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Information about Zonisamide

Zonisamide is a new generation anticonvulsant that is typically used in combination with other antiepileptic medications for partial onset seizures. 

Liver safety of Zonisamide

Zonisamide has not been associated with elevations in serum aminotransferase levels and clinically apparent drug induced liver disease has been reported with its use but is very rare.

Mechanism of action of Zonisamide

Zonisamide (zoe nis' a mide) is synthetic sulfonamide derivative related somewhat in structure to acetazolamide, but not to other anticonvulsant medications.  Zonisamide appears to block the spread of seizure discharges by affecting repetitive firing of voltage-sensitive sodium and calcium channels and stabilizing neuronal membranes. 

FDA approval information for Zonisamide

Zonisamide was approved for use in epilepsy in Japan in 1989 and in the United States in 2000. 

Clinical use of Zonisamide

Current indications include adjunctive therapy for partial seizures in adults.  Zonisamide is used off-label for therapy of migraine headaches, mood disturbances and recently for weight loss. 

Dosage and administration for Zonisamide

Zonisamide is available as capsules of 25, 50 and 100 mg generically and under the brand name of Zonegran.  The recommended initial dose in adults with epilepsy is 100 mg in one or two doses daily, with dose escalation based upon tolerance and effect to a maximum of 200 mg twice daily. 

Side effects of Zonisamide

Common side effects include drowsiness, dizziness, headache, nausea, poor appetite and weight loss.  Rare, but serious side effects include Stevens Johnson syndrome, toxic epidermal necrolysis, aplastic anemia and agranulocytosis.


Generic Name / Brand Name Liver Toxicity Score Approval Year Major Indications
Brivaracetam / Briviact E 2016 Partial seizures
Carbamazepine / Tegretol A 1968 Partial, mixed and generalized seizures, trigeminal neuralgia
Clobazam / Onfi E 2011 Seizures assocated with Lennox-Gastaut syndrome
Clonazepam / Klonopin D 1975 Absence and myoclonic seizures, anxiety and panic disorders
Clorazepate / Tranxene E 1972 Partial seizures, anxiety disorders, and alcohol withdrawal
Diazepam / Valium E 1963 Convulsions, anxiety disorders, muscle spasms
Eslicarbazepine / Aptiom D 2013 Partial seizures
Ethosuximide / Zarontin E 1960 Absence seizures
Ezogabine / Potiga E 2011 Partial seizures
Felbamate / Febatol B 1993 Refractory or severe epilepsy
Fosphenytoin / Cerebyx A 1996 Tonic-clonic seizures, status epilepticus
Gabapentin / Neurontin C 1993 Partial seizures, post-herpetic neuralgia
Lacosamide / Vimpat D 2008 Partial seizures
Lamotrigine / Lamictal B 1994 Partial and generalized tonic-clonic seizures, bipolar disorder
Levetiracetam / Keppra C 1999 Partial, generalized tonic-clonic, and myoclonic seizures
Methsuximide / Celontin E 1957 Absence seizures
Oxcarbazepine / Trileptal D 2000 Partial seziures
Perampanel / Fycompa E 2012 Partial and generalized tonic-clonic seizures
Phenobarbital / Luminal A 1916 Partial and generalized seizures, anxiety, and irritable bowel syndrome
Phenytoin / Dilantin A 1938 Generalized tonic-clonic and partial onset seizures, status epilepticus
Pregabalin / Lyrica C 2004 Partial seizures, fibromyalgia, and neuropathic pain
Primidone / Mysoline E 1954 Partial and generalized tonic-clonic seizures
Rufinamide / Banzel E 2008 Seizures associated with Lennox-Gastaut syndrome
Tiagabine / Gabitril E 1997 Partial seizures
Topiramate / Topamax C 1996 Partial and generalized tonic-clonic seizures, migraine headaches
Valproate / Depakene A 1978 Absence and complex partial seizures
Vigabatrin / Sabril D 2009 Refractory, complex partial seizures, and infantile spasms
Zonisamide / Zonegran D 2000 Partial seizures

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