Orally, regardless of meals. Tablets should not be divided.
For optimal seizure control, it is recommended to start treatment with Epitomax at a low dose with subsequent increase to an effective dose. When used as monotherapy, the possible effect of withdrawal of concomitant antiepileptic drugs on seizure frequency should be considered. In cases where there is no need to abruptly cancel antiepileptic drugs, it is recommended to reduce their doses gradually, reducing doses by 1/3 every 2 weeks. When drugs that are inducers of microsomal liver enzymes are withdrawn, the concentration of Epitomax in plasma will increase, which should be taken into account in the ongoing therapy.
Monotherapy with the drug
In adults at the beginning of monotherapy – 25 mg 1 time per night for 1 week. Then the dose is increased at 1-2 week intervals by 25-50 mg/day (the daily dose is divided into 2 doses). If intolerant to this therapy regimen, the dose is increased by a smaller amount or at longer intervals. The dose is adjusted depending on the effectiveness and tolerability of the therapy. The recommended initial target dose is 100-200 mg/day, the maximum daily dose should not exceed 500 mg in monotherapy. Dosing recommendations apply to all adults, including elderly patients without kidney disease.
For children over 6 years old in monotherapy in the first week of treatment, 0.5-1 mg/kg body weight before bedtime. Then the dose is increased at 1-2 week intervals by 0.5-1 mg/kg/day (daily dose is divided into two doses). If this therapy regimen is intolerant, the dose is increased more gently or at longer intervals between dose increases. The size of the dose and the rate of dose increase are determined by clinical efficacy and tolerability of therapy. The recommended dose range for Epitomax monotherapy in children is 100 mg/day and depends on clinical efficacy (in children aged 6-16 years, it is about 2 mg/kg/day).
As part of combination therapy
Adults. In combination therapy with other anticonvulsants in adults, the initial dose is 25-50 mg 1 time per night for 1 week. Further the dose is increased by 25-50 mg every week until an effective dose is achieved. The minimum effective dose is 200 mg/day, the average daily dose is 200-400 mg, the frequency of administration is 2 times a day. Doses over 1600 mg per day have not been studied. The criterion for dose selection is clinical effect and tolerability, in some patients this effect can be achieved by taking the drug once daily. Dosage recommendations apply to all adults, including elderly patients without kidney disease.
Children. When administered as part of combined anticonvulsant therapy in children over 3 years old, the recommended total daily dose is 5-9 mg/kg in 2 doses. The dose is started with 25 mg/day (at a rate of 1-3 mg/kg/day) at bedtime for 1 week. Later the dose can be increased by 1-3 mg/kg for 1-2 weeks and taken in 2 doses. Stable clinical effect and good tolerability are the criteria for proper dosage selection. A daily dose of up to 30 mg/kg is usually well tolerated.
The recommended total daily dose is 100 mg in 2 doses. Begin treatment with a dose of 25 mg or less before bedtime for 1 week. Then the dose is increased by 25 mg/day at 1 week intervals. If this regimen is not tolerated, the dose is increased by a smaller amount or at longer intervals. The dose is adjusted depending on the clinical effect. In some patients, positive results are achieved at a daily dose of 50 mg/day. No additional effect as migraine prophylaxis is observed when using a daily dose more than 100 mg/day.
Patients with renal insufficiency. For patients with moderate (CKD less than 70 ml/min) and severe (CKD less than 30 ml/min) degree of renal insufficiency, the recommended initial dose should be reduced by half, and it should be increased by a smaller amount or at longer intervals. The dose should be adjusted according to the clinical effect. Note that reaching equilibrium concentration will take longer and will be 10 to 15 days after each increase in the dose of Epitomax.
In patients with hepatic impairment, Epitomax should be taken with caution under medical supervision due to the reduced clearance of Epitomax. No dose adjustment is required in elderly patients.