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About TSC

Standard Antiepileptic Medications

Drug Name Brand Name(s) Formulation (liquid, tablet, capsule, solution) Strengths (mg, mg/L) FDA Approved Indications Notes
Adrenocorticotropic hormone (ACTH) Acthar HP Intramuscular injection  80 units/mL Infantile spasms monotherapy

Ages < 2 years

www.actharishcp.com/
Brivaracetam Briviact Tablet 10, 25, 50, 75, 100 mg Treatment of partial-onset seizures, people > 4 years (tablet, oral solution) www.briviact.com/
Brivaracetam Briviact Oral Solution 10 mg/mL Treatment of partial-onset seizures, people > 4 years (tablet, oral solution) www.briviact.com/
Brivaracetam Briviact IV Solution 50 mg/5 mL Treatment of partial seizures for people ≥ 16 years of age www.briviact.com/
Cannabidiol Epidiolex Oral Solution 100 mg/mL Treatment of seizures associated with Lennox-Gastaut syndrome (LGS),  Dravet syndrome (DS) and tuberous sclerosis complex for age 1 year and older. www.epidiolex.com/

Sample Letter of Medical Necessity

Carbamazepine Carbatrol

 

ER* Capsules 100, 200, 300 mg Partial seizures, generalized tonic clonic, mixed seizure types (not absence)
Carbamazepine Epitol ER* Capsules 100, 200, 300 mg Partial seizures, generalized tonic clonic, mixed seizure types (not absence)
Carbamazepine Tegretol Chewable Tablet 100 mg Partial seizures, generalized tonic clonic, mixed seizure types (not absence)
Carbamazepine Tegretol IR* Tablet 200 mg Partial seizures, generalized tonic clonic, mixed seizure types (not absence)
Carbamazepine Tegretol XR ER* Tablet 100, 200, 400 mg Partial seizures, generalized tonic clonic, mixed seizure types (not absence)
Cenobamate Xcorpri Tablets 12.5, 25, 50, 100, 150, 200 mg Treatment of partial seizures in adults xcoprihcp.com/
Clobazam Onfi Oral Suspension 2.5 mg/mL Adjunctive treatment of seizures for people

Lennox-Gastaut syndrome (LGS) ≥2 years of age

www.onfihcp.com/dosing-administration
Clobazam Onfi Oral Tablet 10, 20 mg
Clobazam Sympazan Oral Film 5, 10, 20 mg Adjunctive treatment of seizures for people with Lennox-Gastaut syndrome (LGS) ≥2 years of age www.sympazan.com/
Clonazepam Klonopin Oral Tablet 0.5, 1, 2 mg Seizure disorders (Lennox-Gastaut Syndrome, akinetic, and myoclonic seizures) Klonopin can be useful for people with absence (petit mal) seizures who have failed to respond to succinimides.
Diazepam Diastat AcuDial Rectal Gel 20 mg/4 mL, 10 mg/2 mL Selected refractory Epilepsy or intermittent use to control seizures People with selected refractory epilepsy are on stable regimens of AED and they require intermittent usage of Diastat to control increased seizures.
Diazepam Diastat Rectal Gel 2.5 mg/0.5 mL Selected refractory Epilepsy or intermittent use to control seizures People with selected refractory epilepsy are on stable regimens of AED and they require intermittent usage of Diastat to control increased seizures.
Diazepam Diazepam Intensol Oral Concentrate 5 mg/mL Selected refractory Epilepsy or intermittent use to control seizures
Diazepam Valium Oral Tablet 2, 5, 10 mg Anxiety, Alcohol Withdrawal, Muscle Spasms, and convulsive disorders
Diazepam Valtoco Nasal Spray 5, 7.5, 10 mg/spray Treatment of intermittent, stereotypic episodes of frequent seizure activity (i.e., seizure clusters, acute repetitive seizures) that are distinct from a people’s usual seizure pattern in people with epilepsy 6 years of age and older. www.valtocohcp.com/
Eslicarbazepine Aptiom Oral Tablet  200, 400, 600, 800 mg Partial-onset seizure –in people ≥ 4 years of age www.sunovionprofile.com/sp/aptiom.html
Ethosuximide Zarontin Oral Capsule 250 mg Absence (petit-mal) epilepsy
Everolimus Afinitor Oral Tablet 2.5, 5, 7.5, 10 mg Advanced breast cancer, neuroendocrine tumors, advanced renal cell carcinoma and tuberous sclerosis complex-associated renal angiomyolipoma Afinitor is a kinase inhibitor that treats people ≥ 1 year of age with tuberous sclerosis complex (TSC) who have subependymal giant cell astrocytoma (SEGA).
Everolimus Afinitor Disperz Oral Tablet for Suspension 2, 3, 5 mg Tuberous sclerosis complex-associated partial-onset seizures Afinitor Disperz is a kinase inhibitor that treats people ≥ 1 year of age with tuberous sclerosis complex (TSC) who have subependymal giant cell astrocytoma (SEGA).

