PAEDIATRIC NEUROLOGY DOSING INFORMATION

DRUG FORM DOSE

Baclofen Tab 10mg 0.2mg/kg 8H to 1mg/kg 8H. Higher dose can be used after discussed
Sy (Ex) 1mg/ml (S30/7) with neurologist (slow titration, 60-80mg/day for dystonia).

Benzhexol Tab 2mg starting dose 0.1mg/kg/day, slow titration, increase every 2 weeks to
targeted dose 0.5-0.75mg/kg/day in 3 divided dose.
Carbamazepine Tab 200mg 5mg/kg/day in 1-2 divided dose, increasing over 2 weeks to 10-
CR Tab 200mg 30mg/kg/day in 2-3 divided dose. CR tablet is given in 2 divided dose
Sy 100mg/5ml
Clobazam Tab 10mg 0.1mg/kg, max 0.4mg/kg BD
Clonazepam Tab 0.5mg, 2mg 0.01mg/kg BD, incr to 0.1mg/kg BD to QID.
Sy (Ex) 0.1mg/ml (S 60/7) Max 4mg/day.
Clonidine Tab 25mcg 1-6mcg/kg/dose 8-12H (max 20-25mcg/kg/day)
Diazepam INJ 10mg/2ml IV: 0.1-0.4mg/kg
Tab 5mg Oral: 0.04 - 0.2mg/kg 8-12H
PR 5mg/2.5ml PR: 0.3-0.5mg/kg
Forlax (macrogol Sachet 10g ≥ 8yo 1-2 sachets per day (0.7-1.5g/kg/day)
4000)
Flunarizine Cap 5mg 5-10mg daily.
Gabapentin Cap 300mg Analgesia: 2mg/kg 8H, max 15mg/kg or higher 8H
Sy (EX) 100mg/ml (S 28/7)
Immunoglobulin INJ 3G, 2.5G 2g/kg over 2-5 days. Start infusion at 0.5ml/kg/hr, 1ml/kg/hr,
1.5ml/kg/hr, 2ml/kg/hr every 15min for 1st hour, then maintained at
2ml/kg/hr until finished (start with 0.25ml/kg/hr for infusion over 5
days). Max 4ml/kg/hr or 200ml/hr.
Lamotrigine Tab 5mg, 25mg, 50mg, 0.15mg/kg daily if taking VPA double dose every 2 weeks, max2-
100mg 5mg/kg/day. Double dose with taking CBZ
Levetiracetam INJ 500mg/5ml IV loading 40mg/kg over 10mins (dilution 20-30mg/ml) then 20mg/kg
Tab 250mg, 500mg BD. Oral start 10mg/kg/day 12H, Max 60mg/kg/day
Sy 100mg/ml
Lorazepam Tab 1mg 0.02-0.06mg/kg 8-24H
Melatonin Tab 3mg 0.1mg/kg ON (usual dose 3mg ON, may ↑ 6mg for older children).

Methylprednisolon INJ 500mg 10mg/kg TDS with IV Omeprazole 1mg/kg 8-12H.

Midazolam INJ 5mg/ml, 15mg/3ml IV 0.1-0.2mg/kg (max 10mg) bolus over at least 2-5mins at conc.1-
5mg/ml (max 5mg/ml), infusion 3-5mcg/kg/min (max 15mcg/kg/min)

Tab 7.5mg
Buccal 10mg/ml Buccal 0.2-0.5mg/kg (max 10mg)
Nitrazepam Tab 5mg 0.125-0.5mg/kg 12H
Oxcarbazepine Tab 300mg Start 5mg/kg/day incr 5mg/kg/day every week target 25mg/kg/day (max
50mg/kg/day)
Perampanel Tab 2mg, 4mg, 8mg Start with 2mg ON inc in 2 weeks interval, maintenance dose 4-8mg/day

Phenytoin INJ 250mg/5ML IV loading 20mg/kg (max 1.25g) in NS (max conc 10mg/ml) over 30mins.
Cap 100mg, 30mg Maintenance IV or oral 4-8mg/kg/day in 2-3 divided dose.
Sy 125mg/5ml
 DRUG FORM DOSE
Phenobarbitone INJ 200mg/ml Loading 20mg/kg (max 1g), infusion over 30 mins, do not exceed
Tab 30mg 1mg/kg/min (max 30mg /min) at conc.10-20mg/ml (NS). Maintenance
Sy (Ex) 10mg/ml (S6/12) 5mg/kg/day.
Pyridostigmine Tab 60mg 1mg/kg4-6H, incr to max 2-3mg/kg (120-180mg) 4-6H.
Pyridoxine Tab 10mg 30mg/kg/day (for seizure)
Behavioural s/e keppra 100-200mg/day (6mg/kg/day)
Scopolamine patch Patch 1.5mg > 10y/o 1 patch every 72 hours. Below 10 y/o, half patch every 72 hours.
1.5mg
Stiripentol Cap 250mg Start with 20mg/kg/day in 2-3 divided dose, incr every 2weeks to
Pulv 250mg recommended dose 50mg/kg/day.
Sulthiame Tab 200mg 3-5mg/kg daily in 2-3 divided dose. (usual dose 5-30mg/kg/day, average
20mg/kg/day)
Topiramate Sprinkle 15mg 0.5-1mg/kg/day then increase in 2 weekly interval, by 1mg/kg/day in 2
Tab 25mg divided doses. Usual maintenance 5-9mg/kg/day.
Tab 50mg
Tab 100mg
Valproate INJ 200mg 20mg/kg (max 1.25g) over 5-10min at 20-40mg/min then infusion 1-
Tab 200mg 5mg/kg/hr for 6-12. Dilute to 4mg/ml with NS, D5% or dextrose saline
Sy 200mg/5ml (S24 hrs). Oral: start 10mg/kg/day in 2-3 divided doses, usual dose 30-
40mg/kg/day.
Vigabatrin 500mg 25mg/kg 12H, incr if required max 150mg/kg/day.

Rufinamide treatment protocol

Wt < 30kg Wt < 30kg Wt ≥ 30kg

not taking VPA taking VPA
Initial dosing 100mg bd x 3/7 100mg bd x 3/7 200mg bd x 3/7
(10mg/kg/day)
Escalation (↑dose 200mg bdx 3/7 150mg bd x 3/7 400mg bd x3/7
over 2 weeks ) 300mg bdx 3/7 200mg bdx 3/7 600mg bdx 3/7
400mg bdx 3/7 250mg bd x 3/7 800mg bdx 3/7
1000mg bdx 3/7
Maintenance 200-500mg bd 150-300mg bd 600-1600mg bd
Targeted dose 20-40mg/kg/day 15-25mg/kg/day 20-40mg/kg/day
Max dose 40mg/kg/day 25mg/kg/day 40mg/kg/day
1000mg/day 600mg/day 3200mg/day
(whichever is less)

References:
1. Frank Shann Sixteeth Edition
2. Pediatric Dosage Handbook 16th Edition Lexi-Comp
3. Neurology Prescribing Information-updated Jan 2004
4. Product insert/ information
5. Paediatric neurologists, HKL personal experience and treatment protocol.

updated 3 AUG 2016