Dawaa Reference

chronic

Epilepsy (continuing therapy)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Egyptian National Drug Formulary - Nervous System Disorders 2025, carbamazepine monograph (chapter PDF p27) · Egyptian National Drug Formulary - Nervous System Disorders 2025, lamotrigine monograph (chapter PDF p40) · Egyptian National Drug Formulary - Nervous System Disorders 2025, levetiracetam monograph (chapter PDF p63) · Egyptian National Drug Formulary - Nervous System Disorders 2025, valproic acid monograph (chapter PDF p83) · Lovik K, Murr NI. Seizure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last update February 7, 2023.

Verified against5 documents
  • Egyptian National Drug Formulary - Nervous System Disorders 2025, carbamazepine monograph (chapter PDF p27)
  • Egyptian National Drug Formulary - Nervous System Disorders 2025, lamotrigine monograph (chapter PDF p40)
  • Egyptian National Drug Formulary - Nervous System Disorders 2025, levetiracetam monograph (chapter PDF p63)
  • Egyptian National Drug Formulary - Nervous System Disorders 2025, valproic acid monograph (chapter PDF p83)
  • Lovik K, Murr NI. Seizure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last update February 7, 2023.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (11)

  • The usual description of a convulsive attack is abrupt loss of awareness with movement
  • A generalised motor attack stiffens first, then breaks into rhythmic jerking
  • There may be a noise or a cry as it begins
  • Some patients feel a warning or aura beforehand
  • Wetting may or may not happen, so its absence proves nothing [urinary incontinence]
  • When the tongue is bitten it is usually bitten at the side
  • Afterwards there is a spell of altered awareness, the postictal state
  • Any brief change in awareness, odd behaviour or strange perception may equally be a seizure [seizures]
  • A seizure with dyscognitive features - the complex partial one - alters awareness, may show no more than lip-smacking or small movements of a limb, and can arrive as an isolated confusional state [confusion · seizures]
  • A partial seizure starts in one area of the cortex and can show simple motor or sensory phenomena before it spreads to the rest; a generalised one starts across the cortex at once [seizures]
  • In adults the commonest type by far is a partial-onset seizure that generalises quickly [seizures]

Signs — what you find (4)

  • A witness may describe open eyes, no reaction to voice or pain, and rhythmic movements in step
  • Examine generally and neurologically, hunting for a focal deficit
  • Red flag for ongoing status: consciousness that stays altered after a suspected seizure [seizures]
  • That subtle form may show only flickering eyes, facial twitching, limb twitches, or no movement at all

Tests (12)

  • First ask the carer whether the event was a seizure at all, or some other passing episode
  • Once it is a seizure, the next question is whether something provoked it
  • What happened in the lead-up matters, and friends, family or workmates may hold that history
  • In known epilepsy, ask straight away whether medication has been taken irregularly
  • Ask about alcohol and illicit drugs, and about immunosuppression or cancer
  • Ask about unresponsive spells in the past, which in hindsight may have been seizures
  • Bloods including electrolytes are usually sent
  • Lumbar puncture where there is fever, immunosuppression, or anything else pointing to brain infection
  • Brain imaging yields most when the history or a focal neurological finding points that way
  • Image for head injury, cancer, low immunity, fever, ongoing headache, anticoagulants, age over 40, or focal onset
  • After a first seizure in a healthy adult back to normal: check blood glucose and sodium, and a pregnancy test where relevant
  • EEG is the marker: focal or generalised epileptiform discharges are its hallmark

If not this — what else fits (8)

  • Fainting is the key distinction; both start abruptly
  • A faint usually has a trigger, the blackout is short, and awareness returns at once without confusion
  • Wetting happens in either, so it does not tell them apart
  • A faint can be accompanied by movements that look like a fit
  • Psychogenic non-epileptic seizures
  • Convulsion at the moment of a head impact
  • A movement disorder, or movements arising out of sleep
  • Rigors, convulsive concussion, convulsive syncope and sleep-related events all belong on the differential of a transient event with movements

SourceStatPearls "Seizure" - disease-level clinical article

Presentation findings are traced to the source above.

1

LEVETIRACETAM

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

16 years and older: 250-500 mg twice daily, increased by 250-500 mg twice daily at 2-week intervals to a recommended 1500 mg twice daily - Long term, specialist-directed

Paediatric dose

(Age-banded, so no weight card is drawn - the bands differ and a single mg/kg figure would contradict them. The formulary doses PER DOSE, twice daily. 4 to 16 years: 10 mg/kg twice daily, increased every 2 weeks to 30 mg/kg twice daily. 6 months to under 4 years: 10 mg/kg twice daily up to 25 mg/kg twice daily. 1 to under 6 months: 7 mg/kg twice daily up to 21 mg/kg twice daily.)

Dose by age
1 to under 6 months:7 mg/kg twice daily, up to 21 mg/kg twice daily
6 months to under 4 years:10 mg/kg twice daily, up to 25 mg/kg twice daily
4 to under 16 years:10 mg/kg twice daily, increased every 2 weeks to 30 mg/kg twice daily
Choice

Alternatives. Levetiracetam is broad-spectrum, has few interactions, and is the option of first choice in a woman who might become pregnant - carbamazepine is not.

