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Serotonergic antiseizure agent

Fenfluramine

Brand names: Fintepla

Adult dose

Dose: Initial 0.1mg/kg BD, titrate weekly to max 0.7mg/kg/day (without stiripentol) or 0.4mg/kg/day (with stiripentol). Total max 26mg/day
Route: PO
Frequency: BD

Paediatric dose

Dose: 0.1 mg/kg
Route: PO
Frequency: BD
Max: 26mg/day
Specialist titration; Dravet/Lennox-Gastaut
Paediatric weight-based calculator

Specialist titration; Dravet/Lennox-Gastaut

Clinical pearls

  • Dravet and Lennox-Gastaut syndrome seizures (specialist epilepsy)
  • Echocardiogram before treatment, every 6 months on therapy, and 3–6 months after stopping

Contraindications

  • Aortic/mitral valve disease
  • Pulmonary hypertension
  • Concurrent MAOI
  • Pregnancy
  • Recent (≤14 days) MAOI

Side effects

  • Cardiac valvulopathy
  • Pulmonary hypertension
  • Decreased appetite
  • Somnolence
  • Diarrhoea

Interactions

  • MAOIs (avoid; serotonin syndrome)
  • Stiripentol (raises levels — dose adjustment)
  • Other serotonergic agents

Monitoring

  • Echocardiogram
  • Behaviour/mood
  • Weight

Reference: BNFc; BNF; NICE TA808; MHRA; SmPC; https://bnf.nice.org.uk/drugs/fenfluramine/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways