Table 3.

Summary of Drug Specific Alterations to General Titration Methods. Antiepileptic Drugs (AEDs) are listed alphabetically. The SPECTRA Panel reached consensus for modification of the usual general titration schemes for each drug in certain situations, and recommended faster or slower tapering, by larger or smaller dose decrements, in the situations listed in each column for each individual AED. CBZ, carbamazepine; FBM, felbamate; GBP, gabapentin; LEV, levetiracetam; LTG, lamotrigine; OXC, oxcarbazepine; PB, phenobarbital; PHT, phenytoin; TGB, tiagabine; TPM, topiramate; VPA, valproate; ZNS, zonisamide. (reproduced and modified with kind permission from Elsevier, Inc. St. Louis et al; Conversions between monotherapies in epilepsy: expert consensus. Epilepsy and Behavior 2007; 11: 226).

AED	Faster Titration	Slower Titration	Larger Dose Increments	Smaller Dose Increments
1. CBZ	Inadequate seizure control Conversion from OXC	Elderly patient Impaired liver function Mild adverse effects Converting from FBM	Inadequate seizure control	Elderly patient
2. FBMa		Mild adverse effects	Inadequate seizure control	Impaired liver function
3. GBP	Inadequate seizure control	Elderly patient Renal insufficiency Mild adverse effects	Inadequate seizure control
4. LTGb		Mild adverse effects Converting to VPAc	Inadequate seizure control	Impaired liver function
5. LEV	Inadequate seizure control	Elderly patient Renal insufficiency Mild adverse effects	Inadequate seizure control	Elderly patient
6. OXC	Converting from CBZ Inadequate seizure control	Impaired liver function	Inadequate seizure control Converting from CBZ	Impaired liver function
7. PBd
8. PHTe
9. TGB	Inadequate seizure control	Elderly patient Impaired liver function Mild adverse effects	Inadequate seizure control	Impaired liver function Elderly patient
10. TPM	Inadequate seizure control	Renal insufficiency	Inadequate seizure control	Elderly patient Renal insufficiency
11. VPA		Elderly patient Mild adverse effectsf	Inadequate seizure control	Elderly patient
12. ZNS	Inadequate seizure control	Elderly patient	Inadequate seizure control	Elderly patient

Note: All references to package insert refer to US packaging: international clinicians are encouraged to consult packaging information and recommended prescribing practices in their own countries, which may vary substantially from US standards.

^aFBM should not be used by a nonepileptologist: should not be used in elderly patients: and should not be used in patients with impaired liver function.

^bShould refer to package insert when converting from PHT.

^cShould refer to package insert when converting from VPA.

^dTitration with PB is not encouraged (the SPECTRA panel decided not to provide specific recommendations regarding phenobarbital, reflecting a general discouragement for use of phenobarbital in modern epilepsy treatment).

^eNo alterations to the general titration method are recommended.

^fAdverse events are final dose related, not titration related.