Afinitor Disperz is a kinase inhibitor that treats people ≥ 2 years of age with TSC-related partial-onset seizures.

Ezogabine Potiga Oral Tablet 50, 200, 300, 400 mg Partial-onset seizures Used in adjunctive treatment for people ≥ 18 years of age who have not responded well to alternative treatments.
Felbamate Felbatol Oral Tablet 400, 600 mg Partial-onset seizures and Lennox-Gastaut Syndrome (LGS) Not supposed to be used for first-line treatment. This is only used for people with severe epilepsy.
Felbamate Felbatol Oral Suspension 600 mg/5 mL Partial-onset seizures and Lennox-Gastaut Syndrome (LGS) Not supposed to be used for first-line treatment. This is only used for people with severe epilepsy.
Fenfluramine Fintelpa Oral Solution 2.2 mg/ml Treatment of seizures associated with Dravet syndrome www.finteplahcp.com/

Indicated in people ≥ 2 years of age.

Gabapentin Neurontin Oral Capsule 100, 300, 400, 600, 800 mg Partial-onset seizures Used in adjunctive therapy for partial-onset seizures in people ≥ 3 years of age with epilepsy.
Gabapentin Neurontin Oral Solution 250 mg/5 mL Partial-onset seizures Used in adjunctive therapy for partial-onset seizures in people ≥ 3 years of age with epilepsy.
Lacosamide Vimpat Oral Tablet 50, 100, 150, 200 mg Partial-Onset seizures www.vimpat.com/

For the treatment of people ≥ 4 years of age.

Lacosamide Vimpat IV Solution 200 mg/20 mL Partial-Onset seizures IV injection is for treatment of people in adult people ≥ 17 year of age.
Lacosamide Vimpat Oral Solution 10 mg/mL Partial-Onset seizures For the treatment of people ≥ 4 years of age.
Lamotrigine Lamictal Oral Tablet 25, 100, 150, 200 mg Epilepsy, Bipolar disorder For epilepsy, used in adjunctive therapy in people ≥ 2 years of age. For epilepsy, it is used in monotherapy in people ≥ 16 years of age.

Limitation in use; Not recommended to treat acute manic or mixed episodes.

Lamotrigine Lamictal CD Oral Tablet, Chewable 2, 5, 25 mg Epilepsy, Bipolar disorder For epilepsy, used in adjunctive therapy in people ≥ 2 years of age. For epilepsy, it is used in monotherapy in people ≥ 16 years of age.
Lamotrigine Lamictal ODT Oral Tablet, Orally Disintegrating 25, 50, 100, 200 mg Epilepsy, Bipolar disorder For epilepsy, used in adjunctive therapy in people ≥ 2 years of age. For epilepsy, it is used in monotherapy in people ≥ 16 years of age.
Lamotrigine Lamictal XR Oral Tablet, Extended Release 25, 50, 100, 200, 250, 300 mg Generalized tonic-clonic seizures, Partial-onset seizures Used in adjunctive therapy for generalized tonic-clonic seizures.

