Zonisamide interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  4 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Conditions

Conditions in which Zonisamide needs care, as documented in this source.

• Bone Marrow Failure Disorders

  Major

  The use of carbonic anhydrase inhibitors may rarely cause bone marrow suppression and blood dyscrasias at recommended dosages. Aplastic anemia, thrombocytopenia or thrombocytopenia purpura, leukopenia, agranulocytosis, and hemolytic anemia have been reported. Extreme caution should be exercised if carbonic anhydrase inhibitors are administered to patients with these preexisting conditions. A baseline CBC and platelet count is recommended, as well as monitoring at regular intervals during therapy.

  12 sources

  1. Keisu M, Wiholm BE, Ost A, Mortimer O "Acetazolamide-associated aplastic anaemia." J Intern Med 228 (1990): 627-32
  2. Gangitano JL, Foster SH, Contro RM "Nonfatal methazolamide-induced aplastic anemia." Am J Ophthalmol 86 (1978): 138-9
  3. Wisch N, Fischbein FI, Siegel R, Glass JL, Leopold I "Aplastic anemia resulting from the use of carbonic anhydrase inhibitors." Am J Ophthalmol 75 (1973): 130-2
  4. Lubeck MJ "Aplastic anemia following acetazolamide therapy." Am J Ophthalmol 69 (1970): 684-5
  5. Kristinsson A "Fatal reaction to acetazolamide." Br J Ophthalmol 51 (1967): 348-9
  6. Englund GW "Fatal pancytopenia and acetazolamide therapy." JAMA 210 (1969): 2282
  7. Rentiers PK, Johnston AC, Buskard N "Severe aplastic anemia as a complication of acetazolamide therapy." Can J Ophthalmol 5 (1970): 337-42
  8. McWhae JA, Chang J, Lipton JH "Drug-induced fatal aplastic anemia following cataract surgery." Can J Ophthalmol 27 (1992): 313-5

  Show all 12 sourcesShow fewer sources

  9. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):
  10. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):
  12. "Product Information. Neptazane (methazolamide)." Wyeth-Ayerst Laboratories (2006):

• Depressive Disorder

  Major

  Antiepileptic drugs including zonisamide can increase depression and suicidal thoughts or behaviors in patients receiving these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts and unusual changes in mood or behavior. Caregivers and family should be alert for the emergence or worsening of symptoms. Behaviors of concern should be reported immediately to the healthcare providers.

  1 source

  1. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

• Hematologic Diseases

  Major

  The use of sulfonamides has been associated with hematologic toxicity, including methemoglobinemia, sulfhemoglobinemia, leukopenia, granulocytopenia, eosinophilia, hemolytic anemia, aplastic anemia, purpura, clotting disorder, thrombocytopenia, hypofibrinogenemia, and hypoprothrombinemia. Acute dose-related hemolytic anemia may occur during the first week of therapy due to sensitization, while chronic hemolytic anemia may occur with prolonged use. Patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency should be observed closely for signs of hemolytic anemia. Therapy with sulfonamides should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly, especially during prolonged therapy (>2 weeks), and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice.

  25 sources

  1. Barak S, Shaked Y, Bar A, Samra Y "Drug-induced post-surgical hemorrhage resulting from trimethoprim-sulphamethoxazole." Int J Oral Maxillofac Surg 18 (1989): 206-7
  2. Chan M, Beale D, Moorhead J "Acute megaloblastosis due to cotrimoxazole." Br J Clin Pract 34 (1980): 87-8
  3. Damergis J, Stoker J, Abadie J "Methemoglobinemia after sulfamethoxazole and trimethoprim therapy." JAMA 249 (1983): 590-1
  4. Finland M, Strauss E, Peterson O "Sulfadiazine." JAMA 251 (1984): 1467-74
  5. Kuipers EJ, Vellenga E, de Wolf JT, Hazenberg BP "Sulfasalazine induced agranulocytosis treated with GM-CSF." J Rheumatol 19 (1992): 621-2
  6. Youssef PP, Bertouch JV "Sulphasalazine induced aplastic anaemia." Aust N Z J Med 22 (1992): 391-2
  7. Keisu M, Ekman E "Sulfasalazine associated agranulocytosis in sweden 1972-1989: clinical features, and estimation of its incidence." Eur J Clin Pharmacol 43 (1992): 215-8
  8. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.

