A 20-kg child takes valproic acid (Depakote) for seizures and has had regular dose increases with a current dose of 250 mg twice daily
The child continues to have one to two seizures each week along with significant drowsiness that interferes with school participation. The primary care NP should contact the child's neurologist to discuss: a. obtaining a serum valproic acid level.
b. changing the medication to gabapentin (Neurontin).
c. increasing the valproic acid by 5 mg per kg of weight.
d. adding lamotrigine (Lamictal) to this child's drug regimen.
D
Research suggests a combination of lamotrigine and valproate to be the most effective regimen in patients with refractory epilepsy. Valproic acid dosing may be increased to a maximum of 60 mg/kg/day unless side effects prevent further increase in dosage. The other drugs are not recommended.
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