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In view of the risk of neonatal bleeding associated with carbamazepine, phenobarbital and phenytoin, prophylactic vitamin K1 (section 9.6.6) is recommended for the mother before delivery (as well as for the neonate).

Breast-feeding is acceptable with all antiepileptic drugs, taken in normal doses, with the possible exception of the barbiturates, and also some of the more recently introduced ones

Dose

Epilepsy

300 mg on day 1, then 300 mg twice daily on day 2, then 300 mg 3 times daily (approx. every 8 hours) on day 3, then increased according to response in steps of 300 mg daily (in 3 divided doses) to max. 2.4 g daily, usual range 0.9–1.2 g daily

child 6–12 years (specialist use only) 10 mg/kg on day 1, then 20 mg/kg on day 2, then 25–35 mg/kg daily (in 3 divided doses approx. every 8 hours), maintenance 900 mg daily (body-weight 26–36 kg) or 1.2 g daily (body-weight 37–50 kg)

Neuropathic pain

adult over 18 years, 300 mg on day 1, then 300 mg twice daily on day 2, then 300 mg 3 times daily (approx. every 8 hours) on day 3, then increased according to response in steps of 300 mg daily (in 3 divided doses) to max. 1.8 g daily

Interactions

No interactions with gabapentin reported

Monitoring – No need for monitoring

Elimination: Gabapentin is eliminated from the systemic circulation by renal excretion as unchanged drug. Gabapentin is not appreciably metabolized in humans.

Migraine

The treatment of migraine may be broken down into:

R

A

P

R

I

O

P

Reassurance

May be worried about brain tumour – explain symptoms and exam findings – reassure as appropriate as to lack of serious pathology.

Advice

Keep a headache diary to monitor triggers and avoid where possible

Prescription

Migraine: sumatripan migraleve, paramax

Migraine prophylaxis (if > 3 attacks / month): Pizotifen, propranalol

Referral

If signs of ICP or trigeminal neuralgia.

Investigation

Not usually req., ESR if temporal arteritis suspected.

Observation

Return if no better within a reasonable space of time.

Prevention

Avoid trigger factors.

Acute Migraine by A. Mcleod

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