  Show all 25 sourcesShow fewer sources

  9. "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories (2001):
  10. "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc (2001):
  11. Peppercorn MA "Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug development." Ann Intern Med 101 (1984): 377-86
  12. Jacobson IM, Kelsey PB, Blyden GT, Demirjian ZN, Isselbacher KJ "Sulfasalazine-induced agranulocytosis." Am J Gastroenterol 80 (1985): 118-21
  13. Wheelan KR, Cooper B, Stone MJ "Multiple haematologic abnormalities associated with sulfasalazine." Ann Intern Med 97 (1982): 726-7
  14. Pena JM, Gonzalez-Garcia JJ, Garcia-Alegria J, Barbado FJ, Vazquez JJ "Thrombocytopenia and sulfasalazine." Ann Intern Med 102 (1985): 277-8
  15. Davies GE, Palek J "Selective erythroid and magakaryocytic aplasia after sulfasalazine administration." Arch Intern Med 140 (1980): 1122
  16. Guillemin F, Aussedat R, Guerci A, Lederlin P, Trechot P, Pourel J "Fatal agranulocytosis in sulfasalazine treated rheumatoid arthritis." J Rheumatol 16 (1989): 1166-7
  17. Mitrane MP, Singh A, Seibold JR "Cholestasis and fatal agranulocytosis complicating sulfasalazine therapy: case report and review of the literature." J Rheumatol 13 (1986): 969-72
  18. Mechanick JI "Coombs' positive hemolytic anemia following sulfasalazine therapy in ulcerative colitis: case reports, review, and discussion of pathogenesis." Mt Sinai J Med 52 (1985): 667-70
  19. Betkowski AS, Lubin A "Sulfamethoxazole-related antiplatelet antibody." Blood 82 (1993): 1683
  20. Gales BJ, Gales MA "Granulocyte-colony stimulating factor for sulfasalazine-induced agranulocytosis." Ann Pharmacother 27 (1993): 1052-4
  21. "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn (2001):
  22. Bates CM "HIV medicine: drug side effects and interactions." Postgrad Med J 72 (1996): 30-6
  23. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):
  24. Hopkinson ND, Garcia FS, Gumpel JM "Haematological side-effects pf sulphasalazine in inflammatory arthritis." Br J Rheumatol 28 (1989): 414-7
  25. Logan EC, Williamson LM, Ryrie DR "Sulphasalazine associated pancytopenia may be caused by acute folate deficiency." Gut 27 (1986): 868-72

• Hypersensitivity, Immediate

  Major

  The use of sulfonamides is associated with large increases in the risk of Stevens-Johnson syndrome, toxic epidermal necrolysis and other serious dermatologic reactions, although these phenomena are rare as a whole. Hepatitis, pneumonitis, and interstitial nephritis have also occurred in association with sulfonamide hypersensitivity. Therapy with sulfonamides should be administered cautiously in patients with severe allergies, bronchial asthma or AIDS, since these patients may be at increased risk for potentially severe hypersensitivity reactions. Patients should be instructed to promptly report signs and symptoms that may precede the onset of cutaneous manifestations of the Stevens-Johnson syndrome, such as high fever, severe headache, stomatitis, conjunctivitis, rhinitis, urethritis, and balanitis. Sulfonamide therapy should be stopped at once if a rash develops.

  53 sources

  1. Johnson M, Goodwin D, Shands J "Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review." Pharmacotherapy 10 (1990): 413-16
  2. Hofer T, Becker EW, Weigand K, Berg PA "Demonstration of sensititzed lymphocytes to trimethoprim/sulfamethoxazole and ofloxacin in a patient with cholestatic hepatitis." J Hepatol 15 (1992): 262-3
  3. Stevenson D, Christie D, Haas J "Hepatic injury in a child caused by trimethoprim-sulfamethoxazole." Pediatrics 61 (1978): 864-6
  4. Smith E, Light J, Filo R, Yum M "Interstitial nephritis caused by trimethoprim-sulfamethoxazole in renal transplant recipients." JAMA 244 (1980): 360-1
  5. Fischl M, Dickinson G, LaVoie L "Safety and efficacy of sulfamethoxazole and trimethoprim chemoprophylaxis for pneumocystis carinii pneumonia in AIDS." JAMA 259 (1988): 1185-9
  6. Whittington R "Toxic epidermal necrolysis and co-trimoxazole." Lancet 2 (1989): 574
  7. Kelly W, Dooley D, Lattuada C, Smith C "A severe, unusual reaction to trimethoprim-sulfamethoxazole in patients infected with human immunodeficiency virus." Clin Infect Dis 14 (1992): 1034-9
  8. Horak J, Mertl L, Hrabal P "Severe liver injuries due to sulfamethoxazole-trimethoprim and sulfamethoxydiazine." Hepatogastroenterology 31 (1984): 199-200

