Commonly Used Anti-Epileptic Medications in Pediatrics
This table provides approximate maintenance dosing ranges for commonly used anti-epileptic medications in children (not neonates). Exact dosing, titration schedules, and drug combinations should follow neurology or local protocols.
Key points:
• Doses are usually given in divided doses (e.g. 2–3 times per day).
• Always adjust for age, weight, renal/hepatic function and comorbidities.
• For status epilepticus, use your local emergency/status protocol (loading doses etc.).
• Doses are usually given in divided doses (e.g. 2–3 times per day).
• Always adjust for age, weight, renal/hepatic function and comorbidities.
• For status epilepticus, use your local emergency/status protocol (loading doses etc.).
Anti-epileptic drugs have significant interactions and toxicity risks.
Never start, stop, or rapidly change doses without senior/neurology input unless in an acute
emergency and according to protocol.
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Common Paediatric Anti-Epileptic Doses (Maintenance)
| Medication | Typical Paediatric Dose (Maintenance) | Route | Precautions / Monitoring |
|---|---|---|---|
| Carbamazepine | ~10–20 mg/kg/day in 2–3 divided doses (start low and titrate up according to response and serum levels, if measured) | Oral | Monitor LFTs, FBC (risk of blood dyscrasias), and sodium (hyponatraemia). Watch for rash and neurotoxicity (dizziness, ataxia). |
| Lamotrigine | Maintenance range ~1–15 mg/kg/day in 1–2 divided doses (titrated very slowly over weeks according to local protocol and co-medications). | Oral | Must be titrated slowly to reduce risk of serious rash (incl. Stevens–Johnson syndrome). Dosing schedules differ if given with valproate or enzyme inducers – follow neurology guidelines. |
| Levetiracetam | ~20–60 mg/kg/day in 2 divided doses (e.g. start around 10 mg/kg twice daily and increase as needed). | Oral or intravenous | May cause behavioural changes (irritability, mood changes). Adjust dose in renal impairment. Generally fewer interactions than many other AEDs. |
| Phenytoin | Maintenance ~4–8 mg/kg/day in 1–2 divided doses (after an appropriate loading dose for status, per protocol). | Oral or intravenous | Narrow therapeutic index – monitor serum levels and watch for toxicity (nystagmus, ataxia, confusion, arrhythmias with IV use). Many drug interactions; adjust in hepatic impairment. |
| Sodium Valproate | ~15–60 mg/kg/day in 2–3 divided doses (start with lower dose and titrate up). | Oral | Monitor LFTs and platelet count. Watch for abdominal pain, jaundice, bruising/bleeding. Avoid or use with extreme caution in known liver disease or metabolic disorders. |