Used in monotherapy for partial-onset seizures.

Treatment for both types of seizures is for people ≥ 13 years of age.

Levetiracetam Keppra Oral Tablet 250 mg, 500 mg, 750 mg, 1000 mg Partial-onset seizures, myoclonic seizures, primary generalized tonic-clonic seizures Treatment of partial-onset seizures for people ≥ 1 year of age.

Used in adjunctive therapy for myoclonic and primary generalized tonic-clonic seizures.

People ≥ 12 years of age treated for myoclonic seizures.

People ≥ 6 years of age with idiopathic generalized epilepsy treated for primary generalized tonic-clonic seizures.

Levetiracetam Keppra Oral Solution 100 mg/mL Partial-onset seizures, myoclonic seizures, primary generalized tonic-clonic seizures Treatment of partial-onset seizures for people ≥ 1 year of age.

Used in adjunctive therapy for myoclonic and primary generalized tonic-clonic seizures.

People ≥ 12 years of age treated for myoclonic seizures.

People ≥ 6 years of age with idiopathic generalized epilepsy treated for primary generalized tonic-clonic seizures.

Levetiracetam Keppra IV Injection 500 mg/5 mL Partial-onset seizures, myoclonic seizures, primary generalized tonic-clonic seizures Keppra IV injection is only used as an alternative treatment option when oral treatment is unavailable.
Levetiracetam Keppra XR Oral Tablets, Extended Release 500, 750 mg Partial-onset seizures Treatment for people ≥ 12 years of age.
Levetiracetam Spritam Oral Tablet, Suspension 250 mg, 500 mg, 750 mg, 1 g Partial-onset seizures, myoclonic seizures, primary generalized tonic-clonic seizures Used in adjunctive therapy for treatment of all people.

People ≥ 4 years of age and weighing more than 44 lbs.

People ≥ 12 years of age treated for myoclonic seizures.

People ≥ 6 years of age with idiopathic generalized epilepsy treated for primary generalized tonic-clonic seizures.

 

Methsuximide Celontin Oral Capsule 300 mg Absence (petit-mal) seizures
Oxcarbazepine Oxtellar XR Oral Tablet, Extended Release 150, 300, 600 mg Partial-onset seizures Treatment for people ≥ 6 years of age.
Oxcarbazepine Trileptal Oral Tablet 150, 300, 600 mg Partial-onset seizures Used in either monotherapy or adjunctive therapy in adults.

Monotherapy for people 4-16 years old.

Adjunctive therapy for people in people 2-16 years old.

Oxcarbazepine Trileptal Oral Suspension 300 mg/5 mL Partial-onset seizures Used in either monotherapy or adjunctive therapy in adults.

Monotherapy for people 4-16 years old.

Adjunctive therapy for people in people 2-16 years old.

Perampanel Fycompa Oral Tablet 2, 4, 6, 8, 10, 12 mg Partial-onset seizures, Primary generalized tonic-clonic seizures www.fycompa.com/

Partial-onset seizures treated in people ≥ 4 years of age.

Used in adjunctive therapy for epilepsy people ≥ 12 years of age with primary generalized tonic-clonic seizures.

Perampanel Fycompa Oral Suspension 0.5 mg/mL Partial-onset seizures, Primary generalized tonic-clonic seizures Partial-onset seizures treated in people ≥ 4 years of age.

Used in adjunctive therapy for epilepsy people ≥ 12 years of age with primary generalized tonic-clonic seizures.

