Clinical Neurology · Epilepsy & EEG
Pediatric AED Dosing
Pediatric anti-seizure drug loading, dosing, target levels, and formulations. “Not before” = minimum age. Target levels in µg/mL unless noted. Verify all doses before prescribing.
| Drug | Not before | Loading | Peds dosing (start–max) | Target level | Peds formulations |
|---|---|---|---|---|---|
| First-generation | |||||
| Carbamazepine (Tegretol) | — | — | 5–35 mg/kg/d (TID) | 4–12 µg/mL | Susp 20/mL; chewable tab 100 mg |
| Ethosuximide (Zarontin) | 3 years | — | 10–40 mg/kg/d (BID) | 40–100 µg/mL | Syr 50/mL; cap 250 mg |
| Phenytoin | — | 15–20 mg/kg* | 4–8 mg/kg/d (BID) | 10–20 µg/mL (free 1–2) | Susp 25/mL; chewable 50 mg |
| Valproate | 6 months | 40 mg/kg | 10–60 mg/kg/d (BID/TID) | 50–100 µg/mL | Syr 50/mL |
| Phenobarbital | — | 15–20 mg/kg | 3–6 mg/kg/d (QD) | 10–40 µg/mL | Elixir 4/mL; tab 15/30/60/100 |
| Clonazepam | — | — | 0.01–0.2 mg/kg/d Max: <1 mg if <1 yr, 6 mg >1 yr | 20–70 ng/mL | Tab 0.5/1/2; ODT 0.125–2 mg |
| Second-generation | |||||
| Gabapentin (Neurontin) | 3 years | — | 10–50 mg/kg/d (TID) | 2–20 µg/mL | Syr 50/mL |
| Topiramate (Topamax) | 2 years | — | 1–9 mg/kg/d (BID; max 400 mg) | 5–20 µg/mL | Sprinkle 15/25 |
| Lamotrigine | 2 years | — | 0.3–15 mg/kg/d (BID; slow titration, ½ with valproate) | 2.5–15 µg/mL | Chewable 2/5/25; disintegrating 25/50/100 |
| Levetiracetam (Keppra) | 1 month | 60 mg/kg | 10–60 mg/kg/d (BID) | 12–46 µg/mL | Syr 100/mL |
| Oxcarbazepine (Trileptal) | 2 years | — | 10–60 mg/kg/d (BID) | 3–35 µg/mL (MHD) | Sus 60/mL |
| Zonisamide (Zonegran) | 16 years | — | 2–12 mg/kg/d (off-label <16 y) | 10–40 µg/mL | Cap 25/50/100 |
| Tiagabine (Gabitril) | 12 years | — | 4–32 mg/d (QHS) | 20–200 ng/mL | — |
| Felbamate (Felbatol) | 2 years | — | 15–45 mg/kg/d (TID) | 30–60 µg/mL | Susp 120 mg/mL |
| Third-generation | |||||
| Lacosamide (Vimpat) | 1 month | 10 mg/kg | 2–15 mg/kg/d (BID, by wt) | 10–20 µg/mL | Syr 10 mg/mL |
| Brivaracetam (Briviact) | 1 month | — | 1–5 mg/kg BID (by weight) | 0.2–2 µg/mL | Sus 10/mL |
| Clobazam (Onfi) | 2 years | — | ≤30 kg: 5 mg HS; >30 kg: 5 mg BID (max 20 / 40 mg/d) | 30–300 ng/mL | Susp 2.5/mL; tab 10/20 |
| Perampanel (Fycompa) | 4 years | 8–36 mg† | 2–12 mg QHS | 180–980 ng/mL | Susp 0.5 mg/mL |
| Vigabatrin (Sabril) | 1 month | — | 50–150 mg/kg/d (BID) | not routinely monitored | Sachets 500 mg |
| Rufinamide (Banzel) | 1 year | — | 10–45 mg/kg/d (BID, with food) | 5–30 µg/mL | Susp 40/mL |
| Eslicarbazepine (Aptiom) | 4 years | — | 200–300 mg start (by weight) → 600–900 mg | 3–35 µg/mL | — |
| Newest agents (2018+) | |||||
| Cannabidiol (Epidiolex) | 1 year | — | 2.5 → 10 mg/kg BID (12.5 for TSC) | not established | Oral soln 100 mg/mL |
| Fenfluramine (Fintepla) | 2 years | — | 0.1–0.35 mg/kg BID (max 26 mg/d; 17 with stiripentol) | not established | Oral soln 2.2 mg/mL |
| Ganaxolone (Ztalmy) | 2 years | — | ≤28 kg: up to 21 mg/kg TID; >28 kg: up to 600 mg TID (with food) | not established | Oral susp 50 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) 5–20 mg by weight/age.
Buccal (cheek): Midazolam 0.5 mg/kg (max 10 mg).
Rectal: Diazepam rectal gel (Diastat) 0.2–0.5 mg/kg.
Dissolvable wafer (ODT): Clonazepam (Klonopin wafers) 0.25–0.5 mg · Lorazepam 0.05–0.1 mg/kg.
Neuro.Wiki by Ahmed Koriesh, MD — Educational only, not a substitute for clinical judgement