BNF for Children 2011-2012

BNFC 2011–2012 4.8.1 Control of the epilepsies 219ical response (plasma concentration monitoring recommended);max. dose by rectum 250 mg 4 times dailyModified releaseCarbagen c SR (Generics) ATablets, m/r, f/c, scored, carbamazepine 200 mg, netprice 56-tab pack = £5.20; 400 mg, 56-tab pack =£10.24. Label: 3, 8, 25, counselling, blood, hepatic orskin disorder symptoms (see above), driving (seenotes above)DoseChild 5–18 years as above; total daily dose given in 1–2divided dosesTegretol c Prolonged Release (Novartis) ATablets, m/r, scored, carbamazepine 200 mg (beigeorange),net price 56-tab pack = £5.20; 400 mg(brown-orange), 56-tab pack = £10.24. Label: 3, 8, 25,counselling, blood, hepatic or skin disorder symptoms(see above), driving (see notes above)DoseChild 5–18 years as above; total daily dose given in 2divided dosesAdministration Tegretol c Prolonged Release tablets can behalved but should not be chewedOXCARBAZEPINECautions hypersensitivity to carbamazepine; avoidabrupt withdrawal; hyponatraemia (monitor plasmasodiumconcentration in patients at risk), heart failure(monitor body-weight), cardiac conduction disorders;avoid in acute porphyria (section 9.8.2); interactions:see p. 215 and Appendix 1 (oxcarbazepine)Blood, hepatic, or skin disorders Children or their carersshould be told how to recognise signs of blood, liver, or skindisorders, and advised to seek immediate medical attention ifsymptoms such as lethargy, confusion, muscular twitching,fever, rash, blistering, mouth ulcers, bruising, or bleedingdevelopHepatic impairment caution in severe impairment—no information availableRenal impairment halve initial dose if estimatedglomerular filtration rate less than 30 mL/minute/1.73 m 2 , increase according to response at intervals ofat least 1 weekPregnancy see Pregnancy, p. 216Breast-feeding amount probably too small to beharmful but manufacturer advises avoid; see alsoBreast-feeding, p. 217Side-effects nausea, vomiting, constipation, diarrhoea,abdominal pain, dizziness, headache, drowsiness,agitation, amnesia, asthenia, ataxia, confusion,impaired concentration, depression, tremor, hyponatraemia,acne, alopecia, rash, nystagmus, visualdisorders including diplopia; less commonly urticaria,leucopenia; very rarely hepatitis, pancreatitis, arrhythmias,blood disorders, systemic lupus erythematosus,Stevens-Johnson syndrome, and toxic epidermalnecrolysis; hypertension and hypothyroidism alsoreported; suicidal ideationIndication and doseMonotherapy and adjunctive therapy of focalseizures with or without secondary generalisedtonic-clonic seizures. By mouthChild 6–18 years initially 4–5 mg/kg (max.300 mg) twice daily, increased according toresponse in steps of up to 5 mg/kg twice daily atweekly intervals (usual maintenance dose foradjunctive therapy 15 mg/kg twice daily); max.23 mg/kg twice dailyNote In adjunctive therapy the dose of concomitant antiepilepticsmay need to be reduced when using high doses ofoxcarbazepineOxcarbazepine (Non-proprietary) ATablets, oxcarbazepine 150 mg, net price 50-tab pack= £11.02; 300 mg, 50-tab pack = £22.38; 600 mg, 50-tab pack = £44.72. Label: 3, 8, counselling, blood,hepatic or skin disorders (see above), driving (seenotes above)Trileptal c (Novartis) ATablets, f/c, scored, oxcarbazepine 150 mg (green),net price 50-tab pack = £8.50; 300 mg (yellow), 50-tabpack = £17.00; 600 mg (pink), 50-tab pack = £34.00.Label: 3, 8, counselling, blood, hepatic or skin disorders(see above), driving (see notes above)Oral suspension, sugar-free, oxcarbazepine 300 mg/5 mL, net price 250 mL (with oral syringe) = £34.00.Label: 3, 8, counselling, blood, hepatic or skin disorders(see above), driving (see notes above)Excipients include propylene glycol (see Excipients, p. 2)EthosuximideEthosuximide is used for typical absence seizures; itmay also be used for myoclonic seizures and for atypicalabsence, atonic, and tonic seizures.ETHOSUXIMIDECautions avoid abrupt withdrawal; avoid in acuteporphyria (section 9.8.2); interactions: see p. 215 andAppendix 1 (ethosuximide)Blood disorders Children or their carers should be told howto recognise signs of blood disorders, and advised to seekimmediate medical attention if symptoms such as fever,mouth ulcers, bruising, or bleeding developHepatic impairment use with cautionRenal impairment use with cautionPregnancy see Pregnancy, p. 216Breast-feeding present in milk; hyperexcitability andsedation reported; see also Breast-feeding, p. 217Side-effects gastro-intestinal disturbances (includingnausea, vomiting, diarrhoea, abdominal pain, andanorexia), weight loss; less frequently headache, fatigue,drowsiness, dizziness, hiccup, ataxia, euphoria,irritability, aggression, and impaired concentration;rarely tongue swelling, sleep disturbances, depression,psychosis, photophobia, dyskinesia, increasedlibido, vaginal bleeding, myopia, gingival hypertrophy,rash; also reported hyperactivity, increase in seizurefrequency, blood disorders (including leucopenia,agranulocytosis, pancytopenia, and aplastic anaemia—bloodcounts required if features of infection),systemic lupus erythematosus, and Stevens-Johnsonsyndrome; suicidal ideationIndication and doseAbsence seizures, atypical absence, myoclonicseizures. By mouthChild 1 month–6 years initially 5 mg/kg (max.125 mg) twice daily, increased gradually over 2–3weeks up to maintenance dose of 10–20 mg/kg(max. 500 mg) twice daily; total daily dose mayrarely be given in 3 divided doses4 Central nervous system