor effects