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

Zonegran

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.

References in periodicals archive ?
Pharmacokinetics and safety of zonisamide after oral administration of single and multiple doses to Hispaniolan Amazon parrots (Amazona ventralis).
Eisai's medicines in Europe include Aricept[R] (donepezil hydrochloride) used in the treatment of Alzheimer's disease, Pariet[R] (rabeprazole sodium) a proton pump inhibitor (PPI) used in the treatment of gastro-intestinal disorders, Zonegran[R] (zonisamide) for the treatment of epilepsy, Inovelon[R] (rufinamide) for Lennox Gastaut Syndrome, NeuroBloc[R] (botulinum toxin type B) for cervical dystonia and Prialt[R] (ziconotide) for severe, chronic pain.
Dogs on phenobarbital will need monitoring of liver values, and if indications of hepatic damage occur, may be switched to a newer anti-seizure medication such as Keppra or zonisamide.
A small study published in the February 2018 issue of Neurology suggested that combining levodopa with the anti-seizure medication zonisamide (Zonegran) may effectively treat LBD movement symptoms without causing additional psychiatric symptoms.
Within the class, the medications with the highest risk were zonisamide, rufinamide, and clorazepate, which had about 70-, 60-, and 56-fold higher odds for SJS and TEN, compared with all other medications.
Valproic acid (VPA) is typically the first pharmacological treatment for myoclonic seizures; however, its mitochondrial toxicity provides limitations for use in the treatment of mitochondrial disorders.[4],[5] Other commonly used agents include levetiracetam (LEV), clonazepam (CZP), zonisamide (ZNS), topiramate (TPM) and a high dose of piracetam.[2],[6] Recent evidence has supported the use of LEV as the first line of treatment for myoclonic seizures; however, the treatment effects have been unsatisfactory and inconsistent.[7],[8],[9] Therefore, additional clinical trials must be conducted to find more suitable treatments for myoclonic seizures in MERRF.
[5] The following drugs have recommendations for treating ET: gabapentin, topiramate (Level B, probably effective); botulinum toxin, DBS, and thalamotomy (Level C, possibly effective); gamma knife surgery, pregabalin, zonisamide, and clozapine (Level U, insufficient evidence).
Her outpatient AEDs included levetiracetam (LEV), valproic acid (VPA), and zonisamide (ZNS).
However, benzodiazepines, brivaracetam (BRV), phenobarbital, tiagabine, vigabatrin, and zonisamide are also associated with a higher occurrence of AB compared to other AEDs [4].
1,2-Benzisoxazole-3 methaesulfonamide (zonisamide) is an antiparkinsonian drug developed relatively recently.
Avoid these enzyme-inducing Consider these non-enzyme-inducing antiepileptic drugs antiepileptic drugs * Carbamazepine (Tegretol) * Ethosuximide (Zarontin) * Felbamate (Felbatol) * Gabapentin (Neurontin) * Lamotrigine (Lamictal) * Levetiracetam (Keppra) * Oxcarbazepine (Trileptal) * Pregabalin (Lyrica) * Phenobarbital (Luminal) * Tiagabine (Gabitril) * Phenytoin (Dilantin) * Valproate (Depakote) * Primidone (Mysoline) * Vigabatrin (Sabril) * Topiramate (Topamax) * Zonisamide (Zonegran) * Benzodiazepines OCs, oral contraceptives.