CLINICAL USE

Anti-epileptic

DOSE IN NORMAL RENAL FUNCTION

Initially: 25 mg twice daily, increasing to maintenance dose of 300–500 mg daily in 1 or 2 divided doses

PHARMACOKINETICS

  • Molecular weight                           : 212.2
  • %Protein binding                           : 40–60
  • %Excreted unchanged in urine     : 15–35
  • Volume of distribution (L/kg)       : 0.8–1.6
  • half-life – normal/ESRD (hrs)      : 60–63/Increased

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function, titrate slowly.
  • <10           : Dose as in normal renal function, titrate slowly.

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                : Dialysed. Dose as in GFR <10 mL/min
  • HD                     : Dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux   : Dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD      : Probably dialysed. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Antidepressants: anticonvulsant effect antagonised by MAOIs, SSRIs and tricyclics
  • Antimalarials: possibly increased risk of convulsions with chloroquine and hydroxychloroquine; anticonvulsant effect antagonised by mefloquine

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    AUC is increased by 35% in patients with a GFR<20 mL/min Increase dose at 2 weekly intervals in people with renal impairment and monitor more frequently .

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