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Table of anti-epileptic drugs used in children
Notes on using the drug treatment table
The table below shows anti-epileptic drugs (AEDs) available to treat epilepsy in children aged 12 and under.
The table lists the usual total daily doses of AEDs.
Doses are usually listed as ‘mg/kg/day’. This means milligrams of AED per kg of the child’s weight, given each day.
The total daily dose is the amount given each day. If the AED is given twice a day, then half the total dose is given each time. If it is taken three times a day, a third of the total dose is given in each dose.
Examples
If the total daily dose of carbamazepine tablets prescribed is '20mg/kg/day': for a 15kg child, this would mean their dose is 300mg per day (20mg for each kg). As this drug is taken twice a day, each dose will be 150mg.
The strength of a liquid AED is given on the bottle. For sodium valproate, this is '200mg per 5ml'. This means that every 5ml of the liquid has 200mg of AED. The daily dose is listed as the amount of AED (not the amount of liquid). If the total daily dose is 200mg, then 5ml of liquid should be given. If the daily dose is 300mg, then 7.5ml should be given.
Click on the links in the table below to see patient information leaflets for that drugs from the Electronic Medicines Compendium. Please note that the patient information leaflets may be listed under the generic name of the drug, such as carbamazepine, even if you are using the brand version, such as Tegretol. All external links open in a new window.
Drug treatment of epilepsy in children aged 12 and under
Drug (generic name) |
Available as (brand name) |
Daily dose mg/kg/day
|
Doses per day |
Treatment |
Possible side effects include the following (report any severe reactions to the GP or paediatrician) |
| Carbamazepine |
Carbamazepine: Tablets 100mg, 200mg, 400mg. Tegretol: Tablets 100mg, 200mg, 400mg. Chewtabs 100mg, 200mg. |
Usual starting daily dose: 5mg/kg Usual daily dose: 10mg/kg - 20mg/kg. |
1 - 3
|
Effective for tonic clonic seizures, and focal seizures with or without secondarily generalised tonic clonic seizures. May worsen myoclonic and absence seizures. |
Skin rash if allergic to carbamazepine. Blurred vision, double vision, dizziness and unsteadiness to start with or if dose is too high. Nausea and vomiting, drowsiness, headache, confusion and agitation. |
| Clobazam |
Clobazam: Tablets 10mg. Frisium: Tablets 10mg. |
Age from 3 years. Age 3 - 6: Usual starting daily dose: 0.125mg/kg. Age 6 - 12: Usual starting daily dose: 5mg. |
2 | Add-on therapy for seizures. May also be used for catamenial seizures (menstrual-related) and cluster seizures. | Light-headedness, confusion, ataxia (shaky movements) and irritability. Drowsiness can occur. |
| Clonazepam |
Clonazepam: Tablets 0.5mg, 2mg. Rivotril: Tablets 0.5mg, 2mg. |
Under 1 year: Usual starting daily dose: 0.25mg. Usual daily dose; 0.5 - 1mg. 1 - 5 years: Usual starting daily dose: 0.25mg. Usual daily dose: 1 - 3mg. 5 - 12 years: Usual starting daily dose: 0.5mg. Usual daily dose: 3 - 6mg. |
1 - 3 | Effective for focal and tonic clonic seizures. | Drowsiness and sedation are common but may wear off. Tolerance can develop. Dizziness, fatigue (tiredness), poor concentration and restlessness. Excess secretions can be a problem (such as increased drooling). |
| Ethosuximide |
Ethosuximide: Capsules 250mg. Emeside: Syrup 250mg/5mL. |
Age up to 6: Usual daily dose 20 - 40mg/kg up to 500mg. Age over 6: Usual daily dose: 1000 - 1500mg. |
2 (rarely, 3). | Effective for typical absence seizures. Also used for myoclonic, atypical absence, atonic and tonic seizures. | Headache, drowsiness, nausea, vomiting, diarrhoea, abdominal pain and anorexia. |
| Gabapentin |
Gabapentin: Capsules 100mg, 300mg, 400mg. Tablets 600mg, 800mg. Neurontin: |
Age 2 - 6: Usual daily dose: 30 - 70mg/kg. Age over 6: Usual daily dose: 25 - 35mg/kg up to 70mg/kg. |
3 |
Add-on therapy for focal seizures with or without secondary generalisation. | Drowsiness, dizziness, unsteadiness, headache, nausea, vomiting, diarrhoea, constipation, abdominal pain and weight gain. |
