BNF for Children 2011-2012

222 4.8.1 Control of the epilepsies BNFC 2011–20124 Central nervous systemChild 12–18 years initially 25 mg on alternatedays for 14 days then 25 mg daily for further 14days, thereafter increased by max. 50 mg every 7–14 days; usual maintenance 100–200 mg daily in1–2 divided dosesAdjunctive therapy of seizures (with enzymeinducing drugs) without valproateChild 2–12 years initially 300 micrograms/kgtwice daily for 14 days then 600 micrograms/kgtwice daily for further 14 days, thereafter increasedby max. 1.2 mg/kg every 7–14 days; usual maintenance2.5–7.5 mg/kg (max. single dose 200 mg)twice dailyChild 12–18 years initially 50 mg daily for 14days then 50 mg twice daily for further 14 days,thereafter increased by max. 100 mg every 7–14days; usual maintenance 100–200 mg twice daily(up to 700 mg daily has been required)Adjunctive therapy of seizures (withoutenzyme inducing drugs) without valproateChild 2–12 years initially 300 micrograms/kgdaily in 1–2 divided doses for 14 days then600 micrograms/kg daily in 1–2 divided doses forfurther 14 days, thereafter increased by max.600 micrograms/kg every 7–14 days; usual maintenance1–10 mg/kg daily in 1–2 divided doses;max. 200 mg dailyChild 12–18 years initially 25 mg daily for 14days, increased to 50 mg daily for further 14 days,then increased by max. 100 mg every 7–14 days;usual maintenance 100–200 mg daily in 1–2divided dosesMonotherapy of seizuresChild 12–18 years initially 25 mg daily for 14days, increased to 50 mg daily for further 14 days,then increased by max. 100 mg every 7–14 days;usual maintenance as monotherapy, 100–200 mgdaily in 1–2 divided doses (up to 500 mg daily hasbeen required)Monotherapy of typical absence seizures. By mouthChild 2–12 years initially 300 micrograms/kgdaily in 1–2 divided doses for 14 days, then600 micrograms/kg daily in 1–2 divided doses forfurther 14 days, thereafter increased by max.600 micrograms/kg every 7–14 days; usual maintenance1–10 mg/kg daily in 1–2 divided doses (upto 15 mg/kg daily has been required)Note Dose titration should be repeated if restarting afterinterval of more than 5 daysSafe PracticeDo not confuse the different combinations; see alsonotes aboveLamotrigine (Non-proprietary) TATablets, lamotrigine 25 mg, net price 56-tab pack =£2.25; 50 mg, 56-tab pack = £3.07; 100 mg, 56-tabpack = £4.53; 200 mg, 30-tab pack = £27.53, 56-tabpack = £7.51. Label: 8, counselling, driving (see notesabove), skin reactions (see above)Dispersible tablets, lamotrigine 5 mg, net price 28-tab pack = £2.27; 25 mg, 56-tab pack = £2.91; 100 mg,56-tab pack = £5.86. Label: 8, 13, counselling, driving(see notes above), skin reactions (see above)Lamictal c (GSK) TATablets, yellow, lamotrigine 25 mg, net price 56-tabpack = £19.61; 50 mg, 56-tab pack = £33.35; 100 mg,56-tab pack = £57.53; 200 mg, 56-tab pack = £97.79.Label: 8, counselling, driving (see notes above), skinreactions (see above)Dispersible tablets, chewable, lamotrigine 2 mg, netprice 30-tab pack = £10.45; 5 mg, 28-tab pack = £7.82;25 mg, 56-tab pack = £19.61; 100 mg, 56-tab pack =£57.53. Label: 8, 13, counselling, driving (see notesabove), skin reactions (see above)LevetiracetamLevetiracetam is used for monotherapy and adjunctivetreatment of focal seizures with or without secondarygeneralisation, and for adjunctive treatment of myoclonicseizures in children with juvenile myoclonic epilepsy,and primary generalised tonic-clonic seizures.LEVETIRACETAMCautions avoid abrupt withdrawal; interactions:Appendix 1 (levetiracetam)Hepatic impairment halve dose in severe hepaticimpairment if estimated glomerular filtration rate lessthan 60 mL/minute/1.73 m 2Renal impairment reduce dose if estimated glomerularfiltration rate less than 80 mL/minute/1.73 m 2(consult product literature)Pregnancy see Pregnancy, p. 216Breast-feeding present in milk—manufactureradvises avoid; see also Breast-feeding, p. 217Side-effects anorexia, weight changes, abdominalpain, nausea, vomiting, dyspepsia, diarrhoea, cough,drowsiness, amnesia, ataxia, convulsion, dizziness,headache, tremor, hyperkinesia, malaise, impairedattention, aggression, agitation, depression, insomnia,anxiety, irritability, personality disorder, thrombocytopenia,myalgia, diplopia, blurred vision, rash; alsoreported pancreatitis, hepatic failure, paraesthesia,confusion, hallucinations, psychosis, suicidal ideation,leucopenia, neutropenia, pancytopenia, alopecia,toxic epidermal necrolysis, Stevens-JohnsonsyndromeIndication and doseMonotherapy of focal seizures with or withoutsecondary generalisation. By mouth or by intravenous infusionNote If switching between oral therapy and intravenoustherapy (for those temporarily unable to take oral medication),the intravenous dose should be the same as theestablished oral doseChild 16–18 years initially 250 mg once dailyincreased after 1 week to 250 mg twice daily;thereafter, increased according to response insteps of 250 mg twice daily every 2 weeks; max.1.5 g twice dailyAdjunctive therapy of focal seizures with orwithout secondary generalisation. By mouthChild 1–6 months initially 7 mg/kg once daily,increased gradually by max. 7 mg/kg twice dailyevery 2 weeks; max. 21 mg/kg twice daily