Zonisamide (Zonegran)



Excerpt from Cafer's Mood Stabilizers and Antiepileptics


  Zonisamide (ZONEGRAN)
 Pronunciation: zoe NIS a mide / ZAHN uh gran
 “Zone is mighty, Zone is grand”
Zonisamide (Zonegran) mascot by Jason Cafer MD cafermed
❖ Antiepileptic 
❖ Voltage-gated sodium channel blocker 
❖ Glutamate ⇩		FDA approved for:
❖ Focal seizures		Used off label for: 
❖ Other types of seizures 
❖ PTSD nightmares 
❖ Sleep-related eating disorder 
❖ Obesity 
❖ Binge eating disorder 
❖ Alcohol use disorder 
❖ Migraine prophylaxis 
❖ Parkinsonian symptoms associated with Lewy body dementia

 
Zonisamide (Zonegran) is a broad-spectrum antiepileptic drug (AED) that blocks sodium and calcium channels and increases dopaminergic and serotonergic transmission. It is unrelated to other antiseizure medications. 

Zonegran can cause weight loss:
Zonegran can cause weight loss by Jason Cafer MD (cafermed)
Zonisamide decreases appetite and has been shown to decrease binge-eating. Cognitive impairment including “brain fog”, confusion, difficulty concentrating, and word-finding difficulty are relatively common. It is not used as a mood stabilizer because it may cause irritability. There have been rare cases of zonisamide-induced psychosis.

 
Due to carbonic anhydrase inhibitor activity (although weak) there is a chance of kidney stones (4%) and metabolic acidosis. Aplastic anemia and agranulocytosis have been reported. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported. Oligohidrosis (decreased ability to sweat) has occurred with children. 

 
Half-life is over 60 hours. About 30% is excreted unchanged in the urine.

Zonisamide has a sulfonamide structure. It is contraindicated in patients allergic to sulfa drugs. Other sulfonamides include the antibiotic sulfamethoxazole (Bactrim, Septra) and the  disease-modifying antirheumatic drug (DMARD) sulfasalazine.

Dosing: Start 100 mg daily. May increase by 100 mg q 2 weeks for a maximum of 600 mg. However, doses above 400 mg are rarely more effective. As with any antiepileptic medication, taper dose gradually to discontinue. 

Dynamic interactions: 
❖ Sedative (mild) 
❖ Hypokalemia 
❖ Metabolic acidosis 
❖ Decreased renal perfusion		Kinetic interactions:
❖ Kinetic interactions: 
❖ Urine alkalization (minor) 
❖ 3A4 substrate (minor)
Zonisamide (Zonegran) is a CYP3A4 substrate by Jason Cafer MD
Zonisamide (Zonegran) decreases lithium levels visual by jason cafer md

Zonegran pill picture cafermed







































Comments











Post a Comment























Popular posts from this blog









Cenobamate (XCOPRI) visual mnemonics




















Image







Excerpt from  Cafer's Mood Stabilizers and Antiepileptics, available on Amazon Cenobamate (XCOPRI) “Cinnab on  Ex-co uple ” Pronunciation:  sen oh BAM ate / EX cop ree  ❖ Antiepileptic  ❖ GABA A  modulator  ❖ DEA Schedule V   FDA approved for:   ❖ Partial-onset seizures (adults)   Cenobamate (Xcopri) is the newest antiepileptic drug (AED) , released in 2020. There are some serious risks , side effects and kinetic drug/drug interactions.   Dosing is similar to lamotrigine (Lamictal), with a slow titration to a recommended dose  of 200 mg over 11 weeks . As with lamotrigine, maximum dose is 400 mg. The slow titration is necessary to avoid Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) , also known as multiorgan hypersensitivity. There were no cases of DRESS among over 1,000 patients with adherence to the slow titration schedule. Cenobamate shortens QT  interval and is contraindicated with Familial Short QT Syndrome. QTc interval under 300 is dangerous.   Dose-dependent








Read more










Lithium




















Image







Excerpt from  Cafer's Mood Stabilizers and Antiepileptics Mood stabilizer      Neuroprotectant   FDA approved for: ❖ Acute mania     ❖ Bipolar disorder (maintenance) Used off-label for:     ❖ Depression     ❖ Suicidal ideation     ❖ Dementia     ❖ Alcoholism     ❖ Agitation     ❖ Headaches     ❖ Neutropenia     ❖ SIADH     ❖ Longevity  Lithium is the gold standard treatment for bipolar disorder. It is superior to all medications at preventing suicide, reducing risk 5-fold for individuals with recurrent unipolar depression and 6-fold for those with bipolar disorder (Tondo et al, 2016).  It works by several mechanisms that are not entirely understood.  Lithium is an element on the periodic table, classified as an alkali metal. Its atomic number is 3, making it the 3rd lightest element. Lithium was one of the first three elements in existence with the big bang (along with helium and hydrogen) over 13 billion years ago.  Lithium citrate was added to 7-Up (originally known as Bib-Label 








Read more










Lumateperone (Caplyta)




















Image







Available on Amazon:  Cafer's Mood Stabilizers and Antiepileptic Drugs        Lumateperone (CAPLYTA) Pronunciation:  luma TEP er ohn / cap LIE ta  “’Lum inated  Cap lighter” Antipsychotics are represented  with spooky mascots. Year of US release: 2020  ❖ Antipsychotic (SGA) ❖ D2 antagonist - ⇩DA ❖ 5-HT2A antagonist - ⇧DA ❖ Glutamate modulator  FDA-approved for:  ❖ Schizophrenia  Lumateperone is a new antipsychotic that purportedly modulates glutamate  in addition to the usual SGA mechanism of blocking D2 and 5-HT2A receptors. However, the official prescribing information does not mention glutamate, suggesting the FDA saw insufficient evidence for lumateperone being a first-in-class novel antipsychotic. It appears to be equally effective as risperidone (Risperdal) with fewer side effects other than sedation (Citrome, 2016).  Lumateperone’s D2 receptor occupancy is lower than most other antipsychotics. This means extrapyramidal side effects are unlikely. The other antipsychotics with








Read more