The dose may be raised above 200 mg by additions of 50 mg/day every two weeks, up to 400 mg PO every day, as needed, depending on the clinical response and tolerability
Note:
Used either alone or in conjunction with other therapies to treat partial-onset seizures
Initial
400 mg orally daily
If there is a need for additional seizure reduction to overcome the higher risk of adverse effects during initiation, some individuals may be started on 800 mg daily.
Maintenance and titration
Increase the dosage in 400-600 mg weekly increments depending on the clinical response & tolerability.
The recommended daily maintenance dosage is 800 to 1600 mg once every day
Monotherapy: In individuals who cannot tolerate 1200 mg daily, consider a maintenance dosage of 800 mg/day.
Adjunctive therapy: In individuals unable to respond satisfactorily to 1200 mg daily, adjunctive treatment at 1600 mg/day should be considered.
Dose Adjustments
Dosage Modifications
Hepatic impairment
Mild and moderate: dose adjustment is not necessary
Severe: Not usually recommended (unstudied) Renal impairment
Mild (CrCl above 50 mL/min): dose adjustment is not necessary
Moderate and severe (CrCl below 50 mL/min): 50% reduction in initial, titration, and the maintenance dosages; titration and maintenance doses may be adjusted based on clinical response.
Initial
400 mg Orally daily
If the need for more significant seizure reduction overcomes the higher risk of adverse effects during initiation, certain patients may be started on 800 mg daily Maintenance and titration
Increase the dosage in 400-600 mg weekly increments depending on clinical response & tolerability
The recommended daily dosage is 800 to 1600 mg once a day
Monotherapy: In individuals who cannot tolerate 1200 mg/day, consider 800 mg/day as a maintenance dosage
Adjuvant therapy: In individuals who did not respond effectively to 1200 mg/day, 1600 mg/day could be considered
Dose Adjustments
Dosage Modifications Renal impairment
Mild (CrCl more than 50 mL/min): dose adjustments are not required
Moderate-severe (CrCl less than 50 mL/min): Reduce the starting, titration, and maintenance dosages by 50%; titration & maintenance doses may be adjusted based on clinical response Hepatic impairment
Mild-moderate: dose adjustment is not required
Severe: usually mot recommended
Indicated for Partial Seizures
Concomitant therapy:
Oxtellar XR: 600 mg orally every day, as the initial dose might enhance at weekly intervals by 600 mg every day to reach the target dose range 1200 mg to 2400 mg every day
Trileptal: 300 mg orally two times a day as the initial dose might enhance at weekly intervals by 600 mg every day, nearly 1200 mg every day
Monotherapy (whether converting from other Antiepileptic Drugs):
Initial dose: 300 mg orally two times a day, enhance by 600 mg every day for every week, nearly 2400 mg every day
while reaching the highest oxcarbazepine dose in two-four weeks, diminish and withdraw adjunctive AED drugs over 3 weeks to 6 weeks
Monotherapy (whether Antiepileptic Drugs are naive):
Initial dose: 300 mg orally two times a day, enhance by 300 mg every day for every 3 days, nearly 1200 mg in divided two times a day
Bipolar Disorder as Off-label
300 mg every day orally, as the initial dose might titrate to 1800 mg to 2400 mg every day for maximum
Diabetic Neuropathy as Off-label
150 mg to 300 mg orally every day as an initial dose, which might enhance to 900 mg to 1200 mg every day
Doses up to 1800 mg every day were studied, with the positive results
Neuralgia/Neuropathy as Off-label
300 mg orally two-three times a day as an initial dose, might adjust the dose to 400 mg to 2000 mg in divided two-three times a day
150 mg/day orally divided every 8-12 hours initially
Maintenance: Depending on clinical response and the tolerability, the dosage may be increased in weekly increments, and should not exceed more than 600 mg/day
Taking valproic acid, conversion to immediate-release lamotrigine
Start and titrate to lamotrigine dose of 200 mg/day and lowers valproic acid dose by 500 mg/day at intervals of 1 week along with maintain this dose for another 1 week
Raised lamotrigine dose to 300 mg while valproic acid is reduced to 250 mg/day along with maintain this dose for another 1 week
Discontinue valproic acid
Raised lamotrigine dose by 100 mg/day at weekly intervals to achieve a maintenance dose of 500 mg/day
taking valproic acid, conversion to extended-release lamotrigine
25 mg orally daily: for week 1 to 2 and then in week 3 to 4
50 mg orally daily: in week 5
100 mg orally daily: in week 6
Weeks 7 to 10: take 150 mg orally daily and start valproic acid withdrawal after 5 to 7 weeks to 500mg/day and maintain for 1 week
Week 11: take 200 mg orally daily also reduces valproic acid dose to 250 mg/day for 1 week
Weeks 12 to 23: take 250 to 300 mg orally daily and then discontinue valproic acid
taking neutral AED, conversion to extended-release lamotrigine
take 25 mg orally for weeks 1 to 2
take 50 mg orally for weeks 3 to 4
take 100 mg orally for week 5
take 150 to 200 orally for week 6
from weeks 7 to 23: take 250 to 300 mg orally and start AED withdrawal over 5-weeks by weekly 20% reduction in daily dose
<16 years:
Safety and efficacy not established
>16 years:
100mg orally every day,increase up to 200mg/day twice a day after two weeks
Do not exceed 600mg/day
Below 4 yrs: Safety & efficacy were not established
4 to 17 yrs
Initial weight-based dose recommendation
11 to 21 kg: 200 mg orally daily at start; titration increment should not exceed more than 200 mg daily
22 to 38 kg: 300 mg orally daily; titration increment should not exceed more than 300 mg daily
Above 38kg: 400 mg orally daily; titration increment should not exceed more than 400 mg daily
Dose should be increased depending on the clinical response and tolerability, not more than once a week.