Phenobarbital Oral Elixir 20 mg/5 mL Sedation, Generalized tonic-clonic seizures, status epilepticus, and partial seizures
Phenobarbital Oral Solution 20 mg/5 mL Sedation, Generalized tonic-clonic seizures, status epilepticus, and partial seizures
Phenobarbital Injection Solution 65, 130 mg/mL Sedation, Generalized tonic-clonic seizures, status epilepticus, and partial seizures
Phenobarbital Oral Tablet 15, 16.2, 30,32.4, 60, 64.8, 97.2, 100 mg Sedation, Generalized tonic-clonic seizures, status epilepticus, and partial seizures
Phenytoin Oral Capsule 100, 300 mg Focal (partial) onset seizures and generalized-onset seizures Prevention of seizures after craniotomy.
Phenytoin Injection Solution 50 mg/mL Focal (partial) onset seizures and generalized-onset seizures Prevention of seizures after craniotomy.
Phenytoin Dilantin Oral Capsule 30, 100 mg Focal (partial) onset seizures and generalized-onset seizures Prevention of seizures after craniotomy.
Phenytoin Dilantin Oral Suspension 125 mg/ 5mL Focal (partial) onset seizures and generalized-onset seizures Prevention of seizures after craniotomy.
Phenytoin Phenytek Oral Capsule 200, 300 mg Focal (partial) onset seizures and generalized-onset seizures Prevention of seizures after craniotomy.
Phenytoin Dilantin Infatabs, Phenytoin Infatabs Oral Tablet Chewable 50 mg Focal (partial) onset seizures and generalized-onset seizures Prevention of seizures after craniotomy.
Pregabalin Lyrica Oral Capsule 25, 50, 75, 100, 150, 200, 225, 300 mg Seizures, focal (partial) onset, Fibromyalgia, Neuropathic pain associated with diabetic peripheral neuropathy, Neuropathic pain associated with spinal cord injury, Postherpetic neuralgia Adjunctive therapy in people ≥1 month of age with focal onset (partial-onset) seizures.
Pregabain Lyrica Oral Solution 20 mg/mL Seizures, focal (partial) onset, Fibromyalgia, Neuropathic pain associated with diabetic peripheral neuropathy, Neuropathic pain associated with spinal cord injury, Postherpetic neuralgia Adjunctive therapy in people ≥1 month of age with focal onset (partial-onset) seizures.
Pregabalin Lyrica CR Oral Extended Release Tablet 24 hours 82.5, 165, 330 mg Neuropathic pain associated with diabetic peripheral neuropathy and Postherpetic neuralgi
Primidone Mysoline Oral Tablet 50, 250 mg Seizures As monotherapy or adjunct therapy for the control of generalized tonic-clonic, psychomotor, and focalepileptic seizures; it may control generalized tonic-clonic seizures refractory to other anticonvulsant therapy.
Rufinamide Banzel Oral Suspension 40 mg/mL Lennox-Gastaut syndrome Adjunctive treatment in adults and pediatric people ≥1 year of age.
Rufinamide Banzel Oral Tablet 200, 400 mg Lennox-Gastaut syndrome Adjunctive treatment in adults and pediatric people ≥1 year of age.
Tiagabine Gabitril Oral Tablet 2, 4, 12, 16 mg Partial Seizures Adjunctive therapy in adults and children 12 years and older.
Topiramate Quedexy XR Oral Capsule ER* 24 Hour Sprinkle 25, 50, 100, 150, 200 mg Seizures and Prevention of Migraines Monotherapy or adjunctive therapy in people ≥2 years of age

with focal (partial) onset or primary generalized tonic-clonic seizures or seizures associated with Lennox-Gastaut syndrome.

Topiramate Trokendi XR Oral Capsule ER* 24 Hour 25, 50, 100, 200 mg Seizures and Prevention of Migraines Monotherapy or adjunctive therapy in people ≥6 years of agewith focal (partial) onset or primary generalized tonic-clonic seizures or seizures associated with Lennox-Gastaut syndrome.
Topiramate Topamax Sprinkle Oral Capsule Sprinkle 15, 25 mg Seizures and Prevention of Migraines Monotherapy or adjunctive therapy in people ≥2 years of age with focal (partial) onset or primary generalized tonic-clonic seizures or seizures associated with Lennox-Gastaut syndrome.
Topiramate Topamax Oral Tablet 25, 50, 100, 200 mg Seizures and Prevention of Migraines Monotherapy or adjunctive therapy in people ≥2 years of age with focal (partial) onset or primary generalized tonic-clonic seizures or seizures associated with Lennox-Gastaut syndrome.
Valproate, Divalproex Sodium Depakene Oral Capsule 250 mg Bipolar Disorder, Migraine Prophylaxis Monotherapy and adjunctive therapy for focal onset seizures with impairment of consciousness or awareness (complex partial) and generalized onset nonmotor seizures (absence), and as adjunctive therapy for multiple seizure types.

