▶ In adults Not licensed for migraine prophylaxis.g Not
licensed for menopausal symptoms. h
The levels of propylene glycol, acesulfame K and
saccharin sodium may exceed the recommended WHO
daily intake limits if high doses of gabapentin oral
solution (Rosemont brand) are given to adolescents or
adults with low body-weight (39–50 kg)—consult
MHRA/CHM ADVICE: GABAPENTIN (NEURONTIN ®): RISK OF
SEVERE RESPIRATORY DEPRESSION (OCTOBER 2017)
Gabapentin has been associated with a rare risk of severe
respiratory depression even without concomitant opioid
medicines. Patients with compromised respiratory
function, respiratory or neurological disease, renal
impairment, concomitant use of central nervous system
(CNS) depressants, and elderly people might be at higher
risk of experiencing severe respiratory depression and
dose adjustments may be necessary in these patients.
MHRA/CHM ADVICE: GABAPENTIN (NEURONTIN ®) AND RISK OF
ABUSE AND DEPENDENCE: NEW SCHEDULING REQUIREMENTS
Following concerns about abuse, gabapentin has been
reclassified as a Class C controlled substance and is now
a Schedule 3 drug, but is exempt from safe custody
requirements. Healthcare professionals should evaluate
patients carefully for a history of drug abuse before
prescribing gabapentin, and observe patients for signs of
abuse and dependence. Patients should be informed of
the potentially fatal risks of interactions between
gabapentin and alcohol, and with other medicines that
cause CNS depression, particularly opioids.
l CAUTIONS Diabetes mellitus . elderly (in adults). high
doses of oral solution in adolescents and adults with low
body-weight. history of psychotic illness . history of
substance abuse . mixed seizures (including absences)
l INTERACTIONS → Appendix 1: antiepileptics
lability . flatulence . gait abnormal . gastrointestinal
discomfort. headache . hypertension . increased risk of
infection . insomnia . leucopenia . malaise . movement
▶ Uncommon Cognitive impairment. palpitations
hyponatraemia . pancreatitis .rhabdomyolysis . severe
cutaneous adverse reactions (SCARs).thrombocytopenia . tinnitus . urinary incontinence
l PREGNANCY Manufacturer advises avoid unless benefit
outweighs risk — toxicity reported. See also Pregnancy in
l BREAST FEEDING Present in milk—manufacturer advises
use only if potential benefit outweighs risk. See also
Breast-feeding in Epilepsy p. 305.
Dose adjustments ▶ In adults Manufacturer advises reduce
dose to 600–1800 mg daily in 3 divided doses if creatinine
clearance 50–79 mL/minute. Manufacturer advises reduce
dose to 300–900 mg daily in 3 divided doses if creatinine
clearance 30–49 mL/minute. Manufacturer advises reduce
dose to 150–600 mg daily in 3 divided doses if creatinine
clearance 15–29 mL/minute (150 mg daily dose to be given
as 300 mg in 3 divided doses on alternate days).
Manufacturer advises reduce dose to 150–300 mg daily in
3 divided doses if creatinine clearance is less than
15 mL/minute (150 mg daily dose to be given as 300 mg in
3 divided doses on alternate days)—further dose
reductions may be required in proportion to creatinine
clearance, consult product literature.
▶ In children Reduce dose if estimated glomerular filtration
rate less than 80 mL/minute/1.73 m2
l MONITORING REQUIREMENTS Monitor for signs of
l EFFECT ON LABORATORY TESTS False positive readings
with some urinary protein tests.
l DIRECTIONS FOR ADMINISTRATION Capsules can be
opened but the bitter taste is difficult to mask.