| Lamotrigine |
Lamotrigine: Tablets 25mg, 50mg, 100mg, 200mg. Lamictal: Tablets 25mg, 50mg, 100mg, 200mg. Dispersible tablets 2mg, 5mg, 25mg, 100mg. |
Age from 2 years. Used alone: Usual starting daily dose: 0.3mg/kg. Usual daily dose: 1 - 5mg/kg. With oxcarbazepine: Usual daily dose: 1 - 10mg/kg up to 200mg. With enzyme-inducing AEDs and without valproate: Usual daily dose: 5 - 15mg/kg up to 400mg. |
1 - 2 |
Add-on therapy for focal seizures and primary and secondarily generalised tonic clonic seizures. Also used for atypical absence, atonic and tonic seizures, particularly in Lennox-Gastaut syndrome. Monotherapy for typical absence seizures. |
Serious skin rash and hypersensitivity if allergic to lamotrigine. Risk minimised with slow introduction. Nausea, vomiting, diarrhoea, headache, fatigue (tiredness), dizziness and sleep disturbance. Tremor may occur when taken with sodium valproate and may reduce as dose is changed. |
| Levetiracetam |
Levetiracetam: Tablets 250mg, 500mg, 750mg, 1000mg, oral solution 100mg/ml. Keppra: Tablets 250mg, 500mg, 750mg, 1000mg. Oral solution 100mg/ml. |
Age 1 - 6 months: Usual daily dose: up to 42mg/kg. Age 6 months - 12 years: Usual starting daily dose: 10mg/kg. Usual daily dose: up to 60mg/kg. |
2 | Add-on therapy for focal seizures with or without secondary generalisation, myoclonic and tonic clonic seizures. | Nausea, vomiting, diarrhoea, abdominal pain, anorexia, weight changes, dizziness, drowsiness and behaviour change. |
| Nitrazepam | Nitrazepam: Oral suspension 2.5mg/ml. |
Age up to 2 years. Usual starting daily dose: 0.25mg/kg. Usual daily dose: 0.5mg/kg. |
2 - 3 | Effective for infantile spasms only. | Drowsiness, confusion and ataxia (shaky movements). |
| Oxcarbazepine |
Oxcarbazepine: Tablets 150mg, 300mg, 600mg. Trileptal: Tablets 150mg, 300mg, 600mg. Oral suspension (sugar-free) 60mg/ml. |
Age from 6 years. Usual starting daily dose: 8 - 10mg/kg up to 300mg. Usual daily dose: 30 - 46mg/kg. |
2 | Monotherapy and add-on therapy for focal seizures with or without secondarily generalised tonic clonic seizures. |
Skin rash if allergic to oxcarbazepine. Nausea, vomiting, constipation, diarrhoea, dizziness, headache, double vision and drowsiness. |
| Phenobarbital |
Phenobarbital: Tablets 15mg, 30mg, 60mg. Elixir 15mg/5mL. |
Usual starting daily dose: 2 - 3mg/kg. Usual daily dose: 2.5 - 8mg/kg. |
1 - 2 |
Effective for focal and tonic clonic seizures, and neo-natal (birth to 28 days old) seizures. Also used for atypical absence, atonic and tonic seizures. Ineffective for typical absences. |
Drowsiness may happen to start with, sedation and slowed thought may be long-lasting. Lethargy, depression, ataxia (shaky movements), aggression and behavioural problems. |
| Phenytoin |
Phenytoin: Tablets 100mg. Epanutin: chewable Infatabs 50mg, Phenytoin Sodium Flynn: Capsules 25mg, 50mg, 100mg, 300mg. |
Usual starting daily dose: 3 - 5mg/kg. Usual daily dose: 5 - 10mg/kg up to 300mg. |
2 |
Effective for all seizure types except absence seizures. Also used for neo-natal (birth to 28 days old) seizures. Blood testing is essential as the relationship between dose and blood level is complex. |
Skin rash if allergic to phenytoin. Nausea, vomiting, constipation, insomnia (not able to sleep), tremor, pins and needles, dizziness and headache. Can cause coarse facial features, acne, hirsutism (excess hair) and overgrowth of gums if used over a long time. |
| Primidone | Mysoline: Tablets 50mg, 250mg. |
Age up to 2: Usual daily dose: 250 - 500mg. Age 2 - 5: Usual daily dose: 500 - 750mg. Age 5 - 9: Usual daily dose: 750 - 1000mg. Age 9 and over: Usual daily dose: up to 1500mg. |
2 |
Effective for all seizures types except absence seizures. Not often used in children. |
Drowsiness, lethargy, depression, psychosis, ataxia (shaky movements) and behavioural problems. |
| Rufinamide | Inovelon: Tablets 100mg, 200mg, 400mg. Oral suspension 40mg/ml. |
Age from 4 years. Usual starting daily dose: 200mg. Usual daily dose: 1000mg (or 600mg if taking with sodium valproate). |
2
|
Add-on therapy for Lennox-Gastaut syndrome only.
