Renal transplant recipient seizure practical management

Table 3 Dose adjustment for antiepileptic drugs in patients with renal impairment

GFR (mL/min)	60-90	30-60	15-30	< 15	Haemodialysis
Levetiracetam	500-1000 mg BD	250-750 mg BD	250-500 mg BD	500-1000 mg OD	Plus 250-500 mg/d
Toparimate	50% decrease	50% decrease	50% decrease		50-100 mg after HD
Zonisamide	100-400 mg	100-400 mg
Oxcarbazepine	300-600 mg BD	300-600 mg BD	300 mg/d starting dose	NA	NA
Esclicarbazepine	None	400-600 mg OD	400-600 mg OD
Clobazam	None	None	None	NA	None
Pregabalin	None	50% decrease	25-125 mg/d	25-75 mg /d	25-150 mg after HD
Lacosamide	None	None	300 mg/d		Plus < 50% after HD
Rufinamide	None	None	None	NA	Plus 30% after HD
Vigabatrin	25% decrease	50% decrease	75% decrease	NA	NA
Tiagabine	None	None	None	None	None
Lamotrigine	None	None	None	None	NA
Phenytoin	None	None	None	None	May need in high flux HD
Carbamazepine	None	NA	NA	75% dose	Plus 75% after HD
Valproate	None	None	None	None	May need in high flux HD
Perampanel	None	None	NA	NA	NA
Brivaracetam	None	None	NA	NA	None

This table is modified from Glynn et al[9], Diaz et al[15] Lexicomp online drug information[16]. NA: Not available.