Medicines for Children leaflet: Gabapentin for neuropathic pain
www.medicinesforchildren.org.uk/gabapentin-neuropathic-pain
Medicines for Children leaflet: Gabapentin for preventing seizures
www.medicinesforchildren.org.uk/gabapentin-preventingseizures
Patient leaflet NHS England has produced a patient leaflet
with information on the reclassification of gabapentin.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 3, 5, 8, 25
▶ Gabapentin (Non-proprietary)
Gabapentin 600 mg Gabapentin 600mg tablets | 100 tablet P £106.00 DT = £5.99c
Gabapentin 600 mg Neurontin 600mg tablets | 100 tablet P £84.80 DT = £5.99c
Gabapentin 800 mg Neurontin 800mg tablets | 100 tablet P £98.13 DT = £25.96c
CAUTIONARY AND ADVISORY LABELS 3, 5, 8
EXCIPIENTS: May contain Propylene glycol
ELECTROLYTES: May contain Potassium, sodium
▶ Gabapentin (Non-proprietary)
Gabapentin 50 mg per 1 ml Gabapentin 50mg/ml oral solution sugar
free sugar-free | 150 ml P £69.00 DT = £66.05c
CAUTIONARY AND ADVISORY LABELS 3, 5, 8, 25
▶ Gabapentin (Non-proprietary)
Gabapentin 100 mg Gabapentin 100mg capsules |
100 capsule P £18.29 DT = £1.81c
Gabapentin 300 mg Gabapentin 300mg capsules | 100 capsule P £42.40 DT = £3.15c
Gabapentin 400 mg Gabapentin 400mg capsules | 100 capsule P £49.06 DT = £3.86c
316 Epilepsy and other seizure disorders BNF 78
Gabapentin 100 mg Neurontin 100mg capsules | 100 capsule P £18.29 DT = £1.81c
Gabapentin 300 mg Neurontin 300mg capsules | 100 capsule P £42.40 DT = £3.15c
Gabapentin 400 mg Neurontin 400mg capsules | 100 capsule P £49.06 DT = £3.86c
Monotherapy of focal seizures with or without secondary
▶ BY MOUTH, OR BY INTRAVENOUS INFUSION
▶ Child (body-weight 50 kg and above): Initially 50 mg twice
daily, then increased to 100 mg twice daily, after one
week, alternatively initially 100 mg twice daily;
increased in steps of 50 mg twice daily (max. per dose
300 mg twice daily) if necessary and if tolerated, dose
to be increased at weekly intervals
▶ Child 4–17 years (body-weight up to 50 kg): (consult
▶ Adult: Initially 50 mg twice daily, then increased to
100 mg twice daily, after one week, alternatively
initially 100 mg twice daily; increased in steps of 50 mg
twice daily (max. per dose 300 mg twice daily) if
necessary and if tolerated, dose to be increased at
Monotherapy of focal seizures with or without secondary
generalisation (alternative loading dose regimen when it
is necessary to rapidly attain therapeutic plasma
concentrations) (under close medical supervision)
▶ BY MOUTH, OR BY INTRAVENOUS INFUSION
▶ Child (body-weight 50 kg and above): Loading dose
200 mg, followed by 100 mg twice daily, to be given
12 hours after initial dose; increased in steps of 50 mg
twice daily (max. per dose 300 mg twice daily) if
necessary and if tolerated, dose to be increased at
▶ Adult: Loading dose 200 mg, followed by 100 mg twice
daily, to be given 12 hours after initial dose; increased
in steps of 50 mg twice daily (max. per dose 300 mg
twice daily) if necessary and if tolerated, dose to be
Adjunctive treatment of focal seizures with or without
▶ BY MOUTH, OR BY INTRAVENOUS INFUSION
▶ Child (body-weight 50 kg and above): Initially 50 mg twice
daily, then increased to 100 mg twice daily, after one
week; increased in steps of 50 mg twice daily (max. per
dose 200 mg twice daily) if necessary and if tolerated,
dose to be increased at weekly intervals
▶ Child 4–17 years (body-weight up to 50 kg): (consult
▶ Adult: Initially 50 mg twice daily, then increased to
100 mg twice daily, after one week; increased in steps
of 50 mg twice daily (max. per dose 200 mg twice daily)
if necessary and if tolerated, dose to be increased at
Adjunctive treatment of focal seizures with or without
secondary generalisation (alternative loading dose
regimen when it is necessary to rapidly attain
therapeutic plasma concentrations) (under close
▶ BY MOUTH, OR BY INTRAVENOUS INFUSION
▶ Child (body-weight 50 kg and above): Loading dose
200 mg, followed by 100 mg twice daily, to be given
12 hours after initial dose; increased in steps of 50 mg
twice daily (max. per dose 200 mg twice daily) if
necessary and if tolerated, dose to be increased at
▶ Adult: Loading dose 200 mg, followed by 100 mg twice
daily, to be given 12 hours after initial dose; increased
in steps of 50 mg twice daily (max. per dose 200 mg
twice daily) if necessary and if tolerated, dose to be
l CONTRA-INDICATIONS Second- or third-degree AV block
l CAUTIONS Conduction problems . elderly (in adults).risk
of PR-interval prolongation . severe cardiac disease
l INTERACTIONS → Appendix 1: antiepileptics
▶ Common or very common Asthenia . concentration
▶ Frequency not known Agranulocytosis
l ALLERGY AND CROSS-SENSITIVITY Antiepileptic
hypersensitivity syndrome associated with lacosamide. See
under Epilepsy p. 305 for more information.
l PREGNANCY See also Pregnancy in Epilepsy p. 305.
Monitoring The dose should be monitored carefully during
pregnancy and after birth, and adjustments made on a
l BREAST FEEDING Manufacturer advises avoid—present in
l HEPATIC IMPAIRMENT Manufacturer advises caution (risk
of increased exposure), particularly in severe impairment
Dose adjustments Manufacturer advises consider dose
reduction—consult product literature.
l RENAL IMPAIRMENT Consult product literature.
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intermittent intravenous infusion,
manufacturer advises give undiluted or dilute with Glucose
5% or Sodium Chloride 0.9% or Lactated Ringer’s Solution;
give over 15–60 minutes—give doses greater than 200 mg
l PRESCRIBING AND DISPENSING INFORMATION Flavours of
Medicines for Children leaflet: Lacosamide for preventing seizures
www.medicinesforchildren.org.uk/lacosamide-preventingseizures
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (February
2009) that lacosamide (Vimpat ®) is accepted for restricted
use within NHS Scotland as adjunctive treatment for focal
seizures with or without secondary generalisation in
patients from 16 years. It is restricted for specialist use in
The Scottish Medicines Consortium has advised (February
2018) that lacosamide (Vimpat ®) is accepted for restricted
use within NHS Scotland as adjunctive treatment for focal
seizures with or without secondary generalisation in
adolescents and children from 4 years of age with epilepsy.
It is restricted for specialist use in refractory epilepsy.
All Wales Medicines Strategy Group (AWMSG) decisions
The All Wales Medicines Strategy Group has advised (March
2018) that lacosamide (Vimpat ®) is recommended as an
option for use within NHS Wales as adjunctive therapy in
BNF 78 Epilepsy and other seizure disorders 317
the treatment of focal seizures with or without secondary
generalisation in children from 4 years of age up to
15 years of age with epilepsy.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
ELECTROLYTES: May contain Sodium
Lacosamide 10 mg per 1 ml Vimpat 200mg/20ml solution for
infusion vials | 1 vial P £29.70
CAUTIONARY AND ADVISORY LABELS 8
EXCIPIENTS: May contain Aspartame, propylene glycol
ELECTROLYTES: May contain Sodium
Lacosamide 10 mg per 1 ml Vimpat 10mg/ml syrup sugar-free | 200 ml P £25.74 DT = £25.74
CAUTIONARY AND ADVISORY LABELS 8
Lacosamide 50 mg Vimpat 50mg tablets | 14 tablet P £10.81
Lacosamide 100 mg Vimpat 100mg tablets | 14 tablet P £21.62
| 56 tablet P £86.50 DT = £86.50
Lacosamide 150 mg Vimpat 150mg tablets | 14 tablet P £32.44
| 56 tablet P £129.74 DT = £129.74
Lacosamide 200 mg Vimpat 200mg tablets | 56 tablet P £144.16 DT = £144.16
Monotherapy of focal seizures |Monotherapy of primary
and secondary generalised tonic-clonic seizures |
Monotherapy of seizures associated with LennoxGastaut syndrome
▶ Child 12–17 years: Initially 25 mg once daily for 14 days,
then increased to 50 mg once daily for further 14 days,
then increased in steps of up to 100 mg every
7–14 days; maintenance 100–200 mg daily in
1–2 divided doses; increased if necessary up to 500 mg
daily, dose titration should be repeated if restarting
after interval of more than 5 days
▶ Adult: Initially 25 mg once daily for 14 days, then
increased to 50 mg once daily for further 14 days, then
increased in steps of up to 100 mg every 7–14 days;
maintenance 100–200 mg daily in 1–2 divided doses;
increased if necessary up to 500 mg daily, dose titration
should be repeated if restarting after interval of more
Adjunctive therapy of focal seizures with valproate |
Adjunctive therapy of primary and secondary
generalised tonic-clonic seizures with valproate |
Adjunctive therapy of seizures associated with LennoxGastaut syndrome with valproate
▶ Child 2–11 years (body-weight up to 13 kg): Initially 2 mg
once daily on alternate days for first 14 days, then
300 micrograms/kg once daily for further 14 days, then
increased in steps of up to 300 micrograms/kg every
7–14 days; maintenance 1–5 mg/kg daily in
1–2 divided doses, dose titration should be repeated if
restarting after interval of more than 5 days; maximum
▶ Child 2–11 years (body-weight 13 kg and above): Initially
150 micrograms/kg once daily for 14 days, then
300 micrograms/kg once daily for further 14 days, then
increased in steps of up to 300 micrograms/kg every
7–14 days; maintenance 1–5 mg/kg daily in
1–2 divided doses, dose titration should be repeated if
restarting after interval of more than 5 days; maximum
▶ Child 12–17 years: Initially 25 mg once daily on alternate
days for 14 days, then 25 mg once daily for further
14 days, then increased in steps of up to 50 mg every
7–14 days; maintenance 100–200 mg daily in
1–2 divided doses, dose titration should be repeated if
restarting after interval of more than 5 days
▶ Adult: Initially 25 mg once daily on alternate days for
14 days, then 25 mg once daily for further 14 days, then
increased in steps of up to 50 mg every 7–14 days;
maintenance 100–200 mg daily in 1–2 divided doses,
dose titration should be repeated if restarting after
Adjunctive therapy of focal seizures (with enzyme
inducing drugs) without valproate | Adjunctive therapy of
primary and secondary generalised tonic-clonic seizures
(with enzyme inducing drugs) without valproate |
Adjunctive therapy of seizures associated with LennoxGastaut syndromes (with enzyme inducing drugs)
▶ Child 2–11 years: Initially 300 micrograms/kg twice daily
for 14 days, then 600 micrograms/kg twice daily for
further 14 days, then increased in steps of up to
1.2 mg/kg every 7–14 days; maintenance 5–15 mg/kg
daily in 1–2 divided doses, dose titration should be
repeated if restarting after interval of more than
5 days; maximum 400 mg per day
▶ Child 12–17 years: Initially 50 mg once daily for 14 days,
then 50 mg twice daily for further 14 days, then
increased in steps of up to 100 mg every 7–14 days;
maintenance 200–400 mg daily in 2 divided doses,
increased if necessary up to 700 mg daily, dose titration
should be repeated if restarting after interval of more
▶ Adult: Initially 50 mg once daily for 14 days, then
50 mg twice daily for further 14 days, then increased in
steps of up to 100 mg every 7–14 days; maintenance
200–400 mg daily in 2 divided doses, increased if
necessary up to 700 mg daily, dose titration should be
repeated if restarting after interval of more than 5 days
Adjunctive therapy of focal seizures (without enzyme
inducing drugs) without valproate | Adjunctive therapy of
primary and secondary generalised tonic-clonic seizures
(without enzyme inducing drugs) without valproate |
▶ Child 2–11 years: Initially 300 micrograms/kg daily in
1–2 divided doses for 14 days, then 600 micrograms/kg
daily in 1–2 divided doses for further 14 days, then
increased in steps of up to 600 micrograms/kg every
7–14 days; maintenance 1–10 mg/kg daily in
1–2 divided doses, dose titration should be repeated if
restarting after interval of more than 5 days; maximum
▶ Child 12–17 years: Initially 25 mg once daily for 14 days,
then increased to 50 mg once daily for further 14 days,
then increased in steps of up to 100 mg every
7–14 days; maintenance 100–200 mg daily in
1–2 divided doses, dose titration should be repeated if
restarting after interval of more than 5 days
▶ Adult: Initially 25 mg once daily for 14 days, then
increased to 50 mg once daily for further 14 days, then
increased in steps of up to 100 mg every 7–14 days;
maintenance 100–200 mg daily in 1–2 divided doses,
dose titration should be repeated if restarting after
318 Epilepsy and other seizure disorders BNF 78
Monotherapy or adjunctive therapy of bipolar disorder
(without enzyme inducing drugs) without valproate
▶ Adult: Initially 25 mg once daily for 14 days, then
50 mg daily in 1–2 divided doses for further 14 days,
then 100 mg daily in 1–2 divided doses for further
7 days; maintenance 200 mg daily in 1–2 divided doses,
patients stabilised on lamotrigine for bipolar disorder
may require dose adjustments if other drugs are added
to or withdrawn from their treatment regimens—
consult product literature, dose titration should be
repeated if restarting after interval of more than
5 days; maximum 400 mg per day
Adjunctive therapy of bipolar disorder with valproate
▶ Adult: Initially 25 mg once daily on alternate days for
14 days, then 25 mg once daily for further 14 days, then
50 mg daily in 1–2 divided doses for further 7 days;
maintenance 100 mg daily in 1–2 divided doses,
patients stabilised on lamotrigine for bipolar disorder
may require dose adjustments if other drugs are added
to or withdrawn from their treatment regimens—
consult product literature, dose titration should be
repeated if restarting after interval of more than
5 days; maximum 200 mg per day
Adjunctive therapy of bipolar disorder (with enzyme
inducing drugs) without valproate
▶ Adult: Initially 50 mg once daily for 14 days, then
50 mg twice daily for further 14 days, then increased to
100 mg twice daily for further 7 days, then increased to
150 mg twice daily for further 7 days; maintenance
200 mg twice daily, patients stabilised on lamotrigine
for bipolar disorder may require dose adjustments if
other drugs are added to or withdrawn from their
treatment regimens—consult product literature, dose
titration should be repeated if restarting after interval
Do not confuse the different combinations or
l INTERACTIONS → Appendix 1: antiepileptics
▶ Uncommon Alopecia . movement disorders . vision
▶ Rare or very rare Confusion . conjunctivitis . disseminated
SIDE-EFFECTS, FURTHER INFORMATION Serious skin
reactions including Stevens-Johnson syndrome and toxic
epidermal necrolysis have developed (especially in
children); most rashes occur in the first 8 weeks. Rash is
sometimes associated with hypersensitivity syndrome and
is more common in patients with history of allergy or rash
from other antiepileptic drugs. Consider withdrawal if rash
or signs of hypersensitivity syndrome develop. Factors
associated with increased risk of serious skin reactions
include concomitant use of valproate, initial lamotrigine
dosing higher than recommended, and more rapid dose
l ALLERGY AND CROSS-SENSITIVITY Antiepileptic
hypersensitivity syndrome associated with lamotrigine.
See under Epilepsy p. 305 for more information.
l PREGNANCY See also Pregnancy in Epilepsy p. 305.
Monitoring Doses should be adjusted on the basis of
plasma-drug concentration monitoring.
l BREAST FEEDING Present in milk, but limited data suggest
l HEPATIC IMPAIRMENT Manufacturer advises caution in
moderate to severe impairment.
Dose adjustments Manufacturer advises dose reduction of
approx. 50% in moderate impairment, and approx. 75% in
severe impairment; adjust according to response.
l RENAL IMPAIRMENT Caution in renal failure; metabolite
Dose adjustments Consider reducing maintenance dose in
l TREATMENT CESSATION Avoid abrupt withdrawal (taper off
over 2 weeks or longer) unless serious skin reaction occurs.
l PRESCRIBING AND DISPENSING INFORMATION Patients
being treated for epilepsy may need to be maintained on a
specific manufacturer’s branded or generic lamotrigine
Switching between formulations Care should be taken when
switching between oral formulations in the treatment of
epilepsy. The need for continued supply of a particular
manufacturer’s product should be based on clinical
judgement and consultation with the patient or their
carer, taking into account factors such as seizure
frequency and treatment history.
Skin reactions Warn patients and carers to see their doctor
immediately if rash or signs or symptoms of
hypersensitivity syndrome develop.
Blood disorders Patients and their carers should be alert for
symptoms and signs suggestive of bone-marrow failure,
such as anaemia, bruising, or infection. Aplastic anaemia,
bone-marrow depression, and pancytopenia have been
associated rarely with lamotrigine.
Medicines for Children leaflet: Lamotrigine for preventing seizures
www.medicinesforchildren.org.uk/lamotrigine-preventingseizures
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 8, 13
▶ Lamotrigine (Non-proprietary)
Lamotrigine 5 mg Lamotrigine 5mg dispersible tablets sugar free
sugar-free | 28 tablet P £15.00 DT = £6.86
Lamotrigine 25 mg Lamotrigine 25mg dispersible tablets sugar free
sugar-free | 56 tablet P £20.00 DT = £2.20
Lamotrigine 100 mg Lamotrigine 100mg dispersible tablets sugar
free sugar-free | 56 tablet P £58.68 DT = £3.99
▶ Lamictal (GlaxoSmithKline UK Ltd)
Lamotrigine 2 mg Lamictal 2mg dispersible tablets sugar-free | 30 tablet P £18.81 DT = £18.81
Lamotrigine 5 mg Lamictal 5mg dispersible tablets sugar-free | 28 tablet P £9.38 DT = £6.86
Lamotrigine 25 mg Lamictal 25mg dispersible tablets sugar-free |
Lamotrigine 100 mg Lamictal 100mg dispersible tablets sugar-free
| 56 tablet P £69.04 DT = £3.99
CAUTIONARY AND ADVISORY LABELS 8
▶ Lamotrigine (Non-proprietary)
Lamotrigine 25 mg Lamotrigine 25mg tablets | 56 tablet P £8.80 DT = £4.25
BNF 78 Epilepsy and other seizure disorders 319
Lamotrigine 50 mg Lamotrigine 50mg tablets | 56 tablet P £10.24 DT = £6.25
Lamotrigine 100 mg Lamotrigine 100mg tablets | 56 tablet P £16.89 DT = £11.45
Lamotrigine 200 mg Lamotrigine 200mg tablets | 56 tablet P £53.46 DT = £15.01
▶ Lamictal (GlaxoSmithKline UK Ltd)
Lamotrigine 25 mg Lamictal 25mg tablets | 56 tablet P £23.53
Lamotrigine 50 mg Lamictal 50mg tablets | 56 tablet P £40.02
Lamotrigine 100 mg Lamictal 100mg tablets | 56 tablet P £69.04 DT = £11.45
Lamotrigine 200 mg Lamictal 200mg tablets | 56 tablet P £117.35 DT = £15.01
Monotherapy of focal seizures with or without secondary
▶ BY MOUTH, OR BY INTRAVENOUS INFUSION
▶ Child 16–17 years: Initially 250 mg once daily for 1 week,
then increased to 250 mg twice daily, then increased in
steps of 250 mg twice daily (max. per dose 1.5 g twice
daily), adjusted according to response, dose to be
▶ Adult: Initially 250 mg once daily for 1–2 weeks, then
increased to 250 mg twice daily, then increased in steps
of 250 mg twice daily (max. per dose 1.5 g twice daily),
adjusted according to response, dose to be increased
Adjunctive therapy of focal seizures with or without
▶ Child 1–5 months: Initially 7 mg/kg once daily, then
increased in steps of up to 7 mg/kg twice daily (max.
per dose 21 mg/kg twice daily), dose to be increased
▶ Child 6 months–17 years (body-weight up to 50 kg):
Initially 10 mg/kg once daily, then increased in steps of
up to 10 mg/kg twice daily (max. per dose 30 mg/kg
twice daily), dose to be increased every 2 weeks
▶ Child 12–17 years (body-weight 50 kg and above): Initially
250 mg twice daily, then increased in steps of 500 mg
twice daily (max. per dose 1.5 g twice daily), dose to be
▶ Adult: Initially 250 mg twice daily, then increased in
steps of 500 mg twice daily (max. per dose 1.5 g twice
daily), dose to be increased every 2–4 weeks
▶ Child 4–17 years (body-weight up to 50 kg): Initially
10 mg/kg once daily, then increased in steps of up to
10 mg/kg twice daily (max. per dose 30 mg/kg twice
daily), dose to be increased every 2 weeks
▶ Child 12–17 years (body-weight 50 kg and above): Initially
250 mg twice daily, then increased in steps of 500 mg
twice daily (max. per dose 1.5 g twice daily), dose to be
▶ Adult: Initially 250 mg twice daily, then increased in
steps of 500 mg twice daily (max. per dose 1.5 g twice
daily), dose to be increased every 2–4 weeks
Adjunctive therapy of myoclonic seizures and tonic-clonic
▶ BY MOUTH, OR BY INTRAVENOUS INFUSION
▶ Child 12–17 years (body-weight up to 50 kg): Initially
10 mg/kg once daily, then increased in steps of up to
10 mg/kg twice daily (max. per dose 30 mg/kg twice
daily), dose to be increased every 2 weeks
▶ Child 12–17 years (body-weight 50 kg and above): Initially
250 mg twice daily, then increased in steps of 500 mg
twice daily (max. per dose 1.5 g twice daily), dose to be
▶ Adult: Initially 250 mg twice daily, then increased in
steps of 500 mg twice daily (max. per dose 1.5 g twice
daily), dose to be increased every 2–4 weeks
l UNLICENSED USE g Initial dosing recommendations for
levetiracetam lin BNF Publications differ from product
▶ With oral use in children Manufacturer advises granules not
licensed for use in children under 6 years, for initial
treatment in children with body-weight less than 25 kg, or
for the administration of doses below 250 mg—oral
l INTERACTIONS → Appendix 1: antiepileptics
l PREGNANCY See also Pregnancy in Epilepsy p. 305.
Monitoring The dose should be monitored carefully during
pregnancy and after birth, and adjustments made on a
It is recommended that the fetal growth should be
l BREAST FEEDING Present in milk—manufacturer advises
Dose adjustments ▶ In adults Halve dose in severe hepatic
impairment if eGFR less than 60 mL/minute/1.73 m2
▶ In children Halve dose in severe hepatic impairment if
estimated glomerular filtration rate less than
Dose adjustments ▶ In children Reduce dose if estimated
glomerular filtration rate less than 80 mL/minute/1.73 m2
▶ In adults Maximum 2 g daily if eGFR
. Maximum 1 g daily if eGFR less
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intravenous infusion (Keppra ®),
dilute requisite dose with at least 100 mL Glucose 5% or
Sodium Chloride 0.9%; give over 15 minutes.
▶ With oral use For administration of oral solution, requisite
dose may be diluted in a glass of water.
l PRESCRIBING AND DISPENSING INFORMATION If switching
between oral therapy and intravenous therapy (for those
temporarily unable to take oral medication), the
intravenous dose should be the same as the established
Medicines for Children leaflet: Levetiracetam for preventing
seizures www.medicinesforchildren.org.uk/levetiracetampreventing-seizures
320 Epilepsy and other seizure disorders BNF 78
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 8
▶ Desitrend (Desitin Pharma Ltd)
Levetiracetam 250 mg Desitrend 250mg granules sachets sugar-free
| 60 sachet P £22.41 DT = £22.41
Levetiracetam 500 mg Desitrend 500mg granules sachets sugarfree | 60 sachet P £39.46 DT = £39.46
Levetiracetam 1 gram Desitrend 1000mg granules sachets sugarfree | 60 sachet P £76.27 DT = £76.27
CAUTIONARY AND ADVISORY LABELS 8
▶ Levetiracetam (Non-proprietary)
Levetiracetam 250 mg Levetiracetam 250mg tablets | 60 tablet P £26.86 DT = £3.27
Levetiracetam 500 mg Levetiracetam 500mg tablets | 60 tablet P £47.31 DT = £5.30
Levetiracetam 750 mg Levetiracetam 750mg tablets |
Levetiracetam 1 gram Levetiracetam 1g tablets | 60 tablet P £93.09 DT = £8.33
Levetiracetam 250 mg Keppra 250mg tablets | 60 tablet P £28.01 DT = £3.27
Levetiracetam 500 mg Keppra 500mg tablets | 60 tablet P £49.32 DT = £5.30
Levetiracetam 750 mg Keppra 750mg tablets | 60 tablet P £84.02 DT = £7.87
Levetiracetam 1 gram Keppra 1g tablets | 60 tablet P £95.34
ELECTROLYTES: May contain Sodium
▶ Levetiracetam (Non-proprietary)
Levetiracetam 100 mg per 1 ml Levetiracetam 500mg/5ml
concentrate for solution for infusion vials | 10 vial P £127.31 DT =
£127.31 | 10 vial P £114.57–£127.31 DT = £127.31 (Hospital only)
▶ Desitrend (Desitin Pharma Ltd)
Levetiracetam 100 mg per 1 ml Desitrend 500mg/5ml concentrate
for solution for infusion ampoules | 10 ampoule P £127.31 DT =
Levetiracetam 100 mg per 1 ml Keppra 500mg/5ml concentrate for
solution for infusion vials | 10 vial P £127.31 DT = £127.31
CAUTIONARY AND ADVISORY LABELS 8
▶ Levetiracetam (Non-proprietary)
Levetiracetam 100 mg per 1 ml Levetiracetam 100mg/ml oral
solution sugar free sugar-free | 150 ml P £27.00 sugar-free | 300 ml P £60.26 DT = £28.94
Levetiracetam 100 mg per 1 ml Keppra 100mg/ml oral solution
sugar-free | 150 ml P £33.48 sugar-free | 300 ml P £66.95
Monotherapy for the treatment of focal seizures with or
without secondary generalised tonic-clonic seizures
▶ Child 6–17 years: Initially 4–5 mg/kg twice daily (max.
per dose 300 mg), then increased in steps of up to
5 mg/kg twice daily, adjusted according to response,
dose to be adjusted at weekly intervals; maximum
▶ Adult: Initially 300 mg twice daily, then increased in
steps of up to 600 mg daily, adjusted according to
response, dose to be adjusted at weekly intervals; usual
dose 0.6–2.4 g daily in divided doses
Adjunctive therapy for the treatment of focal seizures
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