|
Nausea, vomiting, constipation, diarrhoea, abdominal pain, rhinitis (runny nose), weight loss and dizziness.
|
| Sodium valproate |
Sodium valproate: crushable Tablets 100mg, 200mg, 500mg. Oral solution 200mg/5mL. Epilim: Tablets 200mg, 500mg, Epilim Chrono: Tablets 200mg, 300mg, 500mg. Epilim Chronosphere: (granules) 50mg, 100mg, 250mg, 500mg, 750mg, 1000mg. Episenta (prolonged release): Capsules 150mg, 300mg. Granules 500mg, 1000mg. |
Usual starting daily dose: 15 - 20mg/kg. Usual daily dose: 25 - 30mg/kg, up to 40mg/kg. Up to 60mg/kg for infantile spasms. |
2 |
Effective for generalised tonic clonic, absence and myoclonic seizures. Also used for atypical absence, atonic and tonic 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). Hyperactivity and behaviour problems. Has been associated with polycystic ovaries and menstrual problems. |
| Stiripentol |
Diacomit: Capsules 250mg, 500mg. Powder sachets 250mg, 500mg.
|
Age from 3 years. Usual starting daily dose: 10mg/kg. Usual daily dose: 50mg/kg.
|
2 - 3
|
Add-on therapy for tonic clonic seizures for children with severe myoclonic epilepsy in infancy (SMEI or Dravet syndrome) where other treatment has not worked. |
Nausea, vomiting, aggression, anorexia, ataxia (shaky movements), drowsiness and excitability.
|
| Tiagabine | Gabitril: Tablets 5mg, 10mg, 15mg |
Age from 12 years. Usual starting daily dose: 5 - 10mg. With enzyme-inducing AEDs: With non-enzyme inducing AEDs: |
2 - 3 | Add-on therapy for focal seizures with or without secondary generalisation where other treatment has not worked. | Diarrhoea, dizziness, tiredness, nervousness, tremor, concentration problems, depression and agitation. |
| Topiramate |
Topiramate: Tablets 25mg, 50mg, 100mg, 200mg. Topamax: Tablets 25mg, 50mg, 100mg, 200mg. Sprinkle capsules 15mg, 25mg, 50mg. |
Age from 2 years. Used alone, from age 6: Usual daily dose: 100mg - 500mg. Used with other AEDs, from age 2: Usual daily dose: 5 - 9mg/kg, up to 400mg. |
2 |
Monotherapy or add-on therapy for focal seizures with or without secondary generalisation, and tonic clonic seizures. Add-on therapy for Lennox-Gastaut syndrome. |
Headache, drowsiness, dizziness, weight loss and pins and needles. Slowed thought and speech may occur. Some cases of eye problems have been reported within one month of starting treatment. |
| Vigabatrin | Sabril: Tablets 500mg. Powder 500mg/sachet. |
Usual starting daily dose: 30 - 40mg/kg. Usual daily dose: 60 - 80mg/kg. 150mg/day for infantile spasms. |
2 |
Effective for focal seizures with or without secondary generalisation where other treatment has not worked. First line treatment for infantile spasms. Particularly useful in Tuberous Sclerosis. May worsen absence and myoclonic seizures. |
Drowsiness, fatigue, nausea, behaviour and mood changes. Visual field defects have been reported in some adults: visual fields should be checked every six months. |
Sources include the British National Formulary for Children.
A printed version of this table is in our leaflet 'medication for children'. You can order a copy of our leaflet 'medication for children' from our online shop as part of our 'first five free' offer.
© Epilepsy Society
October 2012.
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