 

Do not use for pregnant women or women with childbearing potential unless it is essential for treating their condition.

Valproate, Divalproex Sodium Depakote Sprinkles Oral Capsule Delayed Release Sprinkle 125 mg Bipolar Disorder, Migraine Prophylaxis Monotherapy and adjunctive therapy for focal onset seizures with impairment of consciousness or awareness (complex partial) and generalized onset nonmotor seizures (absence), and as adjunctive therapy for multiple seizure types.

Do not use for pregnant women or women with childbearing potential unless it is essential for treating their condition

Valproate, Divalproex Sodium Depacon Intravenous Solution 100 mg/mL Bipolar Disorder, Migraine Prophylaxis Monotherapy and adjunctive therapy for focal onset seizures with impairment of consciousness or awareness (complex partial) and generalized onset nonmotor seizures (absence), and as adjunctive therapy for multiple seizure types.

Do not use for pregnant women or women with childbearing potential unless it is essential for treating their condition.

Valproate, Divalproex Sodium Depakene Oral Solution 250 mg/5 mL Monotherapy and adjunctive therapy for focal onset seizures with impairment of consciousness or awareness (complex partial) and generalized onset nonmotor seizures (absence), and as adjunctive therapy for multiple seizure types. Do not use for pregnant women or women with childbearing potential unless it is essential for treating their condition.
Valproate, Divalproex Sodium Depakote Oral Tablet Delayed Release 125, 250, 500 mg Monotherapy and adjunctive therapy for focal onset seizures with impairment of consciousness or awareness (complex partial) and generalized onset nonmotor seizures (absence), and as adjunctive therapy for multiple seizure types. Do not use for pregnant women or women with childbearing potential unless it is essential for treating their condition.
Valproate, Divalproex Sodium Depakote ER* Oral Tablet Extended Release 24 Hour 250, 500 mg Monotherapy and adjunctive therapy for focal onset seizures with impairment of consciousness or awareness (complex partial) and generalized onset nonmotor seizures (absence), and as adjunctive therapy for multiple seizure types. Do not use for pregnant women or women with childbearing potential unless it is essential for treating their condition.
Vigabatrin Sabril, Vigadrone Oral Packet 500 mg Infantile spasms and Refractory complex partial seizures May cause permanent bilateral concentric visual field loss so treatment’s potential benefits should outweigh the potential risk of vision loss.

Monotherapy for pediatric people 1 month to 2 years of age with infantile spasms.

As adjunctive therapy for adults and pediatric people ≥2 years of age with refractory complex partial seizures who have inadequately responded to several alternative treatments.

Vigabatrin Sabril Oral Tablet 500 mg Infantile spasms and Refractory complex partial seizures Boxed Warning: can cause permanent concentric visual field loss so treatment’s potential benefits should outweigh the potential risk of vision loss.

Monotherapy for pediatric people 1 month to 2 years of age with infantile spasms.

As adjunctive therapy for adults and pediatric people ≥2 years of age with refractory complex partial seizures who have inadequately responded to several alternative treatments.

Zonisamide Zonegran Oral Capsule 25, 100 mg Partial-onset seizures Treatment is used in adjunctive therapy for adolescents ≥16  years of age and adult people with epilepsy.

August 3, 2020. 

*ER and XR means extended-release and IR means immediate-release.

This comprehensive table was created by University of Texas Austin School of Pharmacy second-year students Johana Suh and Shankari Sureshbabu and reviewed by Collin Hovinga, PharmD, MS, FCCP, Director of Research at Dell Children’s Medical Center-PSS and Clinical Associate Professor of Pharmacy at UT Austin School of Pharmacy.