| Sodium Channel Blockers | Carbamazepine | Tegretol | Blocks voltage-gated sodium channels | Focal, generalized tonic-clonic | 400–1600 mg/day | 10–35 mg/kg/day | Caution in renal impairment | Oral | Hyponatremia, rash, diplopia | D | CBC, sodium, LFTs, serum levels |
| Oxcarbazepine | Trileptal | Sodium channel blocker, prodrug of licarbazepine | Focal | 600–2400 mg/day | 8–10 mg/kg BID | Adjust if CrCl < 30 mL/min | Oral | Hyponatremia, dizziness | C | Sodium, renal function, CNS side effects |
| Eslicarbazepine | Aptiom | Voltage-gated sodium channel blocker | Focal | 400–1600 mg/day | 10–30 mg/kg/day | Adjust if CrCl < 50 mL/min | Oral | Nausea, rash, hyponatremia | C | Sodium, renal function, mood changes |
| Phenytoin | Dilantin | Delays recovery of inactivated sodium channels | Focal, tonic-clonic, SE | 300–400 mg/day | 5–10 mg/kg/day | Adjust if CrCl < 10 mL/min | Oral/IV | Ataxia, gingival hyperplasia | D | Serum levels, LFTs, CBC |
| Lamotrigine | Lamictal | Inhibits voltage-sensitive sodium channels | Focal, generalized, absence, LGS | 25–400 mg/day | 1–5 mg/kg/day | No adjustment needed | Oral | Rash, dizziness | C | Rash monitoring, serum levels if needed |
| Lacosamide | Vimpat | Enhances slow inactivation of sodium channels | Focal | 200–400 mg/day | 4–12 mg/kg/day | Adjust if CrCl < 30 mL/min | Oral/IV | PR prolongation, dizziness | C | ECG, renal function, CNS effects |
| Rufinamide | Banzel | Prolongs sodium channel inactivation | Lennox-Gastaut | 400–3200 mg/day | 10–45 mg/kg/day | Avoid in severe renal impairment | Oral | QT shortening, sedation | C | ECG, LFTs, behavioral changes |
| GABA Modulators | Clobazam | Onfi | GABA-A receptor potentiation | Lennox-Gastaut, adjunct | 10–40 mg/day | ≤1 mg/kg/day | Caution in liver impairment | Oral | Sedation, dependence | C | Sedation, withdrawal risk |
| Tiagabine | Gabitril | Inhibits GABA reuptake | Focal (adjunct) | 4–56 mg/day | 0.25–0.5 mg/kg/day | Caution in renal impairment | Oral | Confusion, weakness | C | Seizure frequency, CNS changes |
| Gabapentin | Neurontin | Modulates calcium channels; increases GABA | Focal (adjunct) | 900–3600 mg/day | 10–50 mg/kg/day | Adjust if CrCl < 60 mL/min | Oral | Drowsiness, weight gain | C | Renal function, CNS effects |
| Pregabalin | Lyrica | Binds alpha-2-delta subunit of calcium channels | Focal (adjunct) | 150–600 mg/day | Not routine use | Adjust if CrCl < 60 mL/min | Oral | Sedation, edema | C | Weight, edema, renal function |
| Valproic acid | Depakote | Increases GABA, blocks Na+ channels, T-type Ca++ channels | Generalized, absence, focal, LGS | 10–60 mg/kg/day | 10–60 mg/kg/day | No renal adj., avoid in liver disease | Oral/IV | Hepatotoxicity, tremor | D/X (migraine) | LFTs, CBC, ammonia, levels |
| Calcium Channel Blocker | Ethosuximide | Zarontin | Blocks T-type calcium channels | Absence | 250–1500 mg/day | 20 mg/kg/day | No adjustment needed | Oral | GI upset, lethargy | C | CBC, LFTs, behavioral signs |
| SV2A Ligand Modulator | Levetiracetam | Keppra | Binds SV2A synaptic vesicle protein | Focal, myoclonic, GTC | 500–1500 mg BID | 10–60 mg/kg/day | Adjust if CrCl < 80 mL/min | Oral/IV | Irritability, somnolence | C | Mood, behavioral changes |
| AMPA Antagonist | Perampanel | Fycompa | Noncompetitive AMPA receptor antagonist | Focal, GTC | 2–12 mg/day | ≥4 yrs: 2 mg/day | Use with caution | Oral | Aggression, dizziness | C | Mood, aggression, coordination |
