Clinical Neurology · Epilepsy & EEG
AED Dosage & Formulations (All Ages)
Anti-seizure drug dosing and formulations (pediatric and adult). “Not before” = minimum age. Verify all doses before prescribing.
| Drug | Not before | Loading | Target level | Peds dosing (start–max) | Peds formulations | Adult dose | Adult formulations |
|---|---|---|---|---|---|---|---|
| First-generation | |||||||
| Carbamazepine (Tegretol) | — | — | 4–12 µg/mL | 5–35 mg/kg/d (TID) | Susp 20/mL; chewable tab 100 mg | 200–800 BID | Tab IR 200, XR 100/200/400 mg |
| Ethosuximide (Zarontin) | 3 years | — | 40–100 µg/mL | 10–40 mg/kg/d (BID) | Syr 50/mL; cap 250 mg | 500–1500 QD | Cap 250 mg |
| Phenytoin | — | 15–20 mg/kg* | 10–20 µg/mL (free 1–2) | 4–8 mg/kg/d (BID) | Susp 25/mL; chewable 50 mg | 100–200 TID | Cap 100, 200, 300 mg |
| Valproate | 6 months | 40 mg/kg | 50–100 µg/mL | 10–60 mg/kg/d (BID/TID) | Syr 50/mL | 250 BID – 60 mg/kg | Tab DR 125/250/500; ER 250/500; sprinkle 125 |
| Phenobarbital | — | 15–20 mg/kg | 10–40 µg/mL | 3–6 mg/kg/d (QD); target level 10–40 | Elixir 4/mL; tab 15/30/60/100 | 60–200 mg/day | Tab 15/30/60/100; elixir; injectable |
| Clonazepam | — | — | 20–70 ng/mL | 0.01–0.2 mg/kg/d Max: <1 mg if <1 yr, 6 mg >1 yr | — | 0.5–20 mg/day (÷) | Tab 0.5/1/2; ODT 0.125–2 mg |
| Second-generation | |||||||
| Gabapentin (Neurontin) | 3 years | — | 2–20 µg/mL | 10–50 mg/kg/d (TID) | Syr 50/mL | 300–2400/d | Cap 100/300/400; tab 600/800 |
| Topiramate (Topamax) | 2 years | — | 5–20 µg/mL | 1–9 mg/kg/d (BID; max 400 mg) | Sprinkle 15/25 | 25–200 BID | Tab 25/50/100/200; Trokendi XR 25/50/100/200 |
| Lamotrigine | 2 years | — | 2.5–15 µg/mL | 0.3–15 mg/kg/d (BID; slow titration, ½ dose with valproate) | Chewable 2/5/25; disintegrating 25/50/100 | 25/d – 200 BID (½ dose with valproate) | Tab 25/100/150/200 |
| Levetiracetam (Keppra) | 1 month | 60 mg/kg | 12–46 µg/mL | 10–60 mg/kg/d (BID) | Syr 100/mL | 500–1500 BID | Tab 250/500/750/1000 |
| Oxcarbazepine (Trileptal) | 2 years | — | 3–35 µg/mL (MHD) | 10–60 mg/kg/d (BID) | Sus 60/mL | 300–1200 BID | Tab 150/300/600; Oxtellar XR 150/300/600 |
| Zonisamide (Zonegran) | 16 years | — | 10–40 µg/mL | 2–12 mg/kg/d (off-label <16 y) | Cap 25/50/100 | 100 QD, titrate to 400 (max 600) | Cap 25/50/100 |
| Tiagabine (Gabitril) | 12 years | — | 20–200 ng/mL | 4–32 mg/d (QHS) | — | 4–56 mg/day (BID–QID) | Tab 2/4/12/16 |
| Felbamate (Felbatol) | 2 years | — | 30–60 µg/mL | 15–45 mg/kg/d (TID) | Susp 120 mg/mL | 400–1200 TID | Tab 400/600 |
| Third-generation | |||||||
| Lacosamide (Vimpat) | 1 month | 200–400 mg | 10–20 µg/mL | 2–15 mg/kg/d (BID, by wt) | Syr 10 mg/mL | Mono 100–200 BID; adj 50–200 BID | Tab 50/100/150/200 |
| Brivaracetam (Briviact) | 1 month | — | 0.2–2 µg/mL | 1–5 mg/kg BID (by weight) | Sus 10/mL | 25–100 BID | Tab 10/25/50/75/100; IV |
| Clobazam (Onfi) | 2 years | — | 30–300 ng/mL | ≤30 kg: 5 mg HS; >30 kg: 5 mg BID (max 20 / 40 mg/d) | Susp 2.5/mL; tab 10/20 | 10–40 mg/day | Tab 10/20 |
| Perampanel (Fycompa) | 4 years | 8–36 mg (off-label)† | 180–980 ng/mL | 2–12 mg QHS | Susp 0.5 mg/mL | 2–12 mg QHS | Tab 2/4/6/8/10/12 |
| Vigabatrin (Sabril) | 1 month | — | not routinely monitored | 50–150 mg/kg/d (BID) | Sachets 500 mg | 500–1500 BID | Tab 500 mg |
| Rufinamide (Banzel) | 1 year | — | 5–30 µg/mL | 10–45 mg/kg/d (BID, with food) | Susp 40/mL | 200–1600 BID | Tab 200/400 |
| Eslicarbazepine (Aptiom) | 4 years | — | 3–35 µg/mL | 200–300 mg start (by weight) → 600–900 mg | — | 400–1600 QD | Tab 200/400/600/800 |
| Newest agents (2018+) | |||||||
| Cannabidiol (Epidiolex) | 1 year | — | not established | 2.5 → 10 mg/kg BID (12.5 for TSC) | Oral soln 100 mg/mL | Same (weight-based) | Oral soln 100 mg/mL |
| Cenobamate (Xcopri) | Adults only | — | not established | — | — | 12.5 mg QD, slow titration q2wk to 200 (max 400) | Tab 12.5/25/50/100/150/200 |
| Fenfluramine (Fintepla) | 2 years | — | not established | 0.1–0.35 mg/kg BID (max 26 mg/d; 17 with stiripentol) | Oral soln 2.2 mg/mL | Same (weight-based) | Oral soln 2.2 mg/mL |
| Ganaxolone (Ztalmy) | 2 years | — | not established | ≤28 kg: up to 21 mg/kg TID; >28 kg: up to 600 mg TID (with food) | Oral susp 50 mg/mL | — | Oral susp 50 mg/mL |
*Phenytoin oral load: 400 → 2h → 300 → 2h → 300 mg (total 1000 mg over 6 hours). †Perampanel is loaded orally off-label (8–36 mg). Loading doses shown are IV loads for status epilepticus (fosphenytoin/phenytoin 15–20, valproate 40, levetiracetam 60 mg/kg).
Neuro.Wiki by Ahmed Koriesh, MD — Educational only, not a substitute for clinical judgement