ZONISAMIDE
(zon-i′sa-mide)
Zonegran
Classifications: ANTICONVULSANT; SULFONAMIDE
Therapeutic: ANTICONVULSANT Pregnancy Category: C
AVAILABILITY
Capsule
ACTION & THERAPEUTIC EFFECT
A broad-spectrum anticonvulsant that facilitates dopaminergic and serotonergic neurotransmission but does not potentiate the activity of gamma-aminobutyric acid (GABA) in the synapses of the CNS neurons. Suppresses focal spike discharges and electroshock seizures. Effective against a variety of seizure types.
USES
Adjunctive therapy for partial seizures in adults.
UNLABELED USES
Bipolar disorder.
CONTRAINDICATIONS
Hypersensitivity to sulfonamides or zonisamide; suicidal ideation; worsening of depression; severe metabolic
acidosis; lactation.
CAUTIOUS USE
Depressive individuals; history of suicidal tendencies; renal or hepatic insufficiency, dehydration, hypovolemia; renal impairment; older adults; pregnancy (category C); children younger than 16 y.
ROUTE AND DOSAGE
Partial Seizures
Adult: PO Start at 100 mg daily, may increase after 2 wk to 200mg/day, may then increase q2wk, if necessary (max: 400 mg/day in 1–2 divided doses)
ADMINISTRATION
Oral
- Do not crush or break capsules; ensure capsules are swallowed whole with adequate fluid.
- Withdraw drug gradually when discontinued to minimize seizure potential.
- Store at 25° C (77° F); room temperature permitted. Protect from light and moisture.
ADVERSE EFFECTS
(≥1%) Body as a Whole: Flu-like syndrome, weight loss.
CNS: Agitation, irritability, anxiety, ataxia, confusion, depression, difficulty concentrating, difficulty with memory, dizziness, fatigue, headache, insomnia, mental slowing, nervousness, nystagmus, paresthesia, schizophrenic behavior, somnolence, tiredness, tremor, convulsion, abnormal gait, hyperesthesia, incoordination.
GI:Abdominal pain, anorexia, constipation, diarrhea, dyspepsia, nausea, dry mouth, flatulence, gingivitis, gum hyperplasia, gastritis, stomatitis, cholelithiasis, glossitis, melena, rectal hemorrhage, ulcerative stomatitis, ulcer, dysphagia.
Metabolic: Oligohidrosis, sometimes resulting in heat stroke and hyperthermia in children.
Respiratory: Rhinitis, pharyngitis, cough.
Skin: Ecchymosis, rash, pruritus.
Special Senses: Difficulties in verbal expression, diplopia, speech abnormalities, taste perversion, amblyopia, tinnitus.
Urogenital: Kidney stones.
INTERACTIONS
Drug: Phenytoin, carbamazepine, phenobarbital, valproic acid may decrease half-life of zonisamide.
PHARMACOKINETICS
Peak: 2–6 h.
Distribution: 40% protein bound, extensively binds to erythrocytes.
Metabolism: Acetylated in liver by CYP3A4.
Elimination: Primarilyin urine.
Half-Life: 63–105 h.
NURSING IMPLICATIONS
Assessment & Drug Effects
- Withhold drug and notify prescriber if an unexplained rash or S&S of hypersensitivity appear (see Appendix F).
- Monitor for and report S&S of CNS impairment (somnolence, excessive fatigue, cognitive deficits, speech or language problems, incoordination, gait disturbances); oligohidrosis (lack of sweating) and hyperthermia in pediatric patients.
- Montior lab tests: Periodic BUN and serum creatinine, and CBC with differential. Patient & Family Education
- Do not abruptly stop taking this medication.
- Increase daily fluid intake to minimize risk of renal stones. Notify prescriber immediately of S&S of renal stones: Sudden back or abdominal pain, and blood in urine.
- Report any of the following: Dizziness, excess drowsiness, frequent headaches, malaise, double vision, lack of coordination, persistent nausea, sore throat, fever, mouth ulcers, or easy bruising.
- Exercise special caution with concurrent use of alcohol or CNS depressants.
- Do not drive or engage in other potentially hazardous activities until response to drug is known.
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