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  • Q&A with Australian Health Practitioners

    What is the maximum dose per day for Keppra and Zonegram?

    I take Lamictal 300 mg's, Keppra 4 grams and Zonegan 400mgs per day. I am 66 years of age. I worry about the dose not being enough as approximately every 6 months my seizures return (tonic clonics or complex partials) I increase the Zonegram 50mg's. Should I be reducing the keppra or the lamictal as I increased the Zonegram? I feel this has been the successful tablet.
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  • Established in 1952, Epilepsy Action Australia provides education and support for people with epilepsy, their families and community, and professional groups. These services promote self-management … View Profile

    Thank you for your question.
    There is no one size fits all answer for this question because medication doses can vary considerably depending on many individual factors including; other medications being taken, age, other health conditions (particularly liver and kidney function) and type of epilepsy.
    In many people taking more than one anti-epileptic drug, adding a third drug often only slightly improves seizure control if at all. If anything it tends to increase the likelihood of side effects, drug interactions, compliance, and costs and sometimes even worsens seizure control. Everyone has different responses so it's often a case by case situation for the doctor.
    As you know your body and it's reactions better than anyone, if you feel the Zonegram is the successful tablet, then it would be wise to continue with this at a dose that gives you optimum seizure control. Considering that your seizures are currently not fully controlled, you may want to review taking three medications for your epilepsy with your neurologist.
    Below we have added the recommended Adult dosage for the above medications. Please bear in mind this is the recommended dose for adults with no impairments or other health disorders. Dosage would be much lower in some circumstances. Also, some people respond well to medication and may not need as high a dose that is recommended. The doctor is often guided by seizure control rather than doses or blood levels.
    Your pharmacist or Medicines Line Australia ( or 1300 MEDICINE)  should also be able to provide this information.
    Lamictal (Lamotrigine):
    100mg - 200mg if taken alone or with sodium valproate.
    200mg - 400mg if taken with phenytoin, phenobarbitone, or carbamazepine.
    Taken in 1 or 2 doses a day.
    Keppra (Levetiracetam):
    1000mg - 3000mg divided into 2 doses a day.
    Zonegram (Zonisamide):
    300mg - 500mg divided into 1 or 2 doses a day

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