II. Indications
-
Seizure Disorder
- Partial Onset Seizures
III. Mechanism
- Pyrrolidine Anticonvulsant (similar to Levetiracetam)
- Synaptic VesicleProtein 2A (SV2A) Ligand
IV. Dosing: Adult
- Primarily oral dosing
- IV dosing only if unable to take orally (and not FDA approved under age 16 years)
- Start 50 mg orally or IV twice daily
- May need to decrease initial dose to 25 mg if intolerant to sedation, Fatigue or hepatic dysfunction
- May titrate up to maximum 100 mg orally or IV twice daily as needed
- Maximum 75 mg twice daily in hepatic dysfunction
V. Dosing: Children (age >4 years old)
- Weight >=50 kg: Follow adult dosing
- Weight 20 to 50 kg
- Start 0.5 to 1 mg/kg orally twice daily (to maximum 4 mg/kg/day divided twice daily)
- Weight 11 to 20 kg
- Start 0.5 to 1.25 mg/kg orally twice daily (to maximum 5 mg/kg/day divided twice daily)
VI. Safety
VII. Adverse Effects
VIII. Metabolism
- Metabolism by hydrolysis (primary), and also CYP2C19
- Double dose if taken with Rifampin
- Inhibits epoxide hydrolase
- May increase Phenytoin and Carbamazepine epoxide levels
IX. Resources
X. References
- (2022) Presc Lett, Resource #361206, Antiseizure Medications
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia