Zonisamide topiramate

There are minimal or no efficacy data for some adjunctive (add-on) therapies az-adrenergic agonists, calcium channel blockers, gabapentin, tiagabine, topiramate, and zonisamide topiramate may have efficacy as an adjunctive agent with standard agents for maintenance therapy, based on initial trials. 

The last few years has seen an explosion in AEDs. Some of those mentioned above may fall by the wayside and others appear. At the time of writing, we could include felbamate, zonisamide oxcarbazepine and topiramate. They all appear to have a phenytoin-like action on sodium channels, although topiramate appears to also potentiate the action of GABA on GABAa receptors like the benzodiazepines but through a different site. 

Allopurinol, indinavir, sulfadiazine, topiramate, triamterene, and zonisamide... 

Carbamazepine, phenytoin, valproate, gabapentin, lamotrigine, levetiracetam, tiagabine, topiramate, zonisamide... 

U.K. guidelines Tiagabine Topiramate Zonisamide Children Gabapentin Lamotrigine Oxcarbazepine Topiramate Gabapentin ... 

Lamotrigine Levetiracetam Topiramate Valproic acid Zonisamide... 

Phenobarbital Phenytoin (Dilantin) Tiagabine (Gabitril) Topiramate (Topamax) Valproic Acid (Depakene, Depakote) Zonisamide (Zonegran)... 

Specific myoclonic syndromes are usually treated with valproate an intravenous formulation can be used acutely if needed. It is nonsedating and can be dramatically effective. Other patients respond to clonazepam, nitrazepam, or other benzodiazepines, although high doses may be necessary, with accompanying drowsiness. Zonisamide and levetiracetam may be useful. Another specific myoclonic syndrome, juvenile myoclonic epilepsy, can be aggravated by phenytoin or carbamazepine valproate is the drug of choice followed by lamotrigine and topiramate. 

Changes in body weight associated with anticonvulsants have been reviewed (116), including the effects of the antiepileptic drugs that have been most commonly associated with this adverse effect (valproic acid, carbamazepine, vigabatrin, and gabapentin) (117). Unlike most anticonvulsants, topiramate, felbamate, and zonisamide can cause weight loss. 

Topiramate, felbamate, and zonisamide are associated with weight loss. In animals topiramate reduced food intake, but also reduced energy disposition in the absence of reduced intake. In addition, topiramate increased lipoprotein lipase activity in adipose tissue, possibly reflecting enhanced regulatory thermogenesis. In humans and animals topiramate reduces leptin concentrations. With felbamate weight loss is almost always associated with... 

Partial seizures Carbamazepine Phenytoin Lamotrigine Valproic acid Oxcarbazepine Gabapentin Topiramate Levetiracetam Zonisamide Tiagabine Primidone, phenobarbital Felbamate... 

In addition to phenytoin, carbamazepine, and lamotrigine, metabolically optimized analogs of these drugs, such as fosphenytoin and oxcarbazepine, show clinical promise. Other anticonvulsants that block sodium channels, among several mechanisms of action, include zonisamide, felbamate, topiramate, and valproate (Fig. 5). 

Ojemann LM, Crawford CA, Dodrill CB, Holmes MD, Kutsy R, Wilensky AJ. Language disturbances as a side effect of topiramate and zonisamide therapy. Epilepsia 1999 40(Suppl 7) 66. 

PHENYTOIN 1. LAMOTRIGINE 2. TIAGABINE 3. TOPIRAMATE 4. VALPROATE 5. ZONISAMIDE 1 levels of these antiepileptics. Topiramate sometimes t phenytoin levels Induction of metabolism. Uncertain why phenytoin alters topiramate levels Watch for poor response to these antiepileptics... 

Drugs that inhibit carbonic anhydrase (acetazolamide, topiramate, and zonisamide) are associated with a small risk (up to 1.5%) of nephrolithiasis. Increased excretion of V-acetyl-beta-glucosaminidase, a marker of renal tubular integrity, has been reported with valproate and carbamazepine, but it is probably not clinically significant (SEDA-18, 60). 

Phenobarbital Phenytoin Primidone Felbamate Lamotrigine Tiagabide Topiramate Valproate Zonisamide Clobazam Clonazepam Diazepam usually compensated by the effect of the added drug risk of toxicity when interfering drug is discontinued drug... 

Pemcca E, Bialer M. The clinical pharmacokinetics of the newer antiepUeptic dmgs. Focus on topiramate, zonisamide and tiagabine. Clin Pharmacokinet 1996 31(1) 29 6. 

Children receiving zonisamide should be monitored closely for evidence of reduced sweating and increased body temperature, especially in warm or hot weather and when taking other drugs that predispose to this (carbonic anhydrase inhibitors, anticholinergic drugs, topiramate). 

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