Zonisamide
Uses of Zonisamide
Zonisamide is primarily used to manage different types of seizures in adults and children and is part of the sulfonamide class of medicines.
Apart from this, Zonisamide also finds off-label usage in managing conditions including but not limited to partial seizures when used alone, generalized seizures like tonic-clonic, myoclonic, and absence seizures, prevention of migraines, managing bipolar disorder and mood stabilization, and the management of essential tremor and tardive dyskinesia.
Side effects of Zonisamide
Drowsiness and fatigue
Dizziness and loss of coordination
Anorexia and weight loss
Nausea, diarrhoea, and abdominal pain
Confusion and difficulty concentrating
How Zonisamide works
Zonisamide is a type of anti-epileptic medicine.
It works by carrying out several actions in the brain that help to control seizures. Firstly, it blocks specific channels in the nerve cells which prevents abnormal electrical activity and reduces the risk of seizures. Zonisamide also enhances the activity of a substance in the brain called GABA. GABA is an inhibitory neurotransmitter and its enhancement results in a decrease of nerve signal transmission in the brain, further reducing seizure incidence. It weakly inhibits an enzyme called carbonic anhydrase, which contributes to its anti-seizure activity. Further, it impacts both dopamine and serotonin neurotransmission and decreases glutamate-mediated excitatory neurotransmission. All these actions together help suppress the abnormal electrical discharges in the brain that cause seizures.
Certified content
Written By
BDS, MDS
Reviewed By
BMS, FMC, MD Resident
Expert Advice
Dosage Forms Available
Zonisamide can be taken orally (capsule, tablet and suspension).
Age and Dose Restrictions
This medicine is meant for adults.
Contraindications
Zonisamide is contraindicated in patients with known allergies to sulfonamides. Patients with severe liver impairment or Addison's disease should not take this medication.
Other Medications to Avoid
Zonisamide may interact with other medications that induce hepatic CYP3A4 enzymes (such as carbamazepine and phenytoin), and carbonic anhydrase inhibitors (like acetazolamide and topiramate).
Overdose and Missed Dose
An overdose of Zonisamide can cause severe symptoms such as agitation, hallucinations, mental/mood changes, sluggishness, and loss of consciousness. If you experience these symptoms after taking this medicine, consult your doctor immediately.
If you miss a dose of Zonisamide, take it as soon as you remember. But if it is almost time for the next dose, skip the missed one.
Management of Side Effects
Most side effects are temporary and generally harmless and resolve when discontinuing this medicine. However, if you experience any severe side effects or worsening of any of the symptoms, please consult your doctor.
For side effects like drowsiness or dizziness, avoid activities that require alertness until these symptoms subside.
For nausea or stomach upset, try taking this medication with food.
If dry mouth occurs, increase your fluid intake or chew sugarless gum to stimulate saliva production.
Use in Driving and Operating Machinery
Zonisamide may cause drowsiness or dizziness. Therefore, you should avoid driving or operating heavy machinery until you are sure how this medication affects you.
Use in Pregnancy and Lactation
It is advised to consult your doctor before using Zonisamide during pregnancy and breastfeeding.
Caution in Other Conditions
Patients with renal impairment should exercise caution when taking Zonisamide as it is primarily excreted by the kidneys.
Elderly patients or those with a history of kidney stones, osteoporosis, or mental illness also need to be cautious when taking this medication.
Special Dietary and Lifestyle Recommendations
Avoiding triggers (such as flashing lights, lack of sleep, and stress) that might prompt a seizure.
Keeping yourself hydrated can help prevent some of the side effects of Zonisamide such as kidney stones.
Frequently asked questions
Can Zonisamide cause weight loss?
Yes, Zonisamide may cause weight loss. This is a common side effect and can also lead to anorexia. If you experience significant weight loss, it is advised to consult your doctor.
Does Zonisamide affect mood or behaviour?
Zonisamide can have effects on mood or behaviour. Some patients may experience depression, irritability, and even suicidal behaviour and ideation as side effects of this medicine. Regular monitoring and immediate medical attention are necessary if such symptoms are noticed.
How long does Zonisamide stay in the body?
Zonisamide has a long elimination half-life of 50–70 hours. This means it stays in the body quite long, enabling once-daily dosing. However, the exact duration varies from person to person based on factors like age, metabolism, liver health etc.
Is Zonisamide vegan-friendly?
The capsule form of Zonisamide might contain gelatin, which is not suitable for vegetarians or vegans. It's best to consult your pharmacist for detailed information about the ingredients of this medicine.
Can I stop taking Zonisamide abruptly?
No, it is not advisable to stop taking Zonisamide abruptly, as it could lead to withdrawal symptoms or increase the risk of seizures. Always follow your doctor's advice on how to stop this medicine gradually.
Can I develop a dependency on Zonisamide?
Dependency or addiction to Zonisamide is unlikely as it is not a narcotic or psychoactive substance. However, long-term use should be under the guidance of your doctor.
Is Zonisamide a controlled substance?
No, Zonisamide is not a controlled substance. It is an anti-epileptic medication used for managing various types of seizures.
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