Drug Healthy elderly patients Elderly patients with multiple medical problems
Carbamazepine Good Avoid in cardiac or renal disease
Felbamate Too risky for routine use Use caution
Gabapentin Good Very good
Lamotrigine Good Good
Levetiracetam Good Very good
Oxcarbazepine Good Avoid with diuretic use
Phenytoin Good Good, except avoid with use of protein-bound drugs
Phenobarbital Too sedating Too sedating
Valproate Good Avoid in Parkinson's disease
Tiagabine Good Good
Topiramate Good Good, but check cognition
Zonisamide Good Good

Adapted from: Leppik IE and Cloyd JC. Epilepsy in the elderly. In: Levy RH, Mattson RH, Meldrum BS, and Perucca E (eds). Antiepileptic drugs, ed. 5. Philadelphia: Lippincott Williams & Wilkins; 2002:150.

Authored By: 
Ilo E. Leppik MD
James C Cloyd PharmD