Zonegran (zonisamide). The only person we know taking this drug is an eight-year old girl who is taking it for epilepsy. It’s been brutal on her cognitive functions and she’s not gaining weight as expected, but it works as far as the seizures are concerned. So, like Topamax, it’s another supermodel drug that will make you stupid and skinny[1]. Supposedly like Lamictal it is good for bipolar depression. It hits pretty much every neurotransmitter there is in attempting to achieve neural homeostasis. This is the latest anticonvulsant out of Japan, and I’d bet folding money it was developed in response to all those kids seizing while watching the one episode of Pokemon we’ll never see in this country. Zonegran has a spectacularly high rate of SUDEP, 7 out of 991. Normally anyone taking an anticonvulsant for bipolar should not be concerned with SUDEP unless you have a history of tonic-clonic (grand mal) seizures, especially flