Primidone Mesuximide

Of 26 patients with complex partial seizures refractory to phenytoin, carbamazepine, phenobarbital, or primidone, mesuximide produced a 50% or greater reduction in seizure frequency in eight after 8 weeks, and five of those continued to benefit after 3-34 months (1). Drowsiness, gastrointestinal disturbances, hiccups, irritability, and headache were the common adverse effects. 

Sherwin, A. L., Ethosuximide Chnical use, m Antiepileptic Drugs, 4th ed.. Levy, R. H., Mattson, R. H., and Meldrum, B. S., Eds., Raven Press, New York, 1994. Battino, D., Estienne, M., and Avanzini, G., Chnical pharmacokinetics of antiepileptic drugs in paediatric patients. Part 1 Phenobarbital, primidone, valproic acid, ethosuximide and mesuximide, Clin. Pharmacokinet., 29 257-286, 1995. 

A study in hospitalised patients with petit mal epilepsy found that when mesuximide was given to 8 patients taking phenobarbital and 13 patients taking primidone, the mean serum levels of phenobarbital rose by 38% and 40%, respectively. Dose reductions were needed in 50% and 62% of patients, respectively. It was also found that the concurrent use of phenobarbital increased the serum levels of the active metabolite of mesuximide, A-desmethylmesuximide. ... 

Information about these interactions is limited. Nevertheless, concurrent use should be monitored. Anticipate the need to reduce the dose of phenytoin, phenobarbital or primidone if mesuximide is given. The dose of lamotrigine may need to be increased if mesuximide is given. There is also some evidence that the dose of valproate may need to be increased. 

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See also in sourсe #XX -- [ ]

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