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zonisamide (Rx)Brand and Other Names:Zonegran

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 25mg
  • 50mg
  • 100mg
more...

Partial Seizures

Initial: 100 mg PO qDay

Titrate up by 100 mg increments q2Week to no more than 600 mg PO qDay (may divide q12hr after 1st week)

Weight Loss (Off-label)

100 mg increments q2Week to no more than 600 mg PO qDay (may divide q12hr after first week); use 600 mg/day in patients who have not lost at least 5% of their initial body weight

Dosing Modifications

Renal impairment: Slower titration and more frequent monitoring advised; not recommended if patient's glomerular filtration rate is less than 50 mL/min

Hepatic impairment: Slower titration and more frequent monitoring advised

Dosage Forms & Strengths

capsule

  • 25mg
  • 50mg
  • 100mg
more...

<16 years

Not recommended

>16 years

Partial seizures

  • Same as in adults

Administer as in adults; initiate dosing at the lower end of the dosing range

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Interactions

Interaction Checker

zonisamide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Somnolence (17%)

            Anorexia (13%)

            Dizziness (13%)

            1-10%

            Headache (10%)

            Nausea (9%)

            Agitation (9%)

            Abdominal pain (6%)

            Ataxia (6%)

            Confusion (6%)

            Depression (6%)

            Diplopia (6%)

            Insomnia (6%)

            Diarrhea (5%)

            Speech disorder (5%)

            Flu-like symptoms (4%)

            Kidney stones (4%)

            Nystagmus (4%)

            Paresthesia (4%)

            Dysgeusia (3%)

            Weight loss (3%)

            Anxiety (3%)

            Rash (3%)

            Constipation (2%)

            Rhinitis (2%)

            Xerostomia (2%)

            Postmarketing Reports

            Acute pancreatitis

            Rhabdomyolysis

            Creatine phosphokinase increased

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            Warnings

            Contraindications

            Hypersensitivity to zonisamide or sulfonamides

            Cautions

            Maintain fluid intake due to risk of kidney stone formation

            Discontinue treatment if significant sustained increase in creatinine occurs

            Risk of serious skin reactions; consider discontinuation in patients who develop unexplained rash

            Sedation may occur

            Slowing and fatigue may occur within first month of treatment

            Risk of rare, but potentially fatal, anaphylactic reactions (including blood dyscrasias and skin reactions)

            Risk of metabolic acidosis

            Use appropriate precautions for handling and disposal

            Increase in suicidal ideation may occur with use; see FDA Warning on potential suicidal behavior

            Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as multi-organ hypersensitivity reported; early manifestations of hypersensitivity (e.g., fever, lymphadenopathy) may be present even though rash not evident; if such signs or symptoms present, evaluate immediately; discontinue therapy if an alternative etiology for signs or symptoms cannot be established

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown; avoid during breastfeeding

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Unknown; benzisoxazole compound; more active against tonic phase than it is against clonic phase; may stabilize neuronal membranes by acting at sodium and calcium channels; does not affect GABA activity

            It has some weak carbonic anhydrase inhibitor activity

            Absorption

            Peak plasma time: 2-6 hr (concentration: 2-5 mcg/mL)

            Distribution

            Protein bound: 40%

            Vd: 1.45 L/kg

            Metabolism

            Hepatic; through CYP3A4

            Elimination

            Half-life: 63 hr

            Renal clearance: 3.5 mL/min

            Total body clearance: 0.30-0.35 mL/min/kg

            Excretion: Urine (62%); feces (3%)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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