  Show all 53 sourcesShow fewer sources

  9. Gibson J "Recurrent trimethoprim-associated fixed skin eruption." Br Med J 284 (1982): 1529-30
  10. Holdcroft C, Ellison R "Trimethoprim-sulfamethoxazole reaction simulating pneumocystis carinii pneumonia." AIDS 5 (1991): 1029-42
  11. Steinbrecher U, Mishkin S "Sulfamethoxazole-induced hepatic injury." Dig Dis Sci 26 (1981): 756-9
  12. Rudra T, Webb D, Evans A "Acute tubular necrosis following co-trimoxazole therapy." Nephron 53 (1989): 85-6
  13. Ulstad D, Ampel N, Shon B, Galgiani JN, Cutcher AB "Reaction after re-exposure to trimethoprim-sulfamethoxazole." Chest 95 (1989): 937-8
  14. Heer M, Altorfer J, Burger H, Walti M "Bullous esophageal lesions due to co-trimoxazole: an immune-mediated process?" Gastroenterology 88 (1985): 1954-7
  15. Pisanty S, Brayer L "Erythema multiforme-like eruption due to sulfadiazine." J Dent Med 20 (1965): 154-7
  16. Robson M, Levi J, Dolberg L, Rosenfeld J "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci 6 (1970): 561-6
  17. Finland M, Strauss E, Peterson O "Sulfadiazine." JAMA 251 (1984): 1467-74
  18. Goadsby P, Donaghy A, Lloyd A, Wakefield D "Acquired immunodeficiency syndrome (AIDS) and sulfadiazine-associated acute renal failure." Ann Intern Med 107 (1987): 783-4
  19. Carbone L, Bendixen B, Appel G "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis 12 (1988): 72-5
  20. Tenant-Flowers M, Boyle M, Carey D, et al. "Sulphadiazine desenitization in patients with AIDS and cerebral toxoplasmosis." AIDS 5 (1991): 311-5
  21. Leroux JL, Ghezail M, Chertok P, Blotman F "Hypersensitivity reactions to sulfasalazine: skin rash, fever, hepatitis and activated lymphocytes." Clin Exp Rheumatol 10 (1992): 427
  22. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  23. "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories (2001):
  24. "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc (2001):
  25. Peppercorn MA "Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug development." Ann Intern Med 101 (1984): 377-86
  26. Kanner RS, Tedesco FJ, Kalser MH "Azulfidine- (sulfasalazine-) induced hepatic injury." Am J Dig Dis 23 (1978): 956-8
  27. Losek JD, Werlin SL "Sulfasalazine hepatotoxicity." Am J Dis Child 135 (1981): 1070-2
  28. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D "Sulfasalazine hepatotoxicity." Am J Gastroenterol 79 (1984): 401-2
  29. Yaffe BH, Korelitz BI "Sulfasalazine pneumonitis." Am J Gastroenterol 78 (1983): 493-4
  30. Ribe J, Benkov KJ, Thung SN, Shen SC, LeLeiko NS "Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine." Am J Gastroenterol 81 (1986): 205-8
  31. Averbuch M, Halpern Z, Hallak A, Topilsky M, Levo Y "Sulfasalazine pneumonitis." Am J Gastroenterol 80 (1985): 343-5
  32. Gabazza EC, Taguchi O, Yamakami T, Machishi M, Ibata H, Suzuki S, Matsumoto K, Kitagawa T, Yamamoto J "Pulmonary infiltrates and skin pigmentation associated with sulfasalazine." Am J Gastroenterol 87 (1992): 1654-7
  33. Poland GA, Love KR "Marked atypical lymphocytosis, hepatitis, and skin rash in sulfasalazine drug allergy." Am J Med 81 (1986): 707-8
  34. Hamadeh MA, Atkinson J, Smith LJ "Sulfasalazine-induced pulmonary disease." Chest 101 (1992): 1033-7
  35. Williams T, Eidus L, Thomas P "Fibrosing alveolitis, bronchiolitis obliterans, and sulfasalazine therapy." Chest 81 (1982): 766-8
  36. Valcke Y, Pauwels R, Van der Straeten M "Bronchoalveolar lavage in acute hypersensitivity pneumonitis caused by sulfasalazine." Chest 92 (1987): 572-3
  37. Taffet SL, Das KM "Sulfasalazine. Adverse effects and desensitization." Dig Dis Sci 28 (1983): 833-42
  38. Pearl RK, Nelson RL, Prasad ML, Orsay CP, Abcarian H "Serious complications of sulfasalazine." Dis Colon Rectum 29 (1986): 201-2
  39. Sotolongo RP, Neefe LI, Rudzki C, Ishak KG "Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity." Gastroenterology 75 (1978): 95-9
  40. Wang KK, Bowyer BA, Fleming CR, Schroeder KW "Pulmonary infiltrates and eosinophilia associated with sulfasalazine." Mayo Clin Proc 59 (1984): 343-6
  41. Haines JD, Jr "Hepatotoxicity after treatment with sulfasalazine." Postgrad Med 79 (1986): 193-4,
  42. Faintuch J, Mott CB, Machado MC "Pancreatitis and pancreatic necrosis during sulfasalazine therapy." Int Surg 70 (1985): 271-2
  43. Marinos G, Riley J, Painter DM, McCaughan GW "Sulfasalazine-induced fulminant hepatic failure." J Clin Gastroenterol 14 (1992): 132-5
  44. Namias A, Bhalotra R, Donowitz M "Reversible sulfasalazine-induced granulomatous hepatitis." J Clin Gastroenterol 3 (1981): 193-8
  45. Gremse DA, Bancroft J, Moyer MS "Sulfasalazine hypersensitivity with hepatotoxicity, thrombocytopenia, and erythroid hypoplasia." J Pediatr Gastroenterol Nutr 9 (1989): 261-3
  46. Marinac JS, Stanford JF "A severe hypersensitive reaction to trimethoprim-sulfamethoxazole in a patient infected with human immunodeficiency virus." Clin Infect Dis 16 (1993): 178-9
  47. Rubin R "Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis." Am J Gastroenterol 89 (1994): 789-91
  48. "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn (2001):
  49. Roujeau JC, Kelly JP, Naldi L, et al. "Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis." N Engl J Med 333 (1995): 1600-7
  50. Bates CM "HIV medicine: drug side effects and interactions." Postgrad Med J 72 (1996): 30-6
  51. Kawada A, Kobayashi T, Noguchi H, Hiruma M, Ishibashi A, Marshall J "Fixed drug eruption induced by sulfasalazine." Contact Dermatitis 34 (1996): 155-6
  52. Moore RD, Fortgang I, Keruly J, Chaisson RE "Adverse events from drug therapy for human immunodeficiency virus disease." Am J Med 101 (1996): 34-40
  53. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

