📋 Indications & Clinical Dosage
*All form of Epilepsy, Complex Partial Seizures, Absence Seizures:*
ORAL: Adult: Initial: 10-15 mg/kg/day, increase by 5-10 mg/kg/wk. Max: 60 mg/kg/day.
Children: Neonate: initially 20 mg/kg once daily; usual maintenance dose 10 mg/kg twice daily; 1 month-12 yrs: initially 10-15 mg/kg (max 600 mg) daily in 1-2 divided doses; usual maintenance dose 25-30 mg/kg daily in 2 divided doses (up to 60 mg/kg daily in 2 divided doses); 12-18 yrs: initially 600 mg daily in 1-2 divided doses increased gradually (in steps of 150-300 mg) every 3 days; usual maintenance dose 1-2 gm/day in 2 divided doses, max 2.5 gm/day in 2 divided doses.
BY IV INJ: Adult: Initially 10 mg/kg (usually 400-800 mg) by IV injection (over 3-5 mins) followed by IV INF or IV injection (over 3-5 mins) in 2-4 divided doses or by continuous IV INF up to max 2.5 gm daily; usual range 1-2 gm dally(20-30 mg/kg daily).
Children: Neonate: 10 mg/kg twice daily; 1 month-12 yr: initially 10 mg/ kg by IV injection, followed by continuous IV INF, or by intermittent IV INF or IV injection in 2-4 divided doses up to usual range 20-40 mg/kg daily; 12-18 yr: Initially 10 mg/ kg by IV injection, followed by continuous IV INF, or by intermittent IV INF or IV injection in 2-4 divided doses up to max 2.5 gm daily; usual range 1-2 gm daily (20-30 mg/kg/ day).
*Bipolar Disorder, Manic Episodes:*
ORAL: Adult: Initial: 750 mg in divided doses, increase rapidly to clinical effect. Max: 60 mg/kg/day.
*Migraine prophylaxis:*
ORAL: Adult: Starting dose 250 mg twice daily, some patients may benefit from upto 1000 mg/day.
💊 Mode of Administration
Administer over 60 min at a rate of <20 mg/min after dilution to final concentration,alternatively, single doses upto 15 mg/kg have been administered as a rapid infusion over 5-10 min (1.5-3 mg/kg/min).Injection should be diluted in 50 ml of a compatible diluent.
⛔ Contraindications
Active liver disease, history of hepatic disease, acute porphyria.
⚠️ Precautions & Warnings
Women of child bearing age, false positive test in urine testing for diabetes.Infants; in infantile spasms; monitor clinical chemistry and haematological parameters
🔄 Drug Interactions
Barbiturates, MAOls, anticonvulsants and thy-moleptics e.g. imipramine.
⚠️ Adverse Reactions / Side Effects
Aggression, anxiety, amnesia, bronchial and salivary hyper-secretion in infants and small children, coordination disturbances, confusion, dizziness, drowsiness, GI disturbance, hair loss, angioedema, thrombocytopenia, agranulocytosis, bone-marrow failure, rash, pancreatitis.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Avoid unless the potential benefit outweighs the risk.
Lactation / Breastfeeding:
Contraindicated
🧪 Compatibility & Storage Stability
Compatibility: Physically compatible and chemically stable in D5W, NS, and LR for at least 24 hours when stored in glass or PVC. See manufacturer direction.
Stability & Storage: Store vial at room temperature 15C-30C.