Indications & Dose: BIPOLAR DISORDER Combination therapy PO Adult With valproic acid: Initially 25mg alternate day for wk 1& 2, then 25mg/day for wk 3 & 4, further increase to 50mg/day for wk 5, MD 100mg/day from wk 6. With enzyme inducing regimens without valproic acid: Initially 50mg for wk 1 & 2, then 100mg/day in divided doses for wk 3 & 4, further 200mg/day for wk 5, then 300mg/day in divided doses for wk 6, MD 400mg/day from wk 7 | Mono therapy PO Adult Initially 25mg/day for first 2 wk, then increase to 50mg/day wk 3 & 4, further increase to 100mg/day wk 5, MD 200mg/day from 6th wk | GENERALIZED TONIC–CLONIC SEIZURES Chronic PO Adult 25mg/day 14 days, increase to 50mg/day for next 14 days, then increase by max 50-100mg/day q7-14days, MD 100–200mg/day in 1–2 divided doses Child >12 yr: Same as adult dose | Chronic Combination therapy/Adjuvant therapy PO Adult With valproate: Initially 25mg on alternate days for 14 days, then 25mg/day for next 2 wk, further increase by max 25– 50mg/day q7–14days, MD 100–200mg/day in 1–2 divided doses Child 2–12 yr: 150µg/kg/day 14 days (those weighing <13 kg may receive 2mg on alternate days for first 14 days) then 30µg/kg/day for further 14 days, subsequently increase by max 300µg/kg/day q7–14days, MD 1–5mg/kg/day in 1–2 divided doses | Chronic Combination therapy/Adjuvant therapy PO Adult 50mg/day 2 wk, then 50mg BID for next 2 wk, then increased by max 100mg/day q7–14 days, MD 200–400mg/day in 2 divided doses with enzyme inducing drugs & without valproate Child 2– 12 yr: 600µg/kg/day in 2 divided doses for 14 days, then 1.2mg/kg/day in 2 divided doses for next14 days, later increase by max 1.2mg/kg/day q7–14days, MD 5–15mg/kg/day in 2 divided doses | Chronic Combination therapy/Adjuvant therapy PO Adult With oxcarbazepine: Initially 25mg/day for 14 days, then increase to 50mg/day for next 14 days, further increase by max 50–100mg/day q7–14days, MD 100– 200mg/day in 1–2 divided doses Child 2–12 yr: 300µg/kg/day in 1–2 divided doses for 14 days, then 600µg/kg/day in 1–2 divided doses for next 14 days, further increase by max 600µg/kg/day q7–14days, MD 1–10mg/kg/day in 1–2 divided doses

Precautions: Avoid abrupt withdrawal, hepatic/renal impairment

ADR: Serious: SJS, TEN, lymphadenopathy, intravascular coagulation, hepatic dysfunction, multi-organ dysfunction, thrombocytopenia, Others: nausea, vomiting, diarrhea, headache, fatigue, dizziness, tremor, agitation, confusion, hallucinations, leucopenia, pancytopenia, arthralgia, nystagmus, diplopia, conjunctivitis

DDI: Serious Ritonavir -boosted atazanavir and lopinavir reduces drug plasma levels, Phenytoin/Phenobarbital decreases drug levels, Sertraline increases drug level, Valproic acid increases drug levels, Zonisamide levels increased, Oxcarbazepine modestly reduces drug levels, Rifampicin reduces serum drug level, Carbamazepine toxicity has occurred

Diet: With/without food