• Hyperthermia

  Major

  Oligohidrosis (decreased sweating) and hyperthermia have been reported in association with the use of some carbonic anhydrase inhibitor anticonvulsants such as topiramate and zonisamide. Most of the reports have been in children. Caution and close monitoring of body temperature is advised when prescribing these drugs, especially in patients with a fever, in hot weather, or if combined with other drugs that predispose to heat related disorders. Zonisamide is not approved for use in pediatric patients in the U.S.

  3 sources

  1. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  2. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):
  3. Shimizu T, Yamashita Y, Satoi M, Togo A, Wada N, Matsuishi T, Ohnishi A, Kato H "Heat stroke-like episode in a child caused by zonisamide." Brain Dev 19 (1997): 366-8

• Liver Failure

  Major

  The use of carbonic anhydrase inhibitors is contraindicated in patients with marked liver disease or cirrhosis. Carbonic anhydrase inhibitors increase the risk of developing hepatic encephalopathy in these patients. Extreme caution should be exercised if carbonic anhydrase inhibitors are administered in patients with mild to moderate liver disease as the clearance of the drug can be decreased. A dose reduction might be needed and monitoring of the liver function is recommended.

  6 sources

  1. Maren TH "Acetazolamide and advanced liver disease ." Am J Ophthalmol 102 (1986): 672-3
  2. Margo CE "Acetazolamide and advanced liver disease." Am J Ophthalmol 101 (1986): 611-2
  3. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):
  4. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  5. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):
  6. "Product Information. Neptazane (methazolamide)." Wyeth-Ayerst Laboratories (2006):

• Acidosis

  Moderate

  Reduced plasma bicarbonate levels and, in some instances, elevated plasma chloride levels may result in metabolic acidosis during long-term therapy with carbonic anhydrase inhibitors. Therapy with carbonic anhydrase inhibitors should be administered cautiously in patients with metabolic or hyperchloremic acidosis or with conditions that predispose to acidosis (renal disease, severe respiratory disorders, diarrhea). The measurement of baseline and periodic serum bicarbonate is recommended. If metabolic acidosis develops (it may be corrected by administration of sodium bicarbonate), and persists, a dose reduction or treatment discontinuation should be considered.

