Monotherapy Adult & adolescent from 16 yr Initially 250 mg bid, increased to 500 mg bid after 2 wk. May be further increased by 250 mg bid every 2 wk. Max: 1,500 mg bid.
Add-on therapy Adult ≥18 yr, adolescent 12-17 yr weighing ≥50 kg Initially 500 mg bid. May be increased up to 1,500 mg bid. Dose changes can be made in 500 mg bid increases or decreases every 2-4 wk.
Childn 4-11 yr & adolescent 12-17 yr weighing <50 kg Initially 10 mg/kg bid. May be further increased up to 30 mg/kg bid. Dose changes should not exceed increments or decrements of 10 mg/kg bid every 2 wk. Dose recommendations:
Childn & adolescent weighing from 50 kg Initially 500 mg bid. Max: 1,500 mg bid,
25 kg Initially 250 mg bid. Max: 750 mg bid,
20 kg Initially 200 mg (2 mL) bid. Max: 600 mg (6 mL) bid,
15 kg Initially 150 mg (1.5 mL) bid. Max: 450 mg (4.5 mL) bid. Dose adjustment:
Renal impairment: Adult & adolescent weighing >50 kg: Normal >80 mL/min/1.73 m2 500-1,500 mg bid;
mild 50-79 mL/min/1.73 m2 500-1,000 bid;
moderate 30-49 mL/min/1.73 m2 250-750 mg bid;
severe <30 mL/min/1.73 m2 250-500 mg bid;
ESRD patients undergoing dialysis Loading dose: 750 mg on 1st day. 500-1,000 mg once daily. Supplemental dose of 250-500 mg is recommended following dialysis.
Childn & adolescent weighing <50 kg: Normal >80 mL/min/1.73 m2 10-30 mg/kg (0.1-0.3 mL/kg) bid;
mild 50-79 mL/min/1.73 m2 10-20 mg/kg (0.1-0.2 mL/kg) bid;
moderate 30-49 mL/min/1.73 m2 5-15 mg/kg (0.05-0.15 mL/kg) bid;
severe <30 mL/min/1.73 m2 5-10 mg/kg (0.05-0.1 mL/kg) bid;
ESRD patients undergoing dialysis 10-20 mg/kg (0.1-0.2 mL/kg) once daily.
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