For Anti-Epileptic Drug Dosing in Renal Dysfunction and Dialysis, use the highest-yield facts to drive concrete treatment decisions. Pay particular attention to Topiramate: requires ~50% dose reduction; 70% renally cleared, Ethosuximide/phenobarbital: ~30% renally excreted; extend dosing interval, and Phenytoin: not removed by hemodialysis; supportive treatment for overdose when choosing therapy, counseling about risk, planning monitoring, and deciding when closer follow-up or escalation is needed.

Topiramate: requires ~50% dose reduction; 70% renally clearedEthosuximide/phenobarbital: ~30% renally excreted; extend dosing intervalPhenytoin: not removed by hemodialysis; supportive treatment for overdoseUremia reduces protein binding → higher "free" drug fraction → toxicity at therapeutic total levelsLamotrigine: 60% protein-bound; hemodialysis significantly drops plasma levels