Medication

Forms

Dose (Start, Initial Target, Max)

Comments

Lamotrigine (Lamictal)

Tablets

25, 100,150, 200 mg

Adolescent/adults:

Week 1,2: 25 mg morn

Week 3,4: 50 mg morn

Week 5: 50 mg morn + 50 mg qhs

Week 6: 75 mg morn + 75 mg qhs

Week 7: 100 mg morn + 100 mg qhs

Usual target range is 225-375 mg daily, in two divided dosages.

Side effects: nausea (7-14%)

Warnings: Stop immediately if rash is seen (including Stevens Johnson syndrome with mouth ulcers). Higher risk if taking adjunctive divalproex. Seen in <0.8% of pediatric patients and <0.3% of adult patients.

Divalproex (Epival)

Enteric coated tablet: 125,250,500 mg

Adult:

Start 20 mg/kg/day for mania, and increase dosage by 30-50% every 2-3 days; OR

Start 500-750 mg/day, increase by 250-500 mg q1-3 days to reach therapeutic effect.

Target 1,000-3,000 mg / day.

Usually given twice daily, but may be given as single bedtime dosage.

Therapeutic blood level is 50-125 mcg/mL.

Max 60 mg/kg/day

Monitoring in short-term (first few months):

Serum level q1-2 weeks

CBC / liver function monthly

Monitoring in long-term

Serum level q3-6 months

CBC / liver function q6-12 months

Side effects: tremor, sedation, diarrhea, nausea, weight gain, hair loss, mild elevation of liver enzymes.

Lithium

Lithium carbonate capsules

150,300,600 mg

Lithium carbonate controlled release

300, 450 mg

Adult:

Start at 900 / day; increase by 300-600 mg every 2-3 days as tolerated.

Target dosage 900-1,800 mg per day; may give 1,200 mg qhs otherwise, twice-daily dosing. Therapeutic blood level: 0.8-1.5 mEq/L.

Monitoring in short-term (first few months)

Serum level q 1-weeks

Monitoring in long-term

Serum level q 3-6 months

Thyroid function yearly

Renal function q 6-12 months

Side effects: Thirst, polyuria, cognitive complaints, tremors, weight gain, sedation, hypothyroidism.

Adverse effects: Watch for dehydration.

Carbamazepine (Tegretol)

Chewable tablet: 100,200 mg

Long acting (LA) controlled release (CR) tablet: 200,400 mg

Liquid 100 mg/5 ML

Adult:

Start at 200-400 mg daily; increase by 200 mg daily every 2-4 days

Target 400-1,200 mg daily; usually given twice-daily though sometimes given as single bedtime dosage.

Monitoring in short-term (first few months)

Serum level q 1-2 weeks;

CBC / liver enzymes monthly

Side effects: Headache, nystagmus, ataxia, sedation, rash.

Topiramate (Topamax)

Sprinkle capsule: 15,25 mg

Tablet: 25,100,200 mg (Canada)

Age 2-9:

Dose by weight

Up to 11 kg: Target 150 mg / day; max 250 mg day

Dosages for seizures

Usual titration schedule for age 10+ including adults

Week 1: 25 mg morn + 25 mg evening

Week 2: 50 mg morn + 25 mg evening

Week 3: 75 mg morn + 75 mg evening

Week 4: 100 mg morn + 100 mg Week 5: 150 mg morn + 150 mg evening

Week 5: 200 mg morn + 200 mg evening

Max 200 mg morn + 200 mg evening; higher dosages not shown to improve seizure symptoms in adults.

Age 2-9: Note the following max dosages

11-22 kg: Target 100 mg bid; max 150 mg bid

23-31 kg: Target 100 mg bid; max 175 mg bid

32-38 kg: Target 125 mg bid; max 175 mg bid

>38 kg: Target 125 mg bid; max 200 mg bid

Side effects: Blurred vision. burning, prickling, or tingling sensations. clumsiness or unsteadiness; nystagmus; drowsiness; cognitive slowing.