Carbamazepine Dosing for Pediatric Seizure Disorders: The Highs and Lows

Carbamazepine (CBZ) has become a commonly used antiepileptic agent in the pediatric population. It is considered a drug of choice for not only partial seizures but also for primary generalized tonic-clonic seizures. Although this agent is very effective, regulation of serum drug concentrations can sometimes be problematic in children. CBZ elimination is more rapid in children, necessitating the need for higher mg/kg doses than are commonly employed in adults. The accumulation of the pharmacologically active metabolite carbamazepine-10,11-epoxide is often higher in children due to more rapid conversion of the parent compound and may elicit either a better therapeutic response or neurotoxicities. CBZ absorption can also be somewhat altered in children and may be related in part to the dosage form used in small children. This article is intended to discuss some of the obstacles that may be encountered in CBZ therapy in children and to offer suggestions for improved therapy with this agent.