zonisamide (Zonegran)
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Introduction
Tradename: Zonegran.
Indications
- adjunctive therapy for partial seizures
- treatment of generalized seizures[6]
- adjunctive therapy for Parkinson's disease
- adjunctive therapy for diffuse lewy body disease with parkinsonism[9]
Contraindications
Dosage
25-100 mg QD
Take with copious fluids to reduce risk of nephrolithiasis
* dosage adjustment in liver failure uncertain[6]
Dosage adjustment in renal failure
Pharmacokinetics
- metabolized in the liver by cyt P450 3A4
- cleared renally[6]
elimination via liver
Monitor
- renal function periodically[7]
- serum bicarbonate baseline & periodically (may cause metabolic acidosis)[7]
Adverse effects
- allergy to sulfa
- toxic skin reactions
- agranulocytosis
- rash[6]
- fatigue[2]
- sedation[6]
- paresthesias[2]
- cognitive impairment[2][8] affecting verbal fluency
- less so than topiramate[8]
- does not worsen cognitive function in patients with parkinsonism associated with diffuse lewy body disease[9]
- visual impairment[2], visual field defect[6]
- metabolic acidosis[5]
- nephrolithiasis[6]
- anorexia, weight loss[6]
- increased risk of nephrolithiasis[6]
- depression[6]
- psychosis[6]
- does not worsen psychiatric symptoms in patients with parkinsonism associated with diffuse lewy body disease[9]
Drug interactions
- any drug that inhibits cyt P450 3A4 may increase levels of zonisamide
- any drug that induces cyt P450 3A4 may diminish levels of zonisamide
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) anticonvulsants with statins
- drug interaction(s) of antibiotics with warfarin
Laboratory
More general terms
Additional terms
- cytochrome P450 3A4 (cytochrome P450 C3, nifedipine oxidase, P450-PCN1, NF-25, CYP3A4)
- seizure; epileptic seizure
References
- ↑ Prescriber's Letter 7(5):28, May 2000
- ↑ 2.0 2.1 2.2 2.3 2.4 Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 10(6):32 2003
- ↑ Murata M, Hasegawa K, Kanazawa I; The Japan Zonisamide on PD Study Group. Zonisamide improves motor function in Parkinson disease: a randomized, double-blind study. Neurology. 2007 Jan 2;68(1):45-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17200492
- ↑ 5.0 5.1 FDA Medwatch http://www.fda.gov/medwatch/safety/2009/safety09.htm#Zonisamide
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 7.0 7.1 7.2 Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 8.2 Wandschneider B et al. Effect of topiramate and zonisamide on fMRI cognitive networks. Neurology 2017 Feb 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28213372
- ↑ 9.0 9.1 9.2 9.3 Murata M, Odawara T, Hasegawa K et al. Adjunct zonisamide to levodopa for DLB parkinsonism: A randomized, double-blind phase 2 study. Neurology 2018 Jan 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29367449 Free PMC Article <Internet> http://n.neurology.org/content/90/8/e664