(FDA approved in bold)

• Complex partial seizures with or without secondary generalization (adults and children), monotherapy (ages 4 and up) and adjunctive(ages 2 and up)
  
• Generalized tonic-clonic seizures
  
• Mixed seizure patterns
  
• Trigeminal neuralgia
  
• Temporal lobe epilepsy (children and adults)
  
• Neuropathic pain
  
• Alcohol withdrawal
  
• Bipolar I Disorder (acute manic and mixed episodes)

• Inhibits voltage-dependent sodium channel conductance
  
• Modulates calcium channels, potassium conductance, glutamate release and NMDA receptors

• Seizures –2 weeks or less
  
• Trigeminal neuralgia or neuropathic pain – hours to weeks

• Seizures – goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy
  
• Trigeminal neuralgia – should dramatically reduce or eliminate attacks. Periodically attempt to reduce to lowest effective dose or discontinue

• Increase to highest tolerated dose
  
• Epilepsy: consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind
  
• Trigeminal neuralgia: Try an alternative agent. For truly refractory patients referral to tertiary headache center, consider surgical or other procedures

• Epilepsy: drug interactions can complicate multi-drug therapy
  
• Pain: Can combine with other AEDs (gabapentin or pregabalin) or tricyclic antidepressants

• Check sodium levels for symptoms of hyponatremia or in patients susceptible to hyponatremia