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Antiepileptic drugs used in adults

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Table of anti-epileptic drugs used in adults

The following table of anti-epileptic drugs used in adults gives guidelines only. The table gives average daily dose ranges. Treatment will generally start with smaller doses that are then gradually increased. The most appropriate dose of anti-epileptic drugs for any individual may be found, during careful monitoring, to be higher or lower than average.

Click on the links in the table to see patient information leaflets for drugs from the Electronic Medicines Compendium. All external links open in new windows.

The side effects listed in this table are some of the most common possible side effects for each AED. Side effect lists are taken from the British National Formulary, British National Formulary for Chilcdren (Stiripentol) and summary of product characteristics (retigabine).

 

First line drugs
(generic name)

Available as
(brand name)

Average total dose in a day for adults

Treatment

Most common possible side effects include the following (any severe reactions, such as a skin rash, should be reported
to your GP or neurologist)

 Carbamazepine

Carbamazepine:
Tablets 100mg, 200mg, 400mg.

Tegretol:
Tablets 100mg, 200mg, 400mg.
Chewtabs 100mg, 200mg.
Liquid sugar free 100mg/5mL.
Suppositories 125mg, 250mg.

Tegretol Retard:
Tablets 200mg, 400mg.

600mg - 2000mg divided into up to 4 doses a day.

Liquid is given 3 times a day.

Tegretol Retard is usually taken twice a day.

Effective for tonic clonic seizures, and focal seizures.

Ineffective against absences.


May worsen myoclonic seizures  

Skin rash.

Dry mouth, nausea, vomiting, fluid retention, ataxia (unsteadiness), dizziness, drowsiness, fatigue, headache, hyponatreamia (low sodium in the blood), blood disorders, dermatitis, and urticaria (hives).

 Ethosuximide 

Ethosuximide:
Capsules 250mg.

Emeside:
Syrup 250mg/5mL.

Zarontin:
Syrup 250mg/5mL.

750mg - 1500mg divided into 2 or 3 doses a day. Effective for absences only. Gastro-intestinal disturbances (nausea, vomiting, diarrhoea, abdominal pain, anorexia, weight loss).
 Lamotrigine

Lamictal:
Tablets 25mg, 50mg, 100mg, 200mg.
Dispersible tablets 2mg, 5mg, 25mg, 100mg.

Lamotrigine:
Tablets 25mg, 50mg 100mg, 200mg.
Dispersible tablets 5mg, 25mg, 100mg.

100mg - 200mg if taken alone or with sodium valproate.

200mg - 400mg if taken with phenytoin, phenobarbitone, or carbamazepine.

Taken in 1 or 2 doses a day.

Effective for focal and tonic clonic seizures.

Serious skin rash and hypersensitivity. Risk minimised with slow introduction.

Nausea, vomiting, diarrhoea, dry mouth, aggression, agitation, headache, drowsiness, dizziness, tremor, insomnia (difficulty sleeping), ataxia (unsteadiness), back pain, arthralgia (joint pain), nystagmus (eye movements), diplopia (double vision), and blurred vision.

 Levetiracetam Keppra:
Tablets 250mg, 500mg, 750mg, 1000mg.
Oral solution 100mg/1mL.  
1000mg - 3000mg divided into 2 doses a day. 
Effective for focal seizures with or without secondary generalisation. Add-on therapy for myoclonic seizures and Juvenile Myoclonic Epilepsy.  
Anorexia, weight changes, abdominal pain, nausea, vomiting, diarrhoea, drowsiness, ataxia (unsteadiness), dizziness, headache, tremor, amnesia, aggression, agitation, depression, anxiety, and double or blurred vision.
 Oxcarbazepine 

Oxcarbazepine: Tablets 150mg, 300mg, 600mg.

Trileptal:
150mg, 300mg, 600mg.
Oral suspension 60mg/mL. 

1200mg - 2400mg, divided into 2 or 3 doses a day. Effective for focal and secondarily generalised seizures.

Skin rash.

Nausea, vomiting, constipation, diarrhoea, abdominal pain, dizziness, headache, drowsiness, agitation, amnesia, hair loss, asthenia (weakness), ataxia (unsteadiness), confusion, depression, and tremor.

Sodium Valproate

Sodium Valproate: Tablets 200mg, 500mg.
Oral solution 200mg/5mL.

Epilim:
Tablets 200mg, 500mg.
Crushable tablets 100mg.
Liquid (sugar free): 200mg/5mL.
Syrup 200mg/5mL.

Epilim Chrono (slow release): Tablets 200mg, 300mg, 500mg.

Epilim Chronosphere: Sachets 50mg, 100mg, 250mg, 500mg, 750mg, 1000mg.

Episenta (slow release): Capsules 150mg, 300mg. Granules 500mg, 1000mg.

