Monotherapy Adult & adolescent ≥16 yr Initially 250 mg bid, increased to 500 mg bid after 2 wk. May further increase by 250 mg bid every 2 wk. Max dose: 1,500 mg bid.
Add-on therapy Adult (≥18 yr) & adolescent (12-17 yr) weighing ≥50 kg Initially 500 mg bid on 1st day. May be increased up to 1,500 mg bid in 500-mg increments bid every 2-4 wk.
Childn ≥6 yr Initially 10 mg/kg bid. May be increased to 30 mg/kg bid in increments or decrements of 10 mg/kg bid every 2 wk.
Childn weighing ≥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 bid. Max: 600 mg bid,
15 kg Initially 150 mg bid. Max: 450 mg bid.
Renal impairment in adult & adolescent weighing >50 kg: mild (CrCl 50-79 mL/min) 500-1,000 mg bid,
moderate (CrCl 30-48 mL/min) 250-750 mg bid,
severe (CrCl <30 mL/min) 250-500 mg bid,
ESRD patients undergoing dialysis Loading dose: 750 mg on 1st day of treatment. 500-1,000 mg once daily following dialysis, w/ 250-500 mg supplemental dose.
Renal impairment in adult & adolescent weighing <50 kg: mild (CrCl 50-79 mL/min) 10-20 mg/kg bid,
moderate (CrCl 30-48 mL/min) 5-15 mg/kg bid,
severe (CrCl <30 mL/min) 5-10 mg/kg bid,
ESRD patients undergoing dialysis Loading dose: 15 mg/kg on 1st day of treatment. 10-20 mg/kg once daily following dialysis, w/ 5-10 mg/kg supplemental dose.
Severe hepatic impairment (CrCl <60 mL/min/1.73 m2 50% reduction of daily maintenance dose.
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