| Oral
Anticonvulsant
Quick reference table |
| Drug (by
alphabetical order) |
Pros &
Pharmakokinetics |
Cons (PSE =
Potential side effect) |
Carbamazepine
 | Tegretol XR: 100, 200, 400 mg |
| Carbatrol 200, 300 mg |
| Start 200 mg bid, up to 800 mg bid |
|
| T 1/2: 11-24 hr |
| Prot binding: 75% |
| Cost: Tegretol XR 400 mg bid, $70/month |
| Cost: Carbatrol 300 mg bid, $55/month |
|
| Rare severe PSE: Aplastic anemia, hepatotoxicity, Steven’s-Johnson syndrome |
| PSE: ataxia, diplopia, nausea, fatigue, leukopenia, rash,
thrombocytopenia, hyponatremia, tics |
|
Gabapentin
| Neurontin Cap: 100, 300, 400 mg. Neurontin breakable tab 600, 800 mg |
| Start 100 mg qid, up to 4800 mg/day |
|
| Prot binding: 0% |
|
Excreted Renal. |
| No drug interactions |
| No life threatening side effect. |
|
| T 1/2: 5 hr, taken tid or qid |
| Cost: 600 mg half tab qid, $130/month |
| PSE: Somnolence, ataxia, fatigue, nystagmus, weight gain, behavioral
problems in children |
|
Lamotrigine
| Lamictal Tab: 5 mg Chewable; 25, 100, 150, 200 mg |
| Start very slow 25 mg qd, increase weekly |
| Up to 200-700 mg
/day. |
|
| Effective for Generalized onset seizure |
| Less cognitive impairment |
| Very long half life |
|
| Need very slow titration |
| PSE: Steven’s-Johnson syndrome or toxic epidermal necrolysis (greater risk in children and concomitant valproate therapy), acute hepatic
failure/multiorgan failure |
| PSE: ataxia, insomnia, headache, diplopia, blurred vision, nausea, vomiting, rash. |
| Cost 200 mg bid $220/month |
|
Levetiracetam
| Keppra 250, 500, 750 mg |
| Dose: Start at 500 mg BID, up to 1500 bid |
|
| May be effective for Generalized onset seizure |
| T 1/2: 6 to 8 hours. |
| <10% protein bound. |
| 66% renal excreted unchanged. |
| No major drug
interaction. |
| No life threatening side effects |
|
| Cost Keppra 500 mg bid, $120/month |
| PSE: Nausea, headache, fatigue, somnolence, behavioral
abnormalities |
|
Oxcarbazepine
| Trileptal 150 mg, 300 mg, 600 mg splitable tab |
| Start 300 mg bid, up to 1200 mg bid |
|
| MHD, the major active metabolite |
| Tablet can be split |
|
| Cost 600 mg bid, $200/month |
| PSE: Rash, Nausea, headache, fatigue,
hyponatremia |
|
Phenytoin
| Dilantin Susp: 125mg/5ml, Cap: 30, 100mg |
| Start 300 mg hs, slow titration. |
|
| T 1/2: 22 hr |
| Prot bound: 90% |
| Cost: 300 mg hs, brand $30/month |
|
| Nonlinear kinetics |
| Rare PSE: Aplastic anemia, hepatic failure,
Steven’s-Johnson syndrome, lupus-like syndrome, pseudolymphoma |
| PSE: Gum hypertrophy, hirsutism, ataxia, nystagmus, diplopia,
rash, anorexia, nausea, macrocyclosis, peripheral neuropathy |
|
Topiramate
| Topamax: 25, 100, 200 mg |
| Dose: Start 25 mg bid, slow increase by 50
mg/week up to 200 mg bid |
|
| Effective for Generalized onset seizure |
| T 1/2: 21 hr. |
|
Protein bound: 20%. |
| Metabolism: 75% renal |
| Few drug interaction. |
|
| Cost: 100 mg bid, $200/month |
| PSE: Nausea, headache, fatigue, slowed cognition, word-finding difficulty,
parasthesia, weight loss |
|
Valproic acid
| Depakote ER 250 mg, 500 mg. Start 500 mg hs |
| Depakene generic 250 mg capsule. Start 250 mg q8. |
|
| Effective for Generalized onset seizure |
| T 1/2: 8-16 hr. |
| Prot binding: 90%. |
| Cost: Depakene generic 250 mg q8, $30/month |
| IV Depacon available |
|
| Cost: Depakote ER 500 mg 3 hs. $150/month |
| Rare |
| PSE: tremor, weight gain, hair loss, |
|
Zonisamide
| Cap: Zonegran 100 mg |
| Dose: 100 mg qd. Increase 100 mg/d every 1 to 2 weeks to 200-800 mg/d |
|
| May be effective for Generalized onset seizure |
| Once daily dosing. T1/2 50-68 hrs |
| hepatic metabolism |
| Cost 100 mg qd, $62/month |
|
| a sulfonamide |
| PSE: Renal calculi, hypohydrosis (especially in children), ? aplastic anemia |
| PSE: Nausea, headache, fatigue, paresthesia, rash, ? language impairment, weight loss |
|
| Reference:
 | Drugstore.com |
| French, J. 2004 AAN meeting. |
|
|
| Return
to anticonvulsant index page |
|