Dose source

Egyptian National Drug Formulary - Nervous System Disorders 2025, levetiracetam monograph (chapter PDF p63)

Why

Broad spectrum, few interactions, and the option of first choice in a woman who might become pregnant. The formulary gives it as monotherapy for partial-onset seizures from one month of age.

Cautions
  • Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits.
  • Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus.
  • Behavioural change, irritability and low mood are the common reason it is stopped; ask about them.
Egyptian brands
Egyptian brandManufacturerIndicative price
KEPILEPSY 500MG 10 F.C.TAB.CHEMIPHARM34.00 EGP (3.40/unit)
LEVNOSEIZ 500 MG 30 F.C.TABS.GYPTO PHARMA120.00 EGP (4.00/unit)
TRINOVUME 500MG 10 F.C. TABS.SIGMA > HOCHSTER PHARMACEUTICAL INDUSTRIES40.00 EGP (4.00/unit)
SUNSEIZ 500 MG 30 F.C.TABS.SUN PHARMA EGYPT LIMITED171.00 EGP (5.70/unit)
LIPTITAM XR 500 MG 20 F.C.TABS.ORGANOPHARMA > ORGANO148.00 EGP (7.40/unit)
TIRATAM 500 MG 30 F.C.TABS.ANDALOUS PHARMA222.00 EGP (7.40/unit)
SPRIALYPSY 500 MG 30 ORAL DISINTEGRATING TABS.MASH PREMIERE > SAS PHARMA138.00 EGP
KEPRADIL XR 500MG 30 EXTENDED F.C. TABS.HIKMA PHARMA201.00 EGP
KEPILEPSY 10GM/100ML ORAL SOLN. 120 ML? strength differs? different route - not oral solidCHEMIPHARM48.00 EGP
LEVEPEX 100MG/ML SYRUP 100ML? strength differs? different route - not oral solidAPEX PHARMA50.00 EGP
2

CARBAMAZEPINE

1st line

Strength200 mg

Formoral.solid

Adult dose and duration

Initial 100-200 mg once or twice daily, increased gradually at weekly intervals to the optimal response - Long term, specialist-directed

Paediatric dose

Paediatric dosing is specialist-set and is not reproduced here. The formulary's own instruction is a low starting dose with gradual increase to suit the patient.

Dose source

Egyptian National Drug Formulary - Nervous System Disorders 2025, carbamazepine monograph (chapter PDF p27)

Why

The formulary indicates it for partial seizures with complex symptomatology and for generalized tonic-clonic seizures.

Cautions
  • Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits.
  • The formulary states it is NOT for absence seizures or myoclonic seizures - it can make both worse.
  • A strong enzyme inducer: it lowers the effect of combined oral contraceptives, warfarin and many other drugs.
  • Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus.
Egyptian brands
Egyptian brandManufacturerIndicative price
CARBAMAZEPIN 200MG 10 TAB.U.S.P.33SEDICO3.00 EGP (0.30/unit)
CARBAMAZEPINE 200MG XR 10 TAB.SIGMA4.00 EGP (0.40/unit)
TONOCLONE 200MG 30 TAB.UP PHARMA13.50 EGP (0.45/unit)
CARBATOL 200 MG 20 TABS.AMOUN37.00 EGP (1.85/unit)
MAZEMAL 200 MG 20 TABS.UNIPHARMA52.00 EGP (2.60/unit)
CARBAPEX 200 MG CR 30 TABS.MULTI-APEX81.00 EGP (2.70/unit)
TEGRETOL CR 200MG 20 F.C. DIVITAB.NOVARTIS61.00 EGP
TEGRAL 200 MG 50 SCORED TABS.CID140.00 EGP
ALEXTOL 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidALEXANDRIA7.50 EGP
ARBATEG 2% SUSP. 100 ML? strength differs? different route - not oral solidMEDIZEN PHARMACEUTICAL INDUSTRIES35.00 EGP
3

LAMOTRIGINE

2nd line

Strength50 mg

Formoral.solid

Adult dose and duration

13 years and older, monotherapy: 25 mg once daily for 2 weeks, then 50 mg once daily for 2 weeks, then a usual maintenance of 100-200 mg daily. Maximum 500 mg daily - Long term, specialist-directed

Paediatric dose

Adjunctive from 2 years, monotherapy from 13, and the titration differs by what else the child is taking. Specialist-set; not reproduced here.

Dose source

Egyptian National Drug Formulary - Nervous System Disorders 2025, lamotrigine monograph (chapter PDF p40)

Why

The formulary gives it for partial and generalized seizures including tonic-clonic, as monotherapy from 13 years.