400mg - 2000mg divided into 1 or 2 doses a day. Effective for focal, tonic clonic and absence seizures.

Hair loss - not usually severe and is usually reversible if the dose is reduced.

Nausea, stomach upset, diarrhoea , and weight gain (due to increased appetite), hyperammonaemia (increased levels of ammonia in the blood), and thrombocytopenia (reduced platelets in the blood).

Has been associated with polycystic ovaries and menstrual problems.

Sodium valproate carries a higher risk than other AEDs of causing developmental problems in unborn babies if taken during pregnancy. Having preconceptual counselling is recommended.

                   

Second line drugs (generic name)
Available as
(brand name)
Average total dose in a day for adults Treatment
Most common possible side effects include the following (any severe reactions, such as a skin rash, should be reported
to your GP or neurologist)
Acetazolamide Diamox:
Tablets 250mg.
Capsules (slow release) 250mg.
250mg - 1000mg divided into 2 or 3 doses a day. Effective for focal, tonic clonic and absence seizures. Also used for menstrual-related seizures, certain episodic disorders and to enhance other AEDs. Nausea, vomiting, diarrhoea, taste disturbance, loss of appetite, paraesthesia (pins and needles), flushing, headache, dizziness, fatigue, irritability, excitement, ataxia (unsteadiness), depression, thirst, polyuria (increased urination), and reduced libido. Tolerance may develop.
Clobazam

Frisium:
Tablets 10mg.

Clobazam:
Tablets 10mg.

20mg - 50mg divided into 1 or 2 doses a day. Effective for focal and tonic clonic seizures. Drowsiness, lightheadedness, confusion, ataxia (unsteadiness), amnesia, dependence, aggression, and muscle weakness. This drug is less sedating than clonazepam or diazepam. Tolerance may develop.
Clonazepam

Clonazepan: Tablets 0.5mg, 2mg.

Rivotril:
Tablets 0.5mg, 2mg.

1mg - 4mg divided into 2 doses a day. Effective for focal, tonic clonic, myoclonic and absence seizures. Drowsiness, fatigue, dizziness, low muscle tone, coordination problems, low concentration, restlessness, confusion, amnesia, and dependence. Tolerance tends to develop.
Eslicarbazepine acetate Zebinix: Tablets 800mg. 800 - 1200mg once a day. Effective as an add-on therapy for focal seizures with or without secondary generalisation.

Skin rash.

Nausea, vomiting, diarrhoea, dizziness, drowsiness, headache, impaired coordination, tremor, visual problems, and fatigue (tiredness).

Gabapentin

Neurontin:
Tablets 600mg, 800mg.
Capsules 100mg, 300mg, 400mg.

Gabapentin:
Tablets 600mg, 800mg.
Capsules 100mg, 300mg, 400mg.

1800mg - 3600mg divided into 3 doses a day.

Used for focal seizures where other treatment has not worked.

May make myoclonic and absence seizures worse.

rash.

Diarrhoea, nausea, vomiting, dry mouth, appetite changes, weight gain, hypertension (high blood pressure), fluid retention, confusion, depression, sleep disturbance, headache, dizziness, anxiety, tremor, ataxia (unsteadiness), flu-like symptoms, incontinence, impotence, and double vision.

Lacosamide Vimpat: Tablets 50mg, 100mg, 150mg, 200mg.
Syrup: 15mg/mL
200mg - 400mg divided into 2 doses a day. Add-on therapy for focal seizures. Nausea, vomitting, constipation, wind, dizziness, headache, impaired co-ordination, drowsiness, tremor, depression, fatigue, abnormal walking, blurred vision, nystagmus (eye movements), and pruritus (itching).
Phenobarbital Phenobarbital: Tablets 15mg, 30mg, 60mg.
Elixir 15mg/5mL.
30mg - 180mg divided into 2 doses a day. Effective for focal and tonic clonic seizures.

Rash.

Hepatitis, hypotension (low blood pressure), drowsiness, lethargy, depression, ataxia (unsteadiness), and impaired memory or cognition.

Phenytoin

Phenytoin:
Tablets 100mg.

Epanutin:
Capsules 25mg, 50mg, 100mg, 300mg.
Chewable Infatabs 50mg.
Suspension 30mg/5mL.

150mg - 500mg divided into 1 or 2 doses a day.

Effective for focal and tonic clonic seizures.

Ineffective against absences.

Blood testing is essential to guide the doses.

Skin rash.

Nausea, vomiting, constipation, drowsiness, insomnia, nervousness, tremor, paraesthesia (pins and needles), dizziness, headache, anorexia, gum problems, acne, excess hair growth, and coarsening of facial features.

Piracetam Nootropil:
Tablets 800mg, 1200mg.
Oral solution 333.3mg/mL (to be taken with water to reduce the bitter taste).
7.2g - 20g divided into 2 or 3 doses a day.
Used for myoclonic seizures where other treatment has not worked.

Rash.

Weight gain, nervousness, and hyperkinesia (overactive restlessness).

Pregabalin Lyrica:
Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 300mg
300-600mg divided into 2 doses a day
Effective for focal seizures, with or without secondary generalisation. Dry mouth, constipation, vomiting, wind, fluid retention, dizziness, irritability, low attention, muscle and movement problems, speech disorder, impaired memory, paraesthesia (pins and needles), euphoria, confusion, insomnia, blurred or double vision, and sexual dysfunction.
Primidone Mysoline: Tablets 250mg. 500mg - 1500mg divided into 2 doses a day.

Effective for focal and tonic clonic seizures.

May be ineffective against absences.

Rash.

Hepatitis, hypotension (low blood pressure), drowsiness, lethargy, depression, ataxia (unsteadiness), impaired memory or cognition, and nausea.

 

Retigabine Trobalt; Tablets 50mg, 100mg, 200mg, 300mg, 400mg.

900mg - 1200mg divided into 3 doses a day.

 

Add-on treatment for focal seizures.

 

Dizziness, sleepiness, fatigue, weight gain, confusion, anxiety, tremor, double or blurred vision, nausea, constipation, and problems urinating. Retigabine can cause problems with heart rhythm (consult your doctor).
Rufinamide Inovelon: Tablets 100mg, 200mg, 400mg. 200mg - 3600mg (depending on body weight and whether also taking sodium valporate) divided into 2 doses. Add on treatment for Lennox-Gastaut syndrome.

Hypersensitivity syndrome (possibly including rash and fever) – if
concerned seek immediate medical attention.

Nausea, vomiting, diarrhoea,
constipation, indigestion, abdominal pain, weight loss, anorexia, runny
nose, nosebleeds, dizziness, headache, drowsiness, insomnia, anxiety,
tiredness, flu-like symptoms, and blurred or double vision.

Stiripentol Diacomit Capsules 250mg, 500mg. Sachets 250mg, 500mg 50mg/kg/day divided into 2 or 3 doses. Used alongside cloazam and sodium valporate. Add-on therapy for tonic clonic seizures in severe myoclonic epilepsy in infancy (SMEI or Dravet syndrome) where other treatment has not worked.


Nausea, vomiting, aggression, anorexia, ataxia (unsteadiness), drowsiness, dystonia (muscle contractions), excitability, hyperkinesia (overactive restlessness), low muscle tone, irritability, sleep problems, weight loss, and neutropenia (reduced immunity).

Tiagabine Gabitril:
Tablets 5mg, 10mg, 15mg  
30mg - 45mg.
Doses above 30mg should be divided into 3 doses a day.

Used for focal seizures where other treatment has not worked.


May make myoclonic seizures worse.

Diarrhoea, dizziness, tiredness, nervousness, tremor, concentration
problems, emotional reactions, and speech impairment.
Topiramate
Topamax:
Tablets 25mg, 50mg, 100mg, 200mg.
Sprinkle capsules 15mg, 25mg, 50mg.

Up to 400mg daily if taken alone. Usually 200mg - 400mg daily if taken with other AEDs, up to 800mg.

Taken in 2 doses a day.

Used for focal seizures where other treatment has not worked. Topiramate has a licence for monotherapy but is not widely used as a first-line drug.

Rash.

Nausea, diarrhoea, vomiting, constipation, indigestion, abdominal
pain, dry mouth, appetite changes, impaired attention, cognition and
coordination, movement problems, tremor, drowsiness, dizziness,
anxiety, confusion, mood changes, depression, irritability, and anaemia.

Vigabatrin Sabril:
Tablets 500mg.
Powder (sugar free) 500mg/sachet.
1000 - 4000mg divided into 1 or 2 doses a day. 

Effective for focal seizures and secondarily generalised seizures where other treatment has not worked.

Used for West syndrome with Tuberous Sclerosis.

May worsen absence and myoclonic seizures.


Nausea, abdominal pain, fluid retention, drowsiness, fatigue, agitation, dizziness, headache, nervousness, depression, aggression, impaired concentration or memory, and tremor, weight gain.

Visual field defects have been reported in some adults: visual fields should be checked every six months. Talk to your GP or neurologist if you are concerned about this.

Zonisamide Zonegran: Capsules 25mg, 50mg, 100mg. 300 - 500mg divided into 1 or 2 doses a day. Effective for focal seizures, with or without secondarily generalisation.

Skin rash.

Nausea, diarrhoea, abdominal pain, constipation, indigestion, anorexia, weight loss, drowsiness, dizziness, confusion, agitation, irritability, depression, psychosis, and ataxia (unsteadiness).

 

© Epilepsy Society.

Information produced in July 2011.
   

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