Carbamazepine

Drug of choice:

Partial epilepsy

Idiopathic generalized epilepsy

600–1600 mg/day with gradual introduction because of autoinduction

4–10 µg/ml, but very variable upper limit to tolerability

Dizziness, diplopia, and unsteadiness

Rash and acute hypersensitivity reactions Aplastic anaemia (1:200 000)

Few that are well documented (hyponatraemia and neutropenia)

Spina bifida in 1% of pregnancies

Clobazam

Second choice drug:

Probable broad spectrum. Useful for treating clusters of seizures

20–60 mg/day

Therapeutic and adverse effects may show tolerance

Drowsiness and sedation, but less than other benzodiazepines

Ethosuximide

Second choice drug:

Absence persisting into adult life

Partial epilepsy and generalized tonic-clonic seizures

0.5–2.0 g/day

40–100 µg/ml

Nausea, drowsiness,

and dizziness

Rash and acute hypersensitivity reactions.

SLE-like syndromes

Little information

Felbamate

Occasional use:

Lennox–Gastaut syndrome

1200–4800 mg/day

Insomnia and gastrointestinal intolerance

Aplastic

anaemia

(1:3000–5000)

Hepatic failure

Weight loss

Gabapentin

Second choice drug:

Partial epilepsies

900 mg–4.8 g/day

Drowsiness, ataxia, and sedation

None known

Weight gain

Lamotrigine

First choice drug:

Broad spectrum for partial epilepsy and possibly generalized syndromes

100–800 mg/day

Diplopia, dizziness, and sedation

Rash and acute hypersensitivity reactions (particularly with valproate co-medication)

Lorazepam

First choice drug:

status epilepticus

Drug of choice:

status epilepticus

0.1 mg/kg

Oxcarbazepine

Drug of choice: for partial epilepsy— broadly comparable with carbamazepine

Idiopathic generalized epilepsy

600–3000 mg/day

50–150 µmol/l

Dizziness, diplopia, and unsteadiness, but less frequent than carbamazepine

Rash, but less frequent than carbamazepine. 25 per cent of patients sensitive to Carbamazepine will also be sensitive to

Oxcarbazepine

Hyponatraemia

Phenobarbitone

Occassional use in partial and generalized epilepsies (excepting absence) and status

60–200 mg/day

15–35 µg/ml but limits often modified by tolerance

Drowsiness, sedation and unsteadiness, adverse effects on cognition and behaviour

Rash

Tolerance and >habituation. Dupuytrens contracture and connective tissue disorders

Hare-lip/cleft palate, and cardiological abnormalities

Phenytoin

Second choice drug:

Partial epilepsy and

generalized tonic-clonic seizures

200–600 mg/day

10–20 µg/ml. Monitoring is indicated whenever there is poor control of seizures or side effects.

Drowsiness, ataxia, and dysarthria.

Rarely abnormal movements

Rash and acute hypersensitivity reactions

Gum hypertrophy, coarsening of facial features, hirsuitism, and acne. SLE-like syndromes

Hare-lip/cleft palate & cardiological abnormalities

Levetiratcetam

Second choice drug for partial and generalized seizures

750–3000 mg/day

Fatigue, somnolence, dizziness

Little information

Pregabalin

Second choice drug:

Partial epilepsies

75–600 mg/day

Drowsiness, ataxia,

and sedation

None known

Weight gain

Primidone

Rarely used:

Probable efficacy as phenobarbitone

500–1500 mg/day

As pheno-barbitone to which it is metabolized

Drowsiness, sedation, and

unsteadiness, adverse effects on cognition and behaviour

Rash

Tolerance and habituation. Dupuytrens contracture and connective tissue disorders

Hare-lip/cleft palate and cardiological abnormalities

Tiagabine

Second choice drug:

Partial epilepsy

Idiopathic generalized epilepsy

15–60 mg/day

Dizziness, depression, tremor. May be exacerbation of partial seizures at higher doses.

Topiramate

Second choice:

Broad spectrum

100–800 mg/day

Sedation, cognitive difficulty.

Renal calculi

Valproate (Sodium)

First choice broad spectrum drug: may be less effective in partial epilepsy than carbamazepine

1–3 g/day

Of no value

Tremor, irritability, and occasional confusion.

Gastric intolerance.

Hepatotoxicity (rare in adults).

Pancreatitis

Weight gain, alopecia, insulin

intolerance, polycystic ovarian syndrome

Spina bifida in 2–3 per cent of pregnancies.

Foetal valproate syndrome

Vigabatrin

Final choice drug for partial epilepsies. May be useful in adult survivors of West’s syndrome

Idiopathic generalized epilepsy

1.5–6.0 g/day

Of no value

Depression

Psychosis

Weight gain, Visual field constriction.