Maintenance dose
11 to 21 kg: should not exceed more than 400 to 600 mg daily
22 to 31 kg: should not exceed more than 500-800 mg daily
32 to 38 kg: should not exceed more than 600-900 mg daily
Above 38kg: should not exceed more than 800-1200 mg daily
Dose Adjustments
Dosage Modifications
Hepatic impairment
Mild and moderate: dose adjustment is not necessary
Severe: Not usually recommended (unstudied) Renal impairment
Mild (CrCl above 50 mL/min): dose adjustment is not necessary
Moderate and severe (CrCl below 50 mL/min): 50% reduction in initial, titration, and the maintenance dosages; titration and maintenance doses may be adjusted based on clinical response.
Below 4 years: Safety & efficacy were not established
Age: 4 to 17 years initial Recommended weight-based dose
11 to 21 kg: 200 mg orally daily initially; titration increment should not exceed more than 200 mg/day
22 to 38 kg: 300 mg orally daily; titration increment should not exceed more than 300 mg/day
Above 38kg: 400 mg orally daily; titration increment should not exceed more than 400 mg/day
Based on the clinical response & tolerability, Dose should be increased but not more than once a week Maintenance dosage
11 to 21 kg: should not exceed more than 400 to 600 mg daily
22 to 31 kg: should not exceed more than 500 to 800 mg daily
32 to 38 kg: should not exceed more than 600 to 900 mg daily
Above 38kg: should not exceed more than 800 to 1200 mg daily
Dose Adjustments
Dosage Modifications Renal impairment
Mild (CrCl more than 50 mL/min): dose adjustments are not required
Moderate-severe (CrCl less than 50 mL/min): Reduce the starting, titration, and maintenance dosages by 50%; titration & maintenance doses may be adjusted based on clinical response Hepatic impairment
Mild-moderate: dose adjustment is not required
Severe: usually mot recommended
IR tablets are recommended as a monotherapy or adjunctive treatment for patients with partial-onset seizures
Age (1-6 months): 7 mg/kg orally 2 times a day; increase by 7 mg/kg every 12 hours every 2 weeks to the recommended dose of 21 mg/kg every 12 hours
Age (6 months-4 yrs): 10 mg/kg orally 2 times a day; increase by 10 mg/kg every 12 hours every two weeks
Age (4-16 yrs): 10 mg/kg orally 2 times a day; increase by 10 mg/kg/dose every two weeks to 30 mg/kg orally 2 times a day
Age (>16 years): 500 mg orally 2 times a day; increase by 500 mg orally 2 times a day every two weeks
Indicated for Partial Seizures
Concomitant therapy:
Age 2-4 years:
Trileptal: The initial dose is 8 mg-10 mg/Kg every day, orally in divided two times a day. It should not exceed 600 mg in a day
Body weight <20 Kg: It may consider beginning with 16 mg to 20 mg/Kg every day; it might titrate to the maximum dose for over two-four weeks. It should not exceed 60 mg/kg every day
Age 4-16 years:
Trileptal: The initial dose is 8 mg-10 mg/Kg every day, orally in divided two times a day. It should not exceed 600 mg in a day
Maintenance dose: It might titrate to the maximum dose for over two weeks to make the following dose ranges
Body weight 20 kg to 29 Kg: 450 mg orally two times a day
Body weight 29.1 kg to 39 Kg: 600 mg orally two times a day
Body weight >39 Kg: 900 mg orally two times a day
Age 6-17 years:
Oxtellar XR: The initial dose is 8 mg-10 mg/Kg every day, orally. It should not exceed 600 mg every day in the 1st week
Maintenance dose: It might titrate to the maximum dose for weekly intervals in 8 mg to 10 mg/Kg every day enhancements. It should not exceed 600 mg to make the following dose ranges for two-three weeks
Body weight 20 kg to 29 Kg: 900 mg orally every day
Body weight 29 kg to 39 Kg: 1200 mg orally every day
Body weight >39 Kg: 1800 mg orally every day
Monotherapy:
Age 4-16 years:
Trileptal: whether converting from other Antiepileptic Drugs, 8 mg to 10 mg/Kg every day orally in divided two times a day as the initial dose while concomitantly diminishing adjunctive Antiepileptic Drugs dose for over 3 weeks to 6 weeks; might enhance Trileptal dose every week to the highest enhancement of 10 mg/Kg every day
Antiepileptic Drugs naĂŻve: The initial dose is 8 mg to 10 mg/Kg every day orally in divided two times a day; might enhance every 3 days by 5 mg/Kg every day
Maintenance dose:
Body weight 20 Kg-24.99 Kg: 600 mg to 900 mg every day
Body weight 25 Kg-34.99 Kg: 900 mg to 1200 mg every day
Body weight 35 Kg-44.99 Kg: 900 mg to 1500 mg every day
Body weight 45 Kg-49.99 Kg: 1200 mg to 1500 mg every day
Body weight 50 Kg-59.99 Kg: 1200 mg to 1800 mg every day
Body weight 60 Kg-69.99 Kg: 1200 mg to 2100 mg every day
Body weight 70 Kg: 1500 mg to 2100 mg every day
Age 6-17 years:
Oxtellar XR: The initial dose is 8 mg-10 mg/Kg every day, orally. It should not exceed 600 mg every day in the 1st week
Maintenance dose: It might titrate to the maximum dose for weekly intervals in 8 mg to 10 mg/Kg every day enhancements. It should not exceed 600 mg to make the following dose ranges for two-three weeks
Body weight 20 kg to 29 Kg: 900 mg orally every day
Body weight 29 kg to 39 Kg: 1200 mg orally every day
Body weight >39 Kg: 1800 mg orally every day
<1 month: Safety and efficacy not established
One month to 17 years
<6 kg:
IV:0.66 mg/kg thrice a day; increase the weekly dose by 0.66mg/kg-recommended dose-2.5-5mg/kg.
Oral: 1 mg/kg twice daily; increase the weekly dose by 1 mg/kg up to 3.75-7.5mg/kg.
6 to <30kg:
1 mg/kg orally/IV twice daily; increase the weekly dose by 1 mg/kg up to 3-6mg/kg.
30 to <50kg:
1 mg/kg orally/IV twice daily; increase weekly dose by 1 mg/kg up to 2-4mg/kg.
Regular-release capsules and oral solution only
Below 1 month: Safety and efficacy were not established
Above 1 month to below 17 years
From 11 kg to below 30 kg
Starting dose: 3.5 mg/kg/day orally divided three times a day (for 1 month to 4 years) or 2 to 3 times a day (for 4 years)
Maintenance: Depending on clinical response and tolerability, the dosage may be increased in weekly increments and should not exceed more than 14 mg/kg daily
≥30 kg
Starting dose: 2.5 mg/kg/day orally divided every 8-12 hours
Maintenance: Depending on clinical response and the tolerability, the dosage may be increased in weekly increments to a maximum of 10 mg/kg/day (but not more than 600 mg/day)
≥17 years
Starting dose: 150 mg/day orally divided every 8-12 hours
Maintenance: Depending on clinical response and the tolerability, the dosage may be increased in weekly increments and should not exceed more than 600 mg/day
Taking valproic acid, conversion to immediate-release lamotrigine (age>16 year)
Start and titrate to lamotrigine dose of 200 mg/day and lowers valproic acid dose by 500 mg/day at intervals of 1 week along with maintain this dose for another 1 week
Raised lamotrigine dose to 300 mg while valproic acid is reduced to 250 mg/day along with maintain this dose for another 1 week
Discontinue valproic acid
Raised lamotrigine dose by 100 mg/day at weekly intervals to achieve a maintenance dose of 500 mg/day
taking valproic acid, conversion to extended-release lamotrigine (age>13 year)
25 mg orally daily: for week 1 to 2 and then in week 3 to 4
50 mg orally daily: in week 5
100 mg orally daily: in week 6
Weeks 7 to 10: take 150 mg orally daily and start valproic acid withdrawal after 5 to 7 weeks to 500mg/day and maintain for 1 week
Week 11: take 200 mg orally daily also reduces valproic acid dose to 250 mg/day for 1 week
Weeks 12 to 23: take 250 to 300 mg orally daily and then discontinue valproic acid
taking neutral AED, conversion to extended-release lamotrigine (age>13 year)
take 25 mg orally for weeks 1 to 2
take 50 mg orally for weeks 3 to 4
take 100 mg orally for week 5
take 150 to 200 orally for week 6
from weeks 7 to 23: take 250 to 300 mg orally and start AED withdrawal over 5-weeks by weekly 20% reduction in daily dose
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