II. Indications

  1. Seizure Disorder
    1. Partial Onset Seizures

III. Mechanism

  1. Pyrrolidine Anticonvulsant (similar to Levetiracetam)
  2. Synaptic VesicleProtein 2A (SV2A) Ligand

IV. Dosing: Adult

  1. Primarily oral dosing
    1. IV dosing only if unable to take orally (and not FDA approved under age 16 years)
  2. Start 50 mg orally or IV twice daily
    1. May need to decrease initial dose to 25 mg if intolerant to sedation, Fatigue or hepatic dysfunction
  3. May titrate up to maximum 100 mg orally or IV twice daily as needed
    1. Maximum 75 mg twice daily in hepatic dysfunction

V. Dosing: Children (age >4 years old)

  1. Weight >=50 kg: Follow adult dosing
  2. Weight 20 to 50 kg
    1. Start 0.5 to 1 mg/kg orally twice daily (to maximum 4 mg/kg/day divided twice daily)
  3. Weight 11 to 20 kg
    1. Start 0.5 to 1.25 mg/kg orally twice daily (to maximum 5 mg/kg/day divided twice daily)

VI. Safety

  1. Unknown Safety in Pregnancy
    1. Toxicity in animal studies
  2. Unknown Safety in Lactation
  3. Avoid taking with Alcohol (risk of excessive sedation)

VIII. Metabolism

  1. Metabolism by hydrolysis (primary), and also CYP2C19
  2. Double dose if taken with Rifampin
  3. Inhibits epoxide hydrolase
    1. May increase Phenytoin and Carbamazepine epoxide levels

X. References

  1. (2022) Presc Lett, Resource #361206, Antiseizure Medications
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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