II. Mechanism
- Anticonvulsant
- GABA Reuptake Inhibitor
III. Indications: Adjunctive Therapy
- Simple Partial Seizure
- Complex Partial Seizure
- Bipolar Disorder (not FDA approved)
IV. Adverse Effects
- Common (Dose related)
- Sedation
- Dizziness
- Lethargy
- Tremor
- Nervousness
- Irritability
- Abdominal Pain
- Cognitive Impairment
- Serious
- Status Epilepticus, New Seizueres, Nonconvulsive Status Epilepticus
V. Precautions
- Adjust dose in hepatic disease
VI. Dosing
-
General
- Typically combined with enzyme-inducing anticonvulsants (e.g. Carbamazepine, Phenobarbital, Phenytoin, Primidone)
- Decrease starting dose and titration speed when NOT used with an enzyme-inducing anticonvulsant
- Adult
- Initial: 4 mg orally daily for first week
- Increase by 4 to 8 mg/day increments per day weekly (over 6 to 20 weeks)
- Divide dose 2 to 4 times daily after first week
- Maximum: 56 mg/day divided 2 to 4 times daily
- Child (age 12 to 18 years)
- Initial: 4 mg orally daily for first week
- Increase by 4 mg/day increments per day for first week, then up to 4 to 8 mg/day weekly thereafter (over 6 to 20 weeks)
- Divide dose 2 to 4 times daily after first week
- Maximum: 32 mg/day divided 2 to 4 times daily
VII. Safety
- Pregnancy Category C
- Unknown Safety in Lactation
VIII. Resources
IX. References
- (2022) Presc Lett, Resource #361206, Antiseizure Medications
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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