Alternative Route/Drug |
Dose Adjustment |
Notes |
PR Carbamazepine |
Increase dose by 25% (125mg PR can be considered approx. equivalent to 100mg of tabs, final dose adjustment dependent on clinical response) |
For PR dosing: NB: unlicensed use increase total daily dose by 25%, then round dose to nearest suppository size. Suppositories available in 125mg & 250mg sizes [1]. [Max dose by rectum 250mg qds]. Please note that max duration use of carbamazepine suppositories is 7 days, as suppositories may cause rectal irritation. [1,2,3,4] Note: oral liquid has been used rectally(off label), this should only beconsidered if suppositories are not tolerated. The oral liquid will need to be diluted, should be retained for at least 2 hours but may have a laxative effect [5] |
Alternative Route/Drug |
Dose Adjustment |
IV Clonazepam |
10mg clobazam = 0.75mg clonazepam IV |
PR Diazepam |
10mg clobazam = 7.5mg diazepam rectal solution or suppositories |
IV Diazepam |
10mg clobazam = 7.5mg diazepam IV |
Alternative Route/Drug |
Dose Adjustment |
Notes |
PR Diazepam |
0.5mg clonazepam = 5mg diazepam PR |
Speak to paediatric neurology for advice |
IV Diazepam |
0.5mg clonazepam = 5mg diazepam IV |
Alternative Route/Drug |
Dose Adjustment |
Notes |
PR Ethosuxamide |
Give capsule rectally at the same dose |
Unlicensed use |
Alternative Route/Drug |
Speak to paediatric neurology for advice. Poor absorption rectally [8] |
Alternative Route/Drug |
Dose Adjustment |
Notes |
Lacosamide IV Infusion |
Same as oral [9, 10] |
Alternative Route/Drug |
Dose Adjustment |
Notes |
Lacosamide IV Infusion |
Same as oral |
Speak to neurology for advice. NB unlicensed use: 100mg dispersible tablet dissolved in 6ml room temperature water and given rectally [11]. Use enema prior to administration, using a catheter, administer in lateral decubitus position and patient should maintain a supine position for 60 minutes, monitor for expulsion |
Alternative Route/Drug |
Dose Adjustment |
Notes |
IV Levetiracetam Infusion |
Same as oral [12] |
Alternative Route/Drug |
Speak to paediatric neurology for advice. Switch to alternative |
Alternative Route/Drug |
Dose Adjustment |
Notes |
Consider switch to PR Carbamazepine |
300mg oxcarbazepine = 250mg carbamazepine supps. [Max dose by rectum 250mg qds]. |
Check for any contra-indications to carbamazepine e.g. rash. Speak to paediatric neurology. Please note that the conversion of oxcarbazepine to carbamazepine has not been researched thoroughly and as a Category 1 and Category 2 antiepileptic, the MHRA advised that switching should only be conducted by a neurologist with appropriate monitoring. |
Alternative Route/Drug |
Speak to paediatric neurology for advice on alternative |
Alternative Route/Drug |
Dose Adjustment |
Notes |
IV infusion |
Same as oral dose |
Alternative Route/Drug |
Dose Adjustment |
Notes |
Give as IV |
Same as oral dose of phenytoin sodium capsules |
Infatabs and suspension are in the form of phenytoin and the injection is the sodium salt. To convert the dose and multiply the oral phenytoin dose by 1.1 to calculate equivalent IV dose. In practice would recommend using the same dose and adjusting as required. Plasma phenytoin concentration monitoring is recommended [15]. |
Alternative Route/Drug |
Speak to paediatric neurology for advice on alternative |
Alternative Route/Drug |
Dose Adjustment |
Notes |
IV infusion |
Same as oral dose |
Alternative Route/Drug |
Dose Adjustment |
Notes |
Can be given PR |
Same as oral dose |
Speak to paediatric neurology for advice, usually switch to an alternative. NB: unlicensed use tablets dissolved in 5-10ml water and given rectally [17] |
Alternative Route/Drug |
Dose Adjustment |
Notes |
Can be given PR |
Same as oral dose |
NB: unlicensed use Dissolve the contents of sachet in 5- 10ml water and administer rectally [18]. Speak to paediatric neurology for advice. |
Alternative Route/Drug |
Speak to paediatric neurology for advice on alternative |
Document Version:
1.0 Lead Authors: Kate Pryde, Consultant Paediatrician, UHS Jaspal Singh, Consultant Paediatric Neurologist, UHS Rosemary Dempsey, Lead Pharmacist Women & Child Health, UHS |
Approving Network:
Wessex Neuroscience Network Date of Approval: November 2022 Review Due: November 2025 |
PIER Contact |
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