Generalized or Focal Seizures |
Brivaracetam2,3 | 50–100 mg | 2 | 1–2 days | CBC, liver biochemical tests | Somnolence, fatigue, ataxia, vertigo, psychosis, leukopenia, hypersensitivity (bronchospasm and angioedema). |
Cannabidiol4 | 5–20 mg/kg | 2 | 11–13 days | Liver biochemical tests at baseline, 1, 3, and 6 months | Somnolence, fatigue, anorexia, weight loss, anemia, diarrhea, rash, sleep disorder, infections. Elevation in liver enzymes may occur; reduce dose in hepatic impairment. |
Carbamazepine2 | 400–1600 mg (immediate or extended release) | 2 | 3–4 days | 4–8 mcg/mL CBC, liver biochemical tests, BUN/Cr | Nystagmus, dysarthria, diplopia, ataxia, drowsiness, nausea, blood dyscrasias, hepatotoxicity, hyponatremia, Stevens-Johnson syndrome.5 May exacerbate myoclonic seizures. |
Clobazam6 | 10–40 mg | 2 | 7–10 days | | Lethargy and somnolence, ataxia, insomnia, dysarthria, aggression, constipation, fever, Stevens-Johnson syndrome. |
Clorazepate3 | 22.5–90 mg | 2 | 10 days | | Sedation, dizziness, confusion, ataxia, depression, dependency/abuse. |
Eslicarbazepine2,3 | 400–1200 mg | 1 | 4 days | Serum sodium and chloride; liver biochemical tests | As for carbamazepine. |
Ezogabine3 | 300–1200 mg | 3 | 2–3 days | ECG to assess QT interval | Dizziness, somnolence, confusion, vertigo, nausea, ataxia, psychiatric disturbances, prolonged QT interval, retinal abnormalities.7 |
Felbamate2,3,6,8 | 1200–3600 mg | 3 | 4–5 days | CBC and reticulocytes, liver biochemical tests | Anorexia, nausea, vomiting, headache, insomnia, weight loss, dizziness, hepatotoxicity, fatal aplastic anemia. Reserved for refractory epilepsy. |
Gabapentin3 | 900–3600 mg | 3 | 1 day | | Sedation, fatigue, ataxia, nystagmus, weight loss. |
Lacosamide2,3 | 100–400 mg | 2 | 3 days | ECG if known cardiac conduction problems or severe cardiac disease | Vertigo, diplopia, nausea, headache, fatigue, ataxia, tremor, anaphylactoid reactions, PR prolongation, cardiac dysrhythmia, suicidality. |
Lamotrigine3,6,9,10 | 100–500 mg | 2 | 4–5 days | | Sedation, skin rash, visual disturbances, dyspepsia, ataxia. |
Levetiracetam3,9,11 | 1000–3000 mg | 2 | 2 days | | Somnolence, ataxia, headache, behavioral changes. |
Oxcarbazepine2,3 | 900–1800 mg | 2 | 2–3 days | Serum sodium | As for carbamazepine. |
Perampanel2,3,9 | 4–12 mg | 1 | 3 weeks | | Dizziness, somnolence, irritability, weight gain, falls, ataxia, dysarthria, blurred vision. |
Phenobarbital2,12 | 100–200 mg | 1 | 14–21 days | 10–40 mcg/mL CBC, liver biochemical tests, BUN/Cr | Drowsiness, nystagmus, ataxia, skin rashes, learning difficulties, hyperactivity. |
Phenytoin2,12 | 200–400 mg | 1 | 5–10 days | 10–20 mcg/mL CBC, liver biochemical tests, folate | Nystagmus, ataxia, dysarthria, sedation, confusion, gingival hyperplasia, hirsutism, megaloblastic anemia, blood dyscrasias, skin rashes, fever, systemic lupus erythematosus, lymphadenopathy, peripheral neuropathy, dyskinesias. May exacerbate myoclonic seizures. |
Pregabalin3 | 150–300 mg | 2 | 2–4 days | | Somnolence, dizziness, poor concentration, weight gain, thrombocytopenia, skin rashes, anaphylactoid reactions. |
Primidone2,12 | 750–1500 mg | 3 | 4–7 days | 5–12 mcg/mL CBC | Sedation, nystagmus, ataxia, vertigo, nausea, skin rashes, megaloblastic anemia, irritability. |
Rufinamide6 | 800–3200 mg | 2 | 2 days | | Somnolence, headache, dizziness, suicidality, Stevens-Johnson syndrome, leukopenia, shortened QT interval, nausea, vomiting. |
Tiagabine3 | 32–56 mg | 2 | 2 days | | Somnolence, anxiety, dizziness, poor concentration, tremor, diarrhea. |
Topiramate2,3,6,9,12 | 200–400 mg | 2 | 4 days | Serum bicarbonate, BUN/Cr in elderly patients | Somnolence, nausea, dyspepsia, irritability, dizziness, ataxia, nystagmus, diplopia, glaucoma, renal calculi, weight loss, hypohidrosis, hyperthermia. |
Valproic acid2,3,13,14 | 1500–2000 mg | 2–3 | 2–4 days | 50–100 mcg/mL CBC, liver biochemical tests | Nausea, vomiting, diarrhea, drowsiness, alopecia, weight gain, hepatotoxicity, thrombocytopenia, tremor, pancreatitis. Teratogenic; avoid in women of childbearing age. |
Vigabatrin3,15 | 3000 mg | 2 | 2 days | | Somnolence, anorexia, nausea, vomiting, agitation, hostility, confusion, suicidality, neutropenia, Stevens-Johnson syndrome, permanent visual field loss.7 |
Zonisamide3 | 200–600 mg | 1 | 14 days | BUN/Cr, serum bicarbonate | Somnolence, ataxia, anorexia, nausea, vomiting, rash, confusion, renal calculi. Do not use in patients with sulfonamide allergy. |
Absence Seizures |
Clonazepam6,11,13,16,17 | 0.04–0.2 mg/kg | 2 | 7–10 days | 20–80 ng/mL CBC, liver biochemical tests | Drowsiness, ataxia, irritability, behavioral changes, exacerbation of tonic-clonic seizures. |
Ethosuximide13 | 500–1500 mg | 2 | 5–10 days | 40–100 mcg/mL CBC, liver biochemical tests, urinalysis | Nausea, vomiting, anorexia, headache, lethargy, unsteadiness, blood dyscrasias, systemic lupus erythematosus, urticaria, pruritus. |
Valproic acid2,3,13,14 | 1500–2000 mg | 2–3 | 2–4 days | See above | Nausea, vomiting, diarrhea, drowsiness, alopecia, weight gain, hepatotoxicity, thrombocytopenia, tremor, pancreatitis. |
Myoclonic Seizures |
Clonazepam6,11,13,16,17 | 0.04–0.2 mg/kg | 2 | 7–10 days | See above | Drowsiness, ataxia, irritability, behavioral changes, exacerbation of tonic-clonic seizures. |
Levetiracetam3,9,11 | 1000–3000 mg | 2 | 2 days | | Somnolence, ataxia, headache, behavioral changes. |
Valproic acid2,3,13,14 | 1500–2000 mg | 2–3 | 2–4 days | See above | Nausea, vomiting, diarrhea, drowsiness, alopecia, weight gain, hepatotoxicity, thrombocytopenia, tremor, pancreatitis. |