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content:zonisamide [2020/02/14 17:43]
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content:zonisamide [2022/04/30 18:38] (current)
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 ====== Zonisamide ====== ====== Zonisamide ======
 +Zonisamide is a synthetic 1,2-benzisoxazole derivative (1,2-benzisoxazole-3-methanesulfonamide). It is chemically classified as a sulfonamide with a structural similarity to serotonin. It was first introduced as an AED in Japan in 1989.
 ===== Authorised indications ===== ===== Authorised indications =====
  
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   * Zonisamide appears to be an effective broad-spectrum AED with extensive clinical use in Japan   * Zonisamide appears to be an effective broad-spectrum AED with extensive clinical use in Japan
-  * It is efficacious in focal seizures with or without GTCSs, primarily and secondarily generalised seizures including epileptic spasms of [[West syndrome]], other epileptic encephalopathies such as [[content:ohtahara_syndrome|Ohtahara syndrome]], and probably progressive myoclonic epilepsies such as [[Unverricht syndrome]].[(:cite:Baulac2006>Baulac M. Introduction to zonisamide. Epilepsy Res 2006;68 Suppl 2:S3–9.)][(:cite:16542880>{{pubmed>long:16542880}})][(:cite:shinnar2009>Shinnar S, Pellock JM, Conry JA. Open-label, long-term safety study of zonisamide administered to children and adolescents with epilepsy. Eur J Paediatr Neurol 2009;13:3-9)][(:cite:arzimanoglou2006>Arzimanoglou A, Rahbani A. Zonisamide for the treatment of epilepsy. Expert Rev Neurother 2006;6:1283–92.)][(:cite:fukushima2006>Fukushima K, Seino M. A long-term follow-up of zonisamide monotherapy. Epilepsia 2006;47:1860–4)][(:cite:michael2007>Michael CT, Starr JL. Psychosis following initiation of zonisamide. Am J Psychiatry 2007;164:682.)][(:cite:sils2007>Sills G, Brodie M. Pharmacokinetics and drug interactions with zonisamide. Epilepsia 2007;48:435–41.)].+  * It is efficacious in focal seizures with or without GTCSs, primarily and secondarily generalised seizures including epileptic spasms of [[West syndrome]], other epileptic encephalopathies such as [[content:ohtahara_syndrome|Ohtahara syndrome]], and probably progressive myoclonic epilepsies such as [[Unverricht syndrome]].[(:cite:Baulac2006>Baulac M. Introduction to zonisamide. Epilepsy Res 2006;68 Suppl 2:S3–9.)][(:cite:16542880>{{pmid>long:16542880}})][(:cite:shinnar2009>Shinnar S, Pellock JM, Conry JA. Open-label, long-term safety study of zonisamide administered to children and adolescents with epilepsy. Eur J Paediatr Neurol 2009;13:3-9)][(:cite:arzimanoglou2006>Arzimanoglou A, Rahbani A. Zonisamide for the treatment of epilepsy. Expert Rev Neurother 2006;6:1283–92.)][(:cite:fukushima2006>Fukushima K, Seino M. A long-term follow-up of zonisamide monotherapy. Epilepsia 2006;47:1860–4)][(:cite:michael2007>Michael CT, Starr JL. Psychosis following initiation of zonisamide. Am J Psychiatry 2007;164:682.)][(:cite:sils2007>Sills G, Brodie M. Pharmacokinetics and drug interactions with zonisamide. Epilepsia 2007;48:435–41.)].
  
 ==== Dosage and titration ==== ==== Dosage and titration ====
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 **Reference range:** 15–40 mg/l (45–180 μmol/l). **Reference range:** 15–40 mg/l (45–180 μmol/l).
 +
 +see [[https://bnfc.nice.org.uk/drug/zonisamide.html|Zonisamide in the British National Formulary]]
  
 ==== Main ADRs ==== ==== Main ADRs ====
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   * Additional severe ADRs are those seen with the sulfonamides, such as rash, Stevens–Johnson syndrome, toxic epidermal necrolysis and major haematological disturbances including aplastic anaemia, which very rarely can be fatal. The incidence of rash requiring discontinuation of therapy has been approximately 2% in clinical trials.   * Additional severe ADRs are those seen with the sulfonamides, such as rash, Stevens–Johnson syndrome, toxic epidermal necrolysis and major haematological disturbances including aplastic anaemia, which very rarely can be fatal. The incidence of rash requiring discontinuation of therapy has been approximately 2% in clinical trials.
   * Depression and psychosis may be common, particularly in children. In one study, 14 of 74 patients experienced psychotic episodes within a few years of commencement of zonisamide[(:cite:michael2007x>Michael CT, Starr JL. Psychosis following initiation of zonisamide. Am J Psychiatry 2007;164:682.)].   * Depression and psychosis may be common, particularly in children. In one study, 14 of 74 patients experienced psychotic episodes within a few years of commencement of zonisamide[(:cite:michael2007x>Michael CT, Starr JL. Psychosis following initiation of zonisamide. Am J Psychiatry 2007;164:682.)].
-  * Seizure exacerbation: treatment-emergent status epilepticus has been reported in 1.1% of treated patients, compared to no reported cases in placebotreated individuals[(:cite:Willmore2009)][(:cite:2667602>{{pubmed>long:2667602}})]+  * Seizure exacerbation: treatment-emergent status epilepticus has been reported in 1.1% of treated patients, compared to no reported cases in placebotreated individuals[(:cite:Willmore2009)][(:cite:2667602>{{pmid>long:2667602}})]
  
 **Considerations in women** **Considerations in women**
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 ~~AUTHORS~~ ~~AUTHORS~~
 {{tag>pharmacopoeia}} {{tag>pharmacopoeia}}
 +~~DISCUSSION~~
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