neurolists:aed_dosing_and_target_serum_concentration

AED dosing and target serum concentration

Drug Brand Name Initial or Starting Dose Usual Range or Maximum Dose Comments Target Serum Concentration Range
Barbiturates
Phenobarbital Various 1-3 mg/kg/d (10-20 mg/kg LD) 180-300 mg 10-40 μg/mL (43-172 μmol/L)
Primidone Mysoline 100-125 mg/d 750-2000 mg 5-10 μg/mL (23-46 μmol/L)
Benzodiazepines
Clobazam Onfi ≤30 kg 5 mg/d; >30 kg 10 mg/d ≤30 kg up to 20 mg; > 30 kg up to 40 mg 0.03-0.3 ng/mL (0.1-1.0 nmol/L)
20 mg 20-70 ng/mL (0.06-0.22 μmol/L)
Clonazepam Klonopin 1.5 mg/d
Diazepam Valium PO: 4-40 mg PO: 4-40 mg 100-1000 ng/mL (0.4-3.5 μmol/L)
IV: 5-10 mg IV: 5-30 mg
Lorazepam Ativan PO: 2-6 mg PO: 10 mg 10-30 ng/mL (31-93 nmol/L)
IV: 0.05 mg/kg IV: 0.05 mg/kg
IM: 0.05 mg/kg
Hydantoin
Phenytoin Dilantin PO: 3-5 mg/kg (200-400 mg) PO: 500-600 mg Total: 10-20 μg/mL (40-79 μmol/L)
(15-20mg/kg LD)
Unbound: 0.5-3 μg/mL (2-12 μmol/L)
Succinimide
Ethosuximide Zarontin 500 mg/d 500-2000 mg 40-100 μg/mL (282-708 μmol/L)
Other
Carbamazepine Tegretol 400 mg/d 400-2400 mg 4-12 μg/mL (17-51 μmol/L)
Ezoqabine Potiga 300 mg/d 1200 mg Not defined
Felbamate Felbatol 1200 mg/d 3600 mg 30-60 μg/mL (126-252 μmol/L)
Gabapentin Neurontin 300-900 mg/d 4800 mg 2-20 μg/mL (12-117 μmol/L)
Lacosamide Vimpat 100 mg/d 400 mg Not defined
Lamotrigine Lamictal 25 mg every other day if on VPA; 25-50 mg/d if not on VPA 100-150 mg if on VPA; 300-500 mg if not on VPA 4-20 μg/mL (16-78 μmol/L)
Levetiracetam Keppra 500-1000 mg/d 3000-4000 mg 12-46 μg/mL (70-270 μmol/L)
Keppra XR
Oxcarbazepine Trileptal 300-600 mg/d 2400-3000 mg 3-35 μg/mL (MHD) (12-139 μmol/L)
Pregabalin Lyrica 150 mg/d 600 mg Not defined
Rufinamide Banzel 400-800 mg/d 3200 mg Not defined
Tiagabine Gabitril 4-8 mg/d 80 mg 0.02-0.2 μg/mL (0.05-0.5 μmol/L)
Topiramate Topamax 25-50 mg/d 200-1000 mg 5-20 mcg/mL (15-59 μmol/L)
Valproic acid Depakene 15 mg/kg (500-1000 mg) 60 mg/kg (3000-5000 mg) 50-100 μg/mL (347-693 μmol/L)
Depakene SR
Depakote
Depakote ER
Depacon
Vigabatrin Sabril 1000 mg/d 3000 mg 0.8-36 μg/mL (6-279 μmol/L)
Zonisamide Zonegran 100-200 mg/d 600 mg 10-40 μg/mL (47-188 μmol/L)
Abbreviations: IM, intramuscular; LD, loading does; MHD, 10-monohydroxy-derivative; PO, orally; VPA, valproic acid.

Data from Patsalos et al, Halford and Lapointe, Cada et al, Sabril [package insert], Onfi [package insert], and Potiga [package insert].

Reproduced with permission from Rogers SJ, Cavazos JE. Rogers S.J., Cavazos J.E. Epilepsy. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. DiPiro J.T., Talbert R.L., Yee G.C., Matzke G.R., Wells B.G., Posey L eds. Pharmacotherapy: A Pathophysiologic Approach, 9e. New York:

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