BNF for Children 2011-2012

220 4.8.1 Control of the epilepsies BNFC 2011–20124 Central nervous systemChild 6–18 years initially 250 mg twice daily,increased by 250 mg at intervals of 4–7 days tousual dose of 500–750 mg twice daily; occasionallyup to 1 g twice daily may be neededEthosuximide (Non-proprietary) ACapsules, ethosuximide 250 mg, net price 56-cappack = £38.23. Label: 8, counselling, blood disorders(see above), driving (see notes above)Emeside c (Chemidex) ASyrup, black currant, ethosuximide 250 mg/5 mL, netprice 200-mL pack = £6.60. Label: 8, counselling,blood disorders (see above), driving (see notes above)Zarontin c (Pfizer) ASyrup, yellow, ethosuximide 250 mg/5 mL, net price200-mL pack = £4.22. Label: 8, counselling, blooddisorders (see above), driving (see notes above)GabapentinGabapentin is used as adjunctive therapy for the treatmentof focal seizures with or without secondary generalisation;it can be used as monotherapy in childrenover 12 years.GABAPENTINCautions avoid abrupt withdrawal (may cause anxiety,insomnia, nausea, pain, and sweating—taper off overat least 1 week); diabetes mellitus, false positivereadings with some urinary protein tests; history ofpsychotic illness; interactions: Appendix 1 (gabapentin)Renal impairment reduce dose if estimated glomerularfiltration rate less than 80 mL/minute/1.73 m 2 ;consult product literaturePregnancy see Pregnancy, p. 216Breast-feeding present in milk—manufactureradvises use only if potential benefit outweighs risk;see also Breast-feeding, p. 217Side-effects diarrhoea, dry mouth, dyspepsia, nausea,vomiting, constipation, abdominal pain, flatulence,appetite changes, gingivitis, weight gain; hypertension,vasodilation, oedema; dyspnoea, cough,rhinitis; confusion, depression, hostility, sleep disturbances,headache; dizziness, anxiety, amnesia, ataxia,dysarthria, nystagmus, tremor, asthenia, paraesthesia,hyperkinesia; influenza-like symptoms; impotence,urinary incontinence; leucopenia; myalgia, arthralgia;diplopia, amblyopia; rash, purpura, pruritus, acne;rarely pancreatitis, hepatitis, jaundice, palpitation,hallucinations, movement disorders, thrombocytopenia,blood-glucose fluctuations in patients with diabetes,tinnitus, acute renal failure, Stevens-Johnsonsyndrome, and alopecia; suicidal ideation; alsoreported psychosisLicensed use not licensed for use in children under 6years; not licensed at doses over 50 mg/kg daily inchildren under 12 yearsIndication and doseAdjunctive treatment of focal seizures with orwithout secondary generalisation. By mouthChild 2–6 years 10 mg/kg once daily on day 1,then 10 mg/kg twice daily on day 2, then 10 mg/kg3 times daily on day 3, increased according toresponse to usual dose of 30–70 mg/kg daily in 3divided dosesChild 6–12 years 10 mg/kg (max. 300 mg) oncedaily on day 1, then 10 mg/kg (max. 300 mg) twicedaily on day 2, then 10 mg/kg (max. 300 mg) 3times daily on day 3; usual dose 25–35 mg/kg dailyin 3 divided doses; max. 70 mg/kg daily in 3divided dosesChild 12–18 years 300 mg once daily on day 1,then 300 mg twice daily on day 2, then 300 mg 3times daily on day 3 or initially 300 mg 3 timesdaily on day 1; then increased according toresponse in steps of 300 mg (in 3 divided doses)every 2–3 days; usual dose 0.9–3.6 g daily in 3divided dosesMonotherapy for focal seizures with or withoutsecondary generalisation. By mouthChild 12–18 years 300 mg once daily on day 1,then 300 mg twice daily on day 2, then 300 mg 3times daily on day 3 or initially 300 mg 3 timesdaily on day 1; then increased according toresponse in steps of 300 mg (in 3 divided doses)every 2–3 days; usual dose 0.9–3.6 g daily in 3divided dosesNote Some children may not tolerate daily increments;longer intervals (up to weekly) may be more appropriateAdministration capsules can be opened but the bittertaste is difficult to maskGabapentin (Non-proprietary) ACapsules, gabapentin 100 mg, net price 100-cap pack= £3.57; 300 mg, 100-cap pack = £8.83; 400 mg, 100-cap pack = £5.53. Label: 3, 5, 8, counselling, driving(see notes above)Tablets, gabapentin 600 mg, net price 100-tab pack =£24.85; 800 mg, 100-tab pack= £36.42. Label: 3, 5, 8,counselling, driving (see notes above)Neurontin c (Pfizer) ACapsules, gabapentin 100 mg (white), net price 100-cap pack = £18.29; 300 mg (yellow), 100-cap pack =£42.40; 400 mg (orange), 100-cap pack = £49.06.Label: 3, 5, 8, counselling, driving (see notes above)Tablets, f/c, gabapentin 600 mg, net price 100-tabpack = £84.80; 800 mg, 100-tab pack = £98.13.Label: 3, 5, 8, counselling, driving (see notes above)LacosamideLacosamide is licensed for adjunctive treatment offocal seizures with or without secondary generalisation.The Scottish Medicines Consortium (p. 3) has advised(January 2009) that lacosamide (Vimpat c ) is acceptedfor restricted use within NHS Scotland as adjunctivetreatment for focal seizures with or without secondarygeneralisation in patients from 16 years. It is restrictedfor specialist use in refractory epilepsy.