What is the recommended dosage for Quilipta (eslicarbazepine) in treating epilepsy?

Recommended Dosage for Quilipta (Eslicarbazepine) in Treating Epilepsy

For adult patients with epilepsy, the recommended initial dosage of Quilipta (eslicarbazepine acetate) is 400 mg once daily, with weekly increases of 400-600 mg to a maintenance dosage of 800-1600 mg once daily based on clinical response and tolerability. 1

Adult Dosing Protocol

• Initial dosage: 400 mg orally once daily 1
• For some patients, treatment may be initiated at 800 mg once daily if the need for seizure reduction outweighs increased risk of adverse reactions 1
• Titration: Increase dose in weekly increments of 400-600 mg based on clinical response and tolerability 1
• Maintenance dosage: 800-1600 mg once daily 1
• For monotherapy: 800 mg daily maintenance dose should be considered in patients unable to tolerate 1200 mg daily 1
• For adjunctive therapy: 1600 mg daily dose should be considered in patients who don't achieve satisfactory response with 1200 mg daily 1

Pediatric Dosing (Ages 4-17)

• Dosing is weight-based and administered once daily 1
• For children >38 kg: Initial dose 400 mg/day, maintenance 800-1200 mg/day 1
• For children 32-38 kg: Initial dose 300 mg/day, maintenance 600-900 mg/day 1
• For children 22-31 kg: Initial dose 300 mg/day, maintenance 500-800 mg/day 1
• For children 11-21 kg: Initial dose 200 mg/day, maintenance 400-600 mg/day 1

Special Populations

• Patients with moderate to severe renal impairment (creatinine clearance <50 mL/min): Reduce initial, titration, and maintenance doses by 50% 1
• Patients with mild to moderate hepatic impairment: No dose adjustment required 1
• Patients with severe hepatic impairment: Not recommended due to insufficient data 1

Administration Guidelines

• Eslicarbazepine can be taken with or without food 1
• Tablets can be administered either whole or crushed 1
• When discontinuing treatment, reduce dosage gradually to minimize risk of increased seizure frequency 1

Drug Interactions

• When taken with carbamazepine, dose adjustments may be needed due to reduced plasma concentration of eslicarbazepine 1
• Higher doses may be needed when taken with enzyme-inducing AEDs (phenobarbital, phenytoin, primidone) 1
• Should not be taken with oxcarbazepine 1

Efficacy and Safety Considerations

• Clinical trials have shown that eslicarbazepine at 800 mg and 1200 mg daily doses significantly reduces seizure frequency in adults with drug-resistant partial-onset seizures 2
• Median relative reduction in standardized seizure frequency was 33.4% and 37.8% in the 800 mg and 1200 mg daily dose groups, respectively 2
• Responder rates (≥50% reduction in seizure frequency) were 33.8% and 43.1% for 800 mg and 1200 mg daily doses, respectively 2
• Long-term studies have shown sustained therapeutic effect with median seizure frequency reductions of 48-56% after the first 4 weeks of treatment 3
• Quality of life measures have shown significant improvement with long-term eslicarbazepine treatment 4, 3

Common Adverse Effects

• Most common adverse events include dizziness, somnolence, headache, and nausea 2, 5
• Adverse events are generally mild to moderate in intensity 2, 6
• Incidence of treatment-emergent adverse events increases with higher dosages (63.8% at 400 mg, 67.0% at 800 mg, 73.1% at 1200 mg) 2
• Starting treatment at 400 mg/day with 400 mg increments every 7-14 days provides optimal balance of efficacy and tolerability 2

Clinical Pearls

• Once-daily dosing may improve medication adherence compared to multiple daily dosing regimens 5
• Eslicarbazepine has a half-life of 20-24 hours, making it suitable for once-daily administration 5
• Hyponatremia has been observed (0.6%-1.3%), but incidence appears lower than with oxcarbazepine 6
• For patients converting to eslicarbazepine monotherapy, median reduction in seizure frequency can reach 78.3% 4