Basic Neuroscience · Neuropharmacology
Adult AED Dosing
Adult anti-seizure drug loading, dosing, target levels, and formulations. Target levels in µg/mL unless noted. Verify all doses before prescribing.
| Drug | Loading | Adult dose | Target level | Adult formulations |
|---|---|---|---|---|
| First-generation | ||||
| Carbamazepine (Tegretol) | — | 200–800 BID | 4–12 µg/mL | Tab IR 200, XR 100/200/400 mg |
| Ethosuximide (Zarontin) | — | 500–1500 QD | 40–100 µg/mL | Cap 250 mg |
| Phenytoin | 15–20 mg/kg* | 100–200 TID | 10–20 µg/mL (free 1–2) | Cap 100, 200, 300 mg |
| Valproate | 40 mg/kg | 250 BID – 60 mg/kg | 50–100 µg/mL | Tab DR 125/250/500; ER 250/500; sprinkle 125 |
| Phenobarbital | 15–20 mg/kg | 60–200 mg/day | 10–40 µg/mL | Tab 15/30/60/100; elixir; injectable |
| Clonazepam | — | 0.5–20 mg/day (÷) | 20–70 ng/mL | Tab 0.5/1/2; ODT 0.125–2 mg |
| Second-generation | ||||
| Gabapentin (Neurontin) | — | 300–2400/d | 2–20 µg/mL | Cap 100/300/400; tab 600/800 |
| Topiramate (Topamax) | — | 25–200 BID | 5–20 µg/mL | Tab 25/50/100/200; Trokendi XR 25/50/100/200 |
| Lamotrigine | — | 25/d – 200 BID (½ dose with valproate) | 2.5–15 µg/mL | Tab 25/100/150/200; ODT |
| Levetiracetam (Keppra) | 60 mg/kg | 500–1500 BID | 12–46 µg/mL | Tab 250/500/750/1000; IV |
| Oxcarbazepine (Trileptal) | — | 300–1200 BID | 3–35 µg/mL (MHD) | Tab 150/300/600; Oxtellar XR 150/300/600 |
| Zonisamide (Zonegran) | — | 100 QD, titrate to 400 (max 600) | 10–40 µg/mL | Cap 25/50/100 |
| Tiagabine (Gabitril) | — | 4–56 mg/day (BID–QID) | 20–200 ng/mL | Tab 2/4/12/16 |
| Felbamate (Felbatol) | — | 400–1200 TID | 30–60 µg/mL | Tab 400/600 |
| Third-generation | ||||
| Lacosamide (Vimpat) | 200–400 mg | Mono 100–200 BID; adj 50–200 BID | 10–20 µg/mL | Tab 50/100/150/200; IV |
| Brivaracetam (Briviact) | — | 25–100 BID | 0.2–2 µg/mL | Tab 10/25/50/75/100; IV |
| Clobazam (Onfi) | — | 10–40 mg/day | 30–300 ng/mL | Tab 10/20 |
| Perampanel (Fycompa) | 8–36 mg† | 2–12 mg QHS | 180–980 ng/mL | Tab 2/4/6/8/10/12 |
| Vigabatrin (Sabril) | — | 500–1500 BID | not routinely monitored | Tab 500 mg |
| Rufinamide (Banzel) | — | 200–1600 BID | 5–30 µg/mL | Tab 200/400 |
| Eslicarbazepine (Aptiom) | — | 400–1600 QD | 3–35 µg/mL | Tab 200/400/600/800 |
| Newest agents (2018+) | ||||
| Cannabidiol (Epidiolex) | — | 2.5 → 10 mg/kg BID (weight-based) | not established | Oral soln 100 mg/mL |
| Cenobamate (Xcopri) | — | 12.5 mg QD, slow titration q2wk to 200 (max 400) | not established | Tab 12.5/25/50/100/150/200 |
| Fenfluramine (Fintepla) | — | 0.1–0.35 mg/kg BID (weight-based) | not established | Oral soln 2.2 mg/mL |
*Phenytoin oral load: 400 → 2h → 300 → 2h → 300 mg (1000 mg over 6 h). †Perampanel loaded orally off-label. Loading = IV loads for status epilepticus.
SEIZURE RESCUE MEDICATIONS FOR CLUSTERS — CAREGIVER / HOME USE
Give for a seizure lasting ≥5 minutes or a cluster of seizures. Call 911 if the seizure does not stop or clusters continue.Intranasal: Midazolam nasal spray (Nayzilam) 5 mg, may repeat once after 10 min · Diazepam nasal spray (Valtoco) 10–20 mg.
Buccal (cheek): Midazolam 10 mg.
Rectal: Diazepam rectal gel (Diastat) 10–20 mg.
Dissolvable wafer (ODT): Clonazepam (Klonopin wafers) 0.5–1 mg · Lorazepam 1–2 mg.
Neuro.Wiki by Ahmed Koriesh, MD — Educational only, not a substitute for clinical judgement