  10 sources

  1. Reid W, Harrower AD "Acetazolamide and symptomatic metabolic acidosis in mild renal failure ." Br Med J (Clin Res Ed) 284 (1982): 1114
  2. Goodfield M, Davis J, Jeffcoate W "Acetazolamide and symptomatic metabolic acidosis in mild renal failure ." Br Med J (Clin Res Ed) 284 (1982): 422
  3. Maisey DN, Brown RD "Acetazolamide and symptomatic metabolic acidosis in mild renal failure." Br Med J (Clin Res Ed) 283 (1981): 1527-8
  4. Watson WA, Garrelts JC, Zinn PD, Garriott JC, McLemore TL, Clementi WA "Chronic acetazolamide intoxication." J Toxicol Clin Toxicol 22 549-63
  5. Heller I, Halevy J, Cohen S, Theodor E "Significant metabolic acidosis induced by acetazolamide: not a rare complication." Arch Intern Med 145 (1985): 1815-7
  6. Gabay EL "Metabolic acidosis from acetazolamide therapy ." Arch Ophthalmol 101 (1983): 303-4
  7. Berthelsen P "Cardiovascular performance and oxyhemoglobin dissociation after acetazolamide in metabolic alkalosis." Intensive Care Med 8 (1982): 269-74
  8. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  10. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

• Depressive Disorder

  Moderate

  Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

  16 sources

  1. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals (2002):
  2. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  3. "Product Information. Dilantin (phenytoin)." Parke-Davis (2001):
  4. "Product Information. Cerebyx (fosphenytoin)." Parke-Davis (2001):
  5. "Product Information. Mysoline (primidone)." Elan Pharmaceuticals (2001):
  6. "Product Information. Lyrica (pregabalin)." Pfizer U.S. Pharmaceuticals Group (2005):
  7. "Product Information. Sabril (vigabatrin)." Lundbeck Inc (2009):
  8. "Product Information. Potiga (ezogabine)." GlaxoSmithKline (2011):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Qsymia (phentermine-topiramate)." Vivus Inc (2012):
  10. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  11. "Product Information. Briviact (brivaracetam)." UCB Pharma Inc (2016):
  12. "Product Information. Diacomit (stiripentol)." Biocodex USA (2018):
  13. "Product Information. Epidiolex (cannabidiol)." Greenwich Biosciences LLC (2018):
  14. "Product Information. Xcopri (cenobamate)." SK Life Science, Inc. (2020):
  15. "Product Information. Fintepla (fenfluramine)." Zogenix, Inc (2020):
  16. "Product Information. Ztalmy (ganaxolone)." Marinus Pharmaceuticals, Inc (2022):

• Kidney Diseases

  Moderate

  The major route of elimination of carbonic anhydrase inhibitors is through the kidney. These drugs should be administered cautiously in patients with reduced renal function and a dose adjustment might be required depending on the level of impairment.

  3 sources

  1. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):
  2. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  3. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

• Nephrolithiasis

  Moderate

  The use of zonisamide may infrequently be associated with the development of nephrolithiasis. The reported incidence for clinically possible or confirmed kidney stones was 4.0% (40 of 991 patients) during premarketing use, representing a rate of 34 per 1000 patient-years of exposure (40 patients with 1168 years of exposure). Therapy with zonisamide should be administered cautiously with adequate hydration in patients with a history of nephrolithiasis. Patients who are dehydrated may be at increased risk for the development of nephrolithiasis and should be encouraged to consume additional amounts of liquid during zonisamide therapy.

  1 source

  1. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

• Seizures

  Moderate

  The abrupt withdrawal of zonisamide capsules in patients with epilepsy may precipitate the increase of seizure frequency or status epilepticus. Caution is advised when using this drug in patients with seizures. Dose reduction or discontinuation should be done gradually.

  1 source

  1. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

Therapeutic duplication

Drug classes that overlap with Zonisamide, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• carbonic anhydrase inhibitor ant

  The recommended maximum number of medicines in the 'carbonic anhydrase inhibitor anticonvulsants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'carbonic anhydrase inhibitor anticonvulsants' category.

  Example product in the source data (US market): Phentermine/topiramate