Names and pronunciation
(zone-is′a-mide) Zonegran
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Drug reference
(zone-is′a-mide) Zonegran
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Func. class.: Anticonvulsant
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Chem. class.: Sulfonamides
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ACTION: May act through action at sodium and calcium channels, but exact action is unknown; serotonergic action
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USES: Adjunctive therapy for partial seizures
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CONTRAINDICATIONS: Hyper sensitivity to this product or sulfonamides Precautions: Pregnancy, breastfeeding, children <16 yr, geriatric patients, aller gies, renal/hepatic disease; psychiatric condition, hepatic failure, pulmonary disease, suicidal ideation
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SIDE EFFECTS CNS: Dizziness, insomnia, paresthesias, depression, fatigue, headache, confu sion, somnolence, agitation, irritability, speech disturbance, suicidal ideation, seizures, status epilepticus EENT: Diplopia, verbal difficulty, speech abnormalities, taste perversion, amblyopia, pharyngitis, rhinitis, tinnitus, nystagmus GI: Nausea, constipation, anorexia, weight loss, diarrhea, dyspepsia, dry mouth, abdominal pain GU: Kidney stones HEMA: Aplastic anemia, granulocytope- nia (rare); ecchymosis INTEG: Rash, pruritus MISC: Flulike symptoms SYST: Stevens-Johnson syndrome, meta bolic acidosis
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INTERACTIONS Increase: metabolic acidosis severity— other carbonic anhydrase inhibitors Decrease: half-life of zonisamide—car BAMazepine, phenytoin, PHENobarbital Altered product levels: CYP3A4 inhibi tors/inducers Increase: CNS depression—alcohol, other CNS depressants Drug/Herb Increase: effect of this product—St. John’s wort Drug/Food • Do not use with grapefruit Drug/Lab Test Increase: BUN, creatinine
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DOSAGE AND ROUTES • Adult/child >16 yr: 100 mg/day, may increase after 2 wk to 200 mg/day, may increase q2wk, max dose 600 mg/day
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Available forms: Caps 25, 50, 100 mg
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Administer: • Without regard to food; swallow whole
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Assess: • Seizures: duration, type, intensity, pre cipitating factors • Assess for hypersensitivity reactions • Renal function: albumin concentra tion, BUN, urinalysis, creatinine, serum bicarbonate at baseline and periodically, renal failure may occur; increase fluid intake to prevent calculi • Mental status: mood, sensorium, af- fect, memory (long-, short-term), suicidal thoughts/behaviors • Stevens-Johnson syndrome, aplastic anemia, fulminant hepatic necrosis (rare); may cause death; monitor for rashes and hypersensitivity reactions, stop product immediately, notify prescriber • Obtain bicarbonate level before treat ment/periodically; metabolic acidosis may occur in children • Beers: avoid in older adults unless safer alternative is unavailable; may cause ataxia, impaired psychomotor function • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, may cause fetal harm; pregnant women should enroll in the North American Antiepileptic Drug Pregnancy Registry, 1-888-233-2334; do not breastfeed, excreted in breast milk, monitor for metabolic acidosis in mother and newborn
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Evaluate: • Therapeutic response: decrease in se verity of seizures
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to discontinue product abruptly because seizures may occur • To avoid hazardous activities until sta bilized on product • To use without regard to food, swallow capsule whole • To carry emergency ID stating product use Z • To notify prescriber of rash immediately; to notify prescriber of back pain, abdomi- nal pain, blood in urine; to increase fluid intake to reduce risk of kidney stones • To notify prescriber if pregnancy is planned, suspected, to use contraception • To avoid grapefruit • To notify prescriber of sore throat, fe ver, easy bruising • To report suicidal thoughts, behaviors immediately, assess for mood changes, increase in depressive symptoms
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PHARMACOKINETICS Peak 2-6 hr, half-life 63 hr, metabolized by liver, excreted by kidneys, protein binding 40%
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• Adult/child >16 yr: 100 mg/day, may increase after 2 wk to 200 mg/day, may increase q2wk, max dose 600 mg/day
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