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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
|
Available as
|
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
|
| Carbamazepine |
Carbamazepine: Tegretol: Tegretol Retard: |
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.
|
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: Emeside: Zarontin: |
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: Lamotrigine: |
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: |
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. Epilim: 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: Clobazam: |
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: |
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: Gabapentin: |
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: Epanutin: |
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 Nausea, vomiting, diarrhoea, |
| 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. |
|
| 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.
|
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 |
| 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. |
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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