Zonisamide
Commercial names and formulations:
Zonegran
Formulations: Capsule, Liquid
Years on the market:
In the US since 2000
How to store it?
Store between 15º–30ºC (59º– 86ºF). Store in a dry place away from light.
What does the body do to the medication?
Can I take it with food?
Yes
How long does it take to get to the blood after I take it?
2-6 hours
How long does it take to start having a steady effect?
Up to 2 weeks (10 days)
Can this medication be started at a high dose or it has to be started gradually?
Gradually
How long does it stay in the body?
63 hours
How is it eliminated?
Liver
What does the medication do to the body?
Type of epilepsy that helps:
Partial Epilepsy
FDA approved for:
Zonegran is indicated as adjunctive therapy in the treatment of partial seizures in adults with epilepsy.
Common side effects:
• Skin: Pruritus (itchiness), maculopapular rash, acne, alopecia, dry skin, sweating, eczema, urticaria, hirsutism, pustular rash, vesiculobullous rash
• Bones: Leg cramps, myalgia, myasthenia, arthralgia, arthritis
• Blood: Leukopenia, anemia, immunodeficiency, lymphadenopathy, thrombocytopenia, microcytic anemia, petechia
• Liver: none
• Kidneys: none
• Stomach and intestines: Vomiting, flatulence, gingivitis, gum hyperplasia, gastritis, gastroenteritis, stomatitis, cholelithiasis, glossitis, melena, rectal hemorrhage, ulcerative stomatitis, gastro-duodenal ulcer, dysphagia, gum hemorrhage, cholangitis, hematemesis, cholecystitis, cholestatic jaundice, colitis, duodenitis, esophagitis, fecal incontinence, mouth ulceration
• Heart: Palpitation, tachycardia, vascular insufficiency, hypotension, hypertension, thrombophlebitis, syncope, bradycardia, atrial fibrillation, heart failure, pulmonary embolus, ventricular extrasystoles
• Brain: Tremor, convulsion, abnormal gait, hyperesthesia, incoordination, hypertonia, twitching, abnormal dreams, vertigo, libido decreased, neuropathy, hyperkinesia, movement disorder, dysarthria, cerebrovascular accident, hypotonia, peripheral neuritis, parathesia, reflexes increased, circumoral paresthesia, dyskinesia, dystonia, encephalopathy, facial paralysis, hypokinesia, hyperesthesia, myoclonus, oculogyric crisis
• Mood: Euphoria
• Others: Peripheral edema, weight gain, edema, thirst, dehydration
Serious side effects:
Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias.
FDA Warning: “Antiepileptic drugs, including Zonegran, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence of worsening of depression, suicidal thoughts or behavior, and/or unusual changes in mood or behavior.”
What happens if I get too much of it (intoxication)?
CNS symptoms: comatose, bradycardia, hypotension, respiratory depression
What happens if I stop it suddenly (withdrawal)?
As with other AEDs, abrupt withdrawal of Zonegran in patients with epilepsy may precipitate increased seizure frequency or status epilepticus. Dose reduction or discontinuation of zonisamide should be done gradually.
Who should not take this medication?
Zonegran is contraindicated in patients who have demonstrated hypersensitivity to sulfonamides or zonisamide.
What is the average dose and how many times a day should be given?
The initial dose of Zonegran should be 100mg daily. After two weeks, the dose may be increased to 200 mg/day for at least two weeks. It can be increased to 300 mg/day and 400 mg/day, with the dose stable for at least two weeks to achieve steady state at each level.
Does the body get used to the medication?
Yes
Medications to be careful with:
Other AEDs that can increase the blood level of zonisamide:
None anticipated
Other AEDs that can decrease the blood level of zonisamide:
Phenobarbital, Phenytoin, Primidone, Carbamazepine, Valproic Acid
Other drug interactions:
None anticipated
Women’s health
Affects contraceptives?
No
Affect fertility?
The effect of zonisamide on human fertility is unknown.
Are safe in pregnancy?
Zonegran during pregnancy may present a significant risk to the fetus. Zonegran should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Category
Pregnancy Category C
Can breastfeed?
It is not known whether zonisamide is excreted in human milk. Zonegran should be used in nursing mothers only if the benefits outweigh the risks.
Affect bones (osteoporosis)?
No
Men’s health
Affects sexual performance?
No
Affects fertility?
The effect of zonisamide on human fertility is unknown.
Use other than epilepsy:
None