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Information on epilepsy: Anti-epileptic drugs used in children

General information on drug treatment of epilepsy in children

Notes on using the drug treatment table.

Notes on using the drug treatment table. The drug table shows the anti-epileptic drugs available to treat epilepsy for children aged 12 and under.
Table of anti-epileptic drugs used in adults.

The table lists the usual total daily doses of AEDs. The starting doses are listed in red and the average doses that usually stop seizures are in blue.

The dose of drugs is usually given in ‘mg/kg/day’ which means milligrams of AED per kg of the child’s weight, given every day.

The total daily amount is the amount that is given every day. If the drug is taken twice a day, then half the daily dose is taken each time. If it is taken three times a day, then a third of the total dose is taken each time.

Examples.

Tablets - if the total daily dose prescribed is 20mg per kg of carbamazepine, and the child weighs 15kg, their total daily dose would be 300mg. Because carbamazepine is usually taken twice a day, each dose would be 150mg.

Liquids - for liquid AEDs, the strength of the liquid is given on the bottle. For example, sodium valproate comes in a liquid of 200mg per 5ml, which means every 5ml of the liquid contains 200mg of the drug. The usual daily dose listed in the table is the amount of the drug (not the amount of liquid). If the total daily dose to be taken is 200mg, then 5ml of liquid would be taken. If the usual daily dose is 300mg then 7.5ml would be taken.

Click on the links in the table below to see patient information leaflets for those drugs from the Electronic Medicines Compendium. All external links open in a new window. Electronic Medicines Compendium logo

Anti-epileptic medication used for treating epilepsy in children under the age of 12
Drug (generic name) Available as (brand name) Usual total daily dosage mg/kg/day (mg of AED per kg of the child's weight per day) Doses/ day Treatment Possible side effects include
Acetazolamide Diamox: Tablets 250mg. Slow release capsules 250mg.

10-20

 

Usual starting dose: 5

 2 May be used for menstrual related seizures, certain episodic disorders and to enhance certain other anti-epileptic drugs e.g. carba-mazepine. Lack of appetite, loss of weight, drowsiness, depression, pins and needles in hands and feet, joint pains, increased urine output, thirst, headache, dizziness, fatigue and irritability.
Carbamazepine Carba-mazepine tablets BP: 100mg, 200mg, 400mg.
Tegretol: Tablets 100mg, 200mg, 400mg. Chewtabs 100mg, 200mg.
Liquid sugar free 100mg/5mL. Suppositories 125mg, 250mg.
Tegretol Retard: Tablets 200mg, 400mg.

10-25

Usual starting dose: 5

2

(Tegretol is given twice a day; liquid is given 3 times a day)

 Effective against generalised tonic clonic and partial seizures. Ineffective against absences.
May worsen myoclonic and absence seizures		 Skin rash, if allergic to carbamazepine. Blurred vision, double vision, unsteadiness and nausea may occur initially or if the dose is too high. Dizziness and headaches.
Clobazam Frisium: Tablets 10mg.

0.25
(Over 12 years old 10-15mg)

Usual starting dose: 0.125

 2 Effective against generalised tonic clonic and partial seizures, but tolerance develops in about one third of children. Drowsiness may occur but this drug is less sedating than clonazepam or diazepam. Fatigue, irritability and depression.
Clonazepam Rivotril: Tablets 0.5mg, 2mg.

0.1-0.3 for under 12 months
0.3-1 for 1-5 years old
1-2 for 5-12 years old

Usual starting dose: 25mcg/kg

 2/3 Effective against generalised tonic clonic and partial seizures, absences, myoclonic seizures, Lennox-Gastaut syndrome, infantile spasms and status epilepticus. Drowsiness and sedation are quite common but these may wear off, and tolerance (decline in effectiveness with time) tends to develop. Increased respiratory tract secretions. Fatigue, aggression and overactive restlessness.
Ethosuximide

Emeside: Syrup 250mg/5mL.
Zarontin: Syrup 250mg/5mL.

15-35

Usual starting dose: 10

 2 Effective against generalised absences. May be used for epilepsies with similar EEG changes to absences Nausea, headache and drowsiness.
Gabapentin Neurontin:
Tablets 600mg, 800mg. Capsules 100mg, 300mg, 400mg.

30-60

Usual starting dose: 10

3

Twice daily is adequate

 Recommended in partial seizures where previous treatment has been ineffective. May make myoclonic and/or absence seizures worse. Drowsiness, dizziness, headache, fatigue. double vision, unsteadiness and shaky movements.
Lamotrigine Lamictal: Tablets 25mg, 50mg, 100mg, 200mg. Dispersible tablets 2mg 5mg, 25mg, 100mg

0.5-8.0 when sodium valproate is taken as well. 2-12 when taken alone or with any other AEDs.

Usual starting dose: 0.1 to increase over 6 weeks to 0.5 when sodium valproate is taken as well. 0.5 to increase over 6 weeks to 2 when taken alone or with any other AEDs*.

 2 Effective against partial, absence, generalised tonic clonic seizures and Lennox-Gastaut syndrome. Skin rash, particularly if rapid dose increase, if allergic to lamotrigine. Drowsiness, double vision, dizziness, headache and flu like symptoms, if the dose is too high. Possibly insomnia. Tremor may occur when used with sodium valproate. This may reduce if either medication is adjusted.
Levetiracetam Keppra: Tablets 250mg, 500mg, 1000mg. Oral solution 100mg/ml.

10-60

Usual starting dose: 10

 2 Can be used in children with partial or generalised seizures, over 4 years of age. Dizziness, nausea, sedation and behaviour change.
Nitrazepam Suspension 2.5mg/5ml suspension

0.5

Usual starting dose: 0.25

 2/3 Infantile spasms. Confusion, dependence, shaky movements, muscle weakness and loss of memory.
Oxcarbazepine Trileptal: Tablets 150mg, 300mg, 600mg

10-50

Usual starting dose: 10

(Not licensed for children under 6 years old)

 2 Partial and generalised seizures. Skin rash if allergic to oxcarbazepine. Double vision, unsteadiness, headache, nausea, and confusion.
Phenobarbitone Pheno-barbitone BP: Tablets 15mg, 30mg, 60mg. Elixir 15mg/5mL.

4-8

Usual starting dose: 4

 2 Effective against generalised tonic clonic and partial seizures. Status epilepticus, neonatal seizures. Drowsiness may occur initially, sedation and slowing of mental performance may persist. Fatigue, listlessness, tiredness, depression, rash, insomnia and irritability. Hyperactivity, aggression and subtle impairment of memory, mood and learning capacity.
Phenytoin Phenytoin BP: Tablets 100mg.
Epanutin: Capsules 25mg, 50mg, 100mg, 300mg. Chewable Infatabs 50mg. Suspension 30mg/5mL.

4-8

(doses vary considerably depending on age)

Usual starting dose: 4

 2 Effective against generalised tonic clonic and partial seizures. Status epilepticus. Blood testing is essential when using phenytoin as the relationship between dose and blood level is complex. Skin rash if allergic to phenytoin. Drowsiness, unsteadiness and slurred speech may occur if the dose is too high. Coarsening of facial features, overgrowth of gums, growth of excess hair and acne may be problems with prolonged therapy, as can some anaemias (treated with folic acid). Shaky movements, unsteady gait, rapid involuntary movement of the eye and sedation.

Primidone

 

Mysoline: Tablets 250mg.

20-30

Usual starting dose: 5

 2 Partial and generalised tonic clonic seizures. Fatigue, listlessness, tiredness, depression, psychosis, overactive restlessness and irritability.
Sodium valproate Sodium Valproate BP: Tablets 200mg, 500mg. Oral solution 200mg/5mL.
Epilim: Tablets 200mg, 500mg. Crushable tablets 100mg.
Liquid sugar free 200mg/5mL. Syrup 200mg/5mL.
Epilim Chrono: Tablets 200mg, 300mg, 500mg.

20-40

Usual starting dose: 5

2

(Epilim Chrono is given once a day)

 Effective against generalised tonic clonic and partial seizures and absences. Hair loss occurs in some people but this is not usually severe and is usually reversible if the dose is reduced. Weight gain may occur with increased appetite. Liver damage due to sodium valproate is very uncommon. Gastric problems, hyperactivity and behaviour problems. The use of sodium valproate has been associated with increased incidence of polycystic ovaries and menstrual irregularities but needs to be evaluated further. Drowsiness and shaky movements are infrequent side effects.
Tiagabine Gabitril: Tablets 5mg, 10mg, 15mg

5-30mg/day not per kg

Usual starting dose: 5mg/day not per kg

(Not licensed for children under 12 years old)

3 Recommended in partial seizures when previous treatment has been ineffective.
May make myoclonic seizures worse.		 Dizziness, fatigue, anxiety, tremor, concentration difficulties, depression of mood, agitation and jerkiness of limbs.
Topiramate Topamax: Tablets 25mg, 50mg, 100mg, 200mg. Sprinkle capsules 15mg, 25mg, 50mg.

6.0-12.0

Usual starting dose: 05-1.0

 2 Recommended in partial and generalised seizures. Severe myoclonic epilepsy in infancy. For children over 2 years old. Headache, drowsiness, dizziness, pins and needles in hands and feet and loss of weight. Increased risk of kidney stones. Slowing of mental performance and of language may occur but minimised if dose started low and increased slowly. Cases of eye reactions have rarely been associated with topiramate occurring within 1 month of starting treatment.
Vigabatrin Sabril: Tablets 500mg. Powder sugar free 500mg per sachet.

Up to 20-100mg for refractory patients or 150mg for infantile spasms.

Usual starting dose: 40

 2 Can be considered for resistant partial seizures if visual fields can be monitored. First line for infantile spasms. May worsen absences and myoclonic seizures. Drowsiness, nausea, behaviour and mood changes. Psychotic reactions have been reported. Visual field defects have been reported in one in three adults taking vigabatrin in the long term. Visual fields should be measured every six months while taking vigabatrin.
Table II: Emergency drug treatment
Drug (generic name) Available as (brand name) Dose Treatment Possible side effects
Diazepam Stesolid: rectal tubes 5mg, 10mg.
Diazepam Rectubes: 2.5mg, 5mg, 10mg.		 0.5mg/kg For emergency use only in status epilepticus Drowsiness, unsteadiness, blurred vision, amnesia and vertigo.

UK Epilepsy Helpline: 01494 601400
Monday - Friday 10am - 4pm

NSE gratefully acknowledges the contribution of the Institute of Child Health & Great Ormond Street Hospital for Children NHS Trust in producing this information.

© The National Society for Epilepsy
March 2006

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  NSE is the largest medical charity for epilepsy in the UK. We provide information and support to professionals and people affected by epilepsy. We also provide care for people with epilepsy through medical, residential and rehabilitation services.