zonisamide


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zonisamide

 [zo-nis´ah-mīd″]
a sulfonamide that acts as an anticonvulsant , used as an adjunct in the treatment of partial seizures in adults; administered orally.

zonisamide

Pharmacologic class: Sulfonamide

Therapeutic class: Anticonvulsant

Pregnancy risk category C

Action

Raises seizure threshold and reduces seizure duration, probably by stabilizing neuronal membranes through action on sodium and calcium channels

Availability

Capsules: 25 mg, 50 mg, 100 mg

Indications and dosages

Adjunctive treatment of partial seizures

Adults and children older than age 16: Initially, 100 mg P.O. daily for 2 weeks, then, if required, increased to 200 mg P.O. daily for at least 2 weeks. May increase in 100-mg increments at 2-week intervals to 300 to 400 mg daily as required. Daily dosage ranges from 100 to 600 mg.

Dosage adjustment

• Hepatic or renal impairment
• Elderly patients

Off-label uses

• Infantile spasms
• Progressive myoclonic epilepsy
• Weight loss

Contraindications

• Hypersensitivity to drug or other sulfonamides

Precautions

Use cautiously in:
• hepatic or renal disease
• pregnant or breastfeeding patients
• children younger than age 16 (safety not established).

Administration

• Give with or without food.

Adverse reactions

CNS: drowsiness, fatigue, agitation, irritability, depression, dizziness, psychomotor slowing, psychosis, asthenia, abnormal gait, incoordination, tremor, ataxia, headache, confusion, impaired memory, hyperesthesia, paresthesia, seizures

EENT: diplopia, amblyopia, nystagmus, tinnitus, rhinitis, pharyngitis

GI: nausea, vomiting, diarrhea, dyspepsia, dry mouth, anorexia, pancreatitis

GU: renal calculi

Hematologic: anemia, leukopenia

Respiratory: cough

Skin: rash, pruritus, bruising, Stevens-Johnson syndrome

Other: abnormal taste, weight loss, allergic reactions, oligohidrosis and hyperthermia (in children), flulike symptoms, accidental injury

Interactions

Drug-drug.Carbamazepine, phenobarbital, phenytoin, valproic acid: decreased zonisamide blood level and effects

CYP450-3A4 inducers: decreased zonisamide half-life

CYP450-3A4 inhibitors: increased zonisamide blood level

Drug-diagnostic tests.Blood urea nitrogen, creatine kinase, creatinine: increased levels

Platelets, white blood cells: decreased counts

Patient monitoring

• Monitor CBC with white cell differential.
• Assess neurologic status; report significant adverse reactions.
• Monitor renal function tests. Watch for signs and symptoms of renal calculi.

Monitor for rash, which may be first sign of Stevens-Johnson syndrome. If rash occurs, discontinue drug and notify prescriber immediately.

Patient teaching

• Explain therapy to patient. Instruct him to keep seizure diary and show it to prescriber.
• Instruct patient to swallow capsules whole. Advise him to drink 6 to 8 glasses of water daily to help prevent kidney stones.

Warn patient that stopping drug abruptly may cause status epilepticus.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects him and until seizures are well controlled.

Tell patient to immediately report rash, fever, sore throat, sudden back pain, depression, speech or language problems, or painful urination.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

zonisamide

/zo·nis·am·ide/ (zo-nis´ah-mīd″) a sulfonamide that acts as an anticonvulsant, used in the treatment of partial seizures in adults.

zonisamide

[zo-nis′ah-mīd′]
a sulfonamide that acts as an anticonvulsant, used as an adjunct in the treatment of partial seizures in adults. It is administered orally.
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She was prescribed ziprasidone 60mg twice daily, duloxetine 90mg daily, oxcarbazepine 900mg twice daily, and zonisamide 200mg twice daily by her outpatient providers.
Medications were started during inpatient hospitalization in two-thirds of patients, with 33% starting on corticotropin; 29% on topiramate; and fewer than 10% of patients on an oral or intravenous steroid, zonisamide, or vigabatrin (Sabril).
Amitriptyline* Elavil Bupropion * Wellbutrin, Zyban Clomipramine* Anafranil Desipramine* Norpramin Exenatide* Byetta, Bydureon Imipramine* Tofranil Levomilnacipran * Fetzima Liraglutide * Victoza, Saxenda Lorcaserin * Belviq Metformin * Glucophage Methylphenidate * Ritalin, Methylin Mirtazapine* Remeron Naltrexone/bupropion * Contrave Nefazodone * Serzone Nortriptyline* Pamelor Olanzapine* Zyprexa Orlistat* Xenical Paroxetine * Paxil Phentermine/topiramate * Qsymia Pramlintide* Symlin Protriptyline* Vivactil Quetiapine* Seroquel Trazodone * Desyrel, Oleptro Vilazodone* Viibryd Vortioxetine * Trintellix Zonisamide * Zonegran
16-19] So, depending on the seizure type, other antiepileptic drugs can be used, which do not cause this fatal reaction such as valproic acid, topiramate, levetiracetam, and zonisamide.
3% of patients for whom it was prescribed, zonisamide for 50%, a corticosteroid for 31.
Empatic is the combination drug of zonisamide and bupropion.
Another AED, zonisamide, produces other cognitive deficits, such as impairment of communication skills and recall of visual-graphic task stimuli, and may cause sleepiness in patients with partial seizures (Berent et al.
Its products include protease inhibitors, levetiracetam assay, topiramate assay, non-nucleoside reverse transcriptase inhibitors, gabapentin assay, lamotrigine assay, zonisamide assay, methotrexate assay, thyroxine assay, and entry inhibitor.
8) In placebo-controlled trials in adult patients with partial onset seizures receiving adjunctive levetiracetam, there was no evidence of PK drug interactions between levetiracetam and carbamazepine, clobazam, clonazepam, diazepam, gabapentin, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, topiramate, valproic acid, vigabatrin, or zonisamide.
Zonisamide or levetiracetam for adults with cyclic vomiting syndrome: a case series.
The data used in the application was from a double-blind, randomized, multicenter, placebo-controlled, pivotal Phase III study (Study 312) that evaluated adjunctive zonisamide in 207 pediatric patients (6 to 17 years) with partial seizures who had received one or two AEDs.