Monotherapy in patients w/ newly diagnosed epilepsy or for conversion to monotherapy in patients w/ epilepsy. Adjunctive therapy in patients w/ partial onset seizures or generalized tonic-clonic seizures, seizures associated w/ Lennox-Gastaut syndrome. Prophylaxis of migraine headache in adults.
Adjunctive therapy epilepsyAdult Initially 25-50 mg nightly for 1 wk. Subsequently at wkly or bi-wkly intervals, increase dose to 25-50 (to 100) mg daily in 2 divided doses. Childn ≥2 yr Approx 5-9 mg/kg daily in 2 divided doses. Titrate at ≤25 mg (based on range of 1-3 mg/kg daily) nightly for the 1st wk. Subsequently at 1 or 2 wkly intervals, w/ increments of 1-3 mg/kg daily in 2 divided doses. Monotherapy epilepsyAdult Titrate at 25 mg nightly for 1 wk. Subsequently at 1 or 2 wkly intervals, increase dose by increments of 25 or 50 mg daily in 2 divided doses. Initial target dose: 100 mg daily. Max: 500 mg. Childn ≥2 yr Initially at 0.5-1 mg/kg daily nightly for the 1st wk. Subsequently at 1 or 2 wkly intervals, increase dose by increments of 0.5-1 mg/kg daily in 2 divided doses. Initial target dose: 3-6 mg/kg daily. Prophylaxis of migraine Initially 25 mg nightly for 1 wk, then increased at 25 mg daily increments at 1-wk intervals. Recommended total daily dose: 100 mg in 2 divided doses.
Predisposition to or history of nephrolithiasis; ensure adequate hydration. Signs of suicidal ideation & behaviour. Acute myopia associated w/ secondary angle-closure glaucoma. Mood disturbance/depression. Serious skin reactions. Hyperammonemia & encephalopathy. Visual field defects. Monitor serum bicarbonate level. W/draw gradually. May affect ability to drive or operate machinery. Renal or hepatic impairment. Women of childbearing potential. Pregnancy & lactation.
Decreased plasma conc by phenytoin & carbamazepine. Increased Cmax & AUC w/ propranolol, hydrochlorothiazide. Increased AUC w/ diltiazem. Not to be used concomitantly w/ alcohol, CNS depressants. Possible decreased contraceptive efficacy & increased breakthrough bleeding w/ OCs. Monitor lithium levels. Increased risk of nephrolithiasis w/ other agents predisposing to nephrolithiasis. hyperammonemia w/ or w/o encephalopathy in concomitant use of valproic acid. Decreased prothrombin time/INR w/ vit K-antagonist anticoagulant medications.
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