Cautions
  • Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits.
  • The slow titration is not optional - it is what prevents Stevens-Johnson syndrome. Any new rash means stop and seek advice the same day.
  • With valproate the starting dose HALVES to 12.5 mg/day (25 mg on alternate days); valproate raises lamotrigine levels.
  • Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus.
Egyptian brands
Egyptian brandManufacturerIndicative price
LAMOTROTIC 50 MG 30 TAB.ARAB DRUG COMPANY (ADCO)27.60 EGP (0.92/unit)
LABILENO 50MG 30 TAB.SEDICO31.50 EGP (1.05/unit)
CONTROLEPSY 50MG 30 TAB.GLOBAL NAPI PHARMACEUTICALS78.00 EGP (2.60/unit)
LAMOTRINE 50MG 30 TAB.MULTI-APEX78.00 EGP (2.60/unit)
LAMICTAL 50MG 30 TAB.GLAXO SMITHKLINE143.00 EGP (4.77/unit)
SUNLAMOTRI 50 MG 30 DISP./CHEW. TABS.SUN PHARMACEUTICAL INDUSTRIES LTD.93.00 EGP
4

VALPROIC ACID

3rd line

Strength500 mg

Formoral.solid

Adult dose and duration

Initial 600 mg daily (10-15 mg/kg/day), increased by 5-10 mg/kg at weekly intervals. Maintenance 1000-2000 mg daily, up to 2500 mg. Maximum 60 mg/kg/day - Long term, specialist-directed

Paediatric dose

10-15 mg/kg/day

(The formulary doses this PER DAY, not per dose. Initial 10-15 mg/kg/day, or 400 mg daily for a child. Maintenance 20-30 mg/kg/day. Maximum 60 mg/kg/day - the formulary gives no absolute mg ceiling for children. Any total daily dose above 250 mg must be split into 2-4 doses. Children under 2 years are at higher risk of fatal liver injury.)

Dose by weight
3kg30-45 mg/day
4kg40-60 mg/day
5kg50-75 mg/day
6kg60-90 mg/day
7kg70-105 mg/day
8kg80-120 mg/day
9kg90-135 mg/day
10kg100-150 mg/day
11kg110-165 mg/day
12kg120-180 mg/day
13kg130-195 mg/day
14kg140-210 mg/day
15kg150-225 mg/day
16kg160-240 mg/day
17kg170-255 mg/day
18kg180-270 mg/day
19kg190-285 mg/day
20kg200-300 mg/day
21kg210-315 mg/day
22kg220-330 mg/day
23kg230-345 mg/day
24kg240-360 mg/day
25kg250-375 mg/day
26kg260-390 mg/day
27kg270-405 mg/day
28kg280-420 mg/day
29kg290-435 mg/day
30kg300-450 mg/day
31kg310-465 mg/day
32kg320-480 mg/day
33kg330-495 mg/day
34kg340-510 mg/day
35kg350-525 mg/day
36kg360-540 mg/day
37kg370-555 mg/day
38kg380-570 mg/day
39kg390-585 mg/day
40kg400-600 mg/day
41kg410-615 mg/day
42kg420-630 mg/day
43kg430-645 mg/day
44kg440-660 mg/day
45kg450-675 mg/day
46kg460-690 mg/day
47kg470-705 mg/day
48kg480-720 mg/day
49kg490-735 mg/day
50kg500-750 mg/day
Dose source

Egyptian National Drug Formulary - Nervous System Disorders 2025, valproic acid monograph (chapter PDF p83)

Why

The formulary indicates it for generalized, partial and other epilepsy. It is ranked below the others here for one reason only: the formulary lists Pregnancy among its contraindications, and this is an entry read while repeating a prescription.

Cautions
  • If the response is inadequate, measure plasma valproate level; acceptable range 50-100 mcg/ml.
  • Contraindicated in pregnancy, active liver disease, and personal or family history of severe hepatic dysfunction.
  • CONTRAINDICATED IN PREGNANCY (Egyptian National Drug Formulary). It causes neural tube defects and developmental disorders.
  • Before prescribing to anyone who could become pregnant: check pregnancy status and ensure reliable contraception - the formulary requires both.
  • In a woman of childbearing potential, levetiracetam or lamotrigine are the alternatives to discuss with the neurologist.
  • Diagnosis and the choice of drug are the neurologist's. This entry is for continuing therapy already started, and for the questions that arise between visits.
  • Also contraindicated in active liver disease, a family history of severe hepatic dysfunction, porphyria and urea cycle disorders.
  • Children under 2 years are at higher risk of fatal hepatotoxicity.
  • Never stop an antiepileptic abruptly - withdrawal can precipitate status epilepticus.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAVIKEN 500MG SR 30 F.C.TAB.AMOUN42.00 EGP (1.40/unit)
VALPROEX CR 500 MG 30 F.C.TABS.MUP48.00 EGP (1.60/unit)
DEPACOM 500MG 30 EXTENDED RELEASE F.C.TAB.CHEMIPHARM > GENESIS PHARMACEUTICALS-EGYPT36.00 EGP
MENTAVERS 250MG/5ML SYRUP 100ML? strength differs? different route - not oral solidSIGMA10.50 EGP
XOPLICT 250MG/5ML SYRUP 100ML? strength differs? different route - not oral solidMEDIZEN PHARMACEUTICAL INDUSTRIES12.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.