This article is based on Dr. Leppik's presentation at the recent National EpiFellows Foundation Fourth Annual Forum in December 1996. Choosing the dose of an antiepileptic drug must be individualized to the patient based on age, weight, co-medications, and genetics.
Age is the most important variable.
There are major differences in dosing among neonates, infants, children, adults, and the elderly. In general, neonates have poor absorption of drugs and slow metabolism. This is even more prominent in premature infants. Metabolism slows in late adolescence and appears to be stable throughout most of adulthood. In the elderly, however, there is a decline in hepatic capacity, and drug metabolism slows.