By Dr Nazia Iftikhar Awan
Anti-Epileptics
Drug Brands Dosage
Phenytoin Inj Epigran Status epilepticus:
(Anticonvulsant, 250mg/5ml Loading dose (all ages): 15–20 mg/kg IV.
class Ib Syp Epitoin An additional load of 5 to 10 mg/kg if
antiarrhythmic) 30mg/5ml status epilepticus is not resolved has been
Tab Epitoin used. Begin maintenance therapy usually
100mg 12 hours after dose.
Max. dose: 1500 mg/24 hr
Maintenance Dose :
Neonate: IV/PO=start with 5 mg/kg/day
usual range 4–8 mg/kg/day÷8-12hrly.
Infant/child: IV/PO= start with 5
mg/kg/day
mo–3 yr: 8–10 mg/kg/24 hr
4–6 yr: 7.5–9 mg/kg/24 hr
7–9 yr: 7–8 mg/kg/24 hr
10–16 yr: 6–7 mg/kg/24 hr
Antiarrhythmic:
Load (all ages): 1.25 mg/kg IV Q5 min up
to a total of 15 mg/kg.
Maintenance:
Child (IV/PO):5–10 mg/kg/day÷Q8–12 hr
Important Points
US Boxed Warning:
Cardiovascular risk associated
with rapid infusion (injection)
The rate of intravenous
phenytoin administration should
not exceed
1 to 3 mg/kg/minute.
Contraindicated
In patients with heart block or
sinus bradycardia.
IM administration is not
recommended
Because of erratic absorption and
pain at injection site.
IV push/infusion rate: Not to
exceed 0.5mg/kg/min in
neonates, or 1mg/kg/min infants,
children, adults with max Dose
of 50mg/min; may cause
cardiovascular collapse.
Side effects
Include gingival hyperplasia,
Hirsutism, dermatitis, blood
dyscrasia, ataxia, lupus-like and
Stevens–Johnson
Syndromes,lymphadenopathy ,
liver damage, and nystagmus.
Hepatic Impairment: Pediatric
Hepatic metabolism and
clearance may be decreased.
Monitor free phenytoin levels
closely. Dosage adjustments may
be necessary.
Renal Impairment:
There are no dosage adjustments
provided in the manufacturer's
labeling.
 By Dr Nazia Iftikhar Awan

Levetri-acetum Inj Lerace Infants 1 to <6 months: IV, Oral Start at 7
500mg/5ml mg/kg/dose BID increase dosage every 2
Syp Lerace weeks as tolerated to the recommended
100/ml dose of 21 mg/kg/dose BID.
Tab Lerace Infant ≥6 mo–child 3 yr (>20 kg): PO/IV
250mg,500mg, Start at 10mg/kg/dose BID
750mg Average tolerated dose of 47mg/kg/day.
Child 4–15 yr: Start at 10 mg/kg/dose PO
BID. Max 30mg/kg/dose.
16 yr–adult: Start at 500 mg PO BID.
Every 2wk as tolerated to reach the target
dosage of 1500 mg BID.
 Do not abruptly withdraw
therapy to reduce risk for
seizures.
 Use with caution in renal
Impairment reduce dose.
 May cause loss of appetite,
vomiting, dizziness,
headaches, somnolence,
agitation, depression, and
mood swings.
 Drug has excellent PO
absorption. For IV use, use
similar immediate-release PO
dosages.

Midazolam Inj Dormicum Pediatric:  Contraindicated in patients

5mg/5ml Intermittent with narrow angle glaucoma
Tab Dormicum 0.05-0.15mg/kg/dose Q1-2hr PRN and shock.
7.5mg Continuous  Use with caution in
15mg Neonate: CHF,Renal impairment
<32-wk gestation: 0.5 mcg/kg/min (reduce dose)
≥32-wk gestation: 1 mcg/kg/min If Crcl 10-29: 25% of usual dose.
Infant and child: <10:50% of usual dose.
1–2 mcg/kg/min  Causes respiratory
(Mean dose of 2.3 mcg/kg/min with a depression, hypotension, and
range of 1–18 mcg/kg/min has been bradycardia. Cardiovascular
reported). monitoring is recommended.
 Use lower doses when given
in combination with narcotics
or in patients with respiratory
compromise.
 Higher recommended dosage
for younger patients (6 mo–5
yr) is attributed to the water
soluble properties of
midazolam and the higher
percent body water for
younger patients.
 By Dr Nazia Iftikhar Awan

Phenobarbital Syrup Debritone Loading dose, IV:  Contraindicated in

20mg/5ml. Neonate, infant, and child: porphyria, severe respiratory
Tab Debritone 15–20 mg/kg/dose (max. loading dose: disease with dyspnea or
30mg 1000 mg) in a single or divided dose. May obstruction.
Inj Phenobarb give additional 5 mg/kg doses Q15–30 min  Use with caution in hepatic
200mg/2ml to a max.total of 40 mg/kg. or renal disease (reduce
Maintenance dose, PO/IV: dose). IV administration may
Neonate: 3-5 mg/kg/day ÷Once –BID cause respiratory arrest or
Infant: 5–6 mg/kg/24 hr÷once daily–BID hypotension. Side effects
Child 1–5 yr:6–8 mg/kg/24 hr÷ once include drowsiness, cognitive
daily–BID impairment, ataxia,
hypotension, hepatitis, rash,
Child 6–12 yr:4–6 mg/kg/24 hr ÷ once
respiratory depression, apnea,
daily–BID
Megaloblastic anemia, and
>12 yr: 1–3 mg/kg/24 hr ÷ once daily– Anticonvulsant
BID hypersensitivity syndrome.
 IV push not to exceed 1
mg/kg/min.
Valproic acid Inj Epival Neonate  Contraindicated in hepatic
500mg/5ml PO loading dose is 20mg/kg followed by disease, and children < 2 yr
Syp Epival 5-10mg/kg/dose BID suspected of the
250mg/5ml Oral: aforementioned
Tab Epival Initial: 10–15 mg/kg/day OD–TID mitochondrial disorder.
250mg,500mg Increment: 5–10 mg/kg/day at weekly  May cause GI, liver, blood,
intervals to max dose of 60 mg/kg/day. and CNS toxicity; weight
Intravenous (use only when PO is not gain; transient alopecia;
possible): pancreatitis (potentially
Use same PO daily dose ÷ Q6 hr. Convert life-threatening); nausea;
back to PO as soon as possible. sedation; vomiting;
headache; thrombocytopenia
(dose-related);platelet
dysfunction; rash (especially
with lamotrigine); and
hyperammonemia
 Hepatic failure has occurred
especially in children < 2 yr
(especially those receiving
multiple anticonvulsants,
with congenital metabolic
disorders, with severe seizure
disorders with mental
retardation, and with organic
brain disease).
 By Dr Nazia Iftikhar Awan
Clonazepam Tab Rivotril Infant and child: <10 yr or <30 kg:
0.5mg,2mg Initial: 0.01–0.03 mg/kg/24 hr PO ÷BID–
Tab Naze TID; maximum initial dose:0.05mg/kg/day
0.5mg,2mg Increment: 0.25–0.5 mg/24 hr Q3 days,
Drop Rivotril up to maximum maintenance dose of
2.5mg/ml 0.1–0.2 mg/kg/24 hr ÷ TID
Child ≥10 yr or ≥30 kg and adult:
Initial: 1.5 mg/24 hr PO ÷ TID
Increment: 0.5–1 mg/24 hr Q3 days; max.
dose: 20 mg/24 hr.
 Contraindicated in severe
liver disease and acute
narrow-angle glaucoma.
 Drowsiness, behavior
changes, increased bronchial
secretions and hematopoietic
toxicity (thrombocytopenia,
leukopenia) may occur.
 Use with caution in patients
with compromised
respiratory function,
porphyria and renal
impairment.
 Do not discontinue abruptly.
 Carbamazepine, phenytoin,
and phenobarbital may
decrease clonazepam levels
and effect.
 Drugs that inhibit CYP-450
3A4 isoenzyme (e.g.,
erythromycin) may increase
clonazepam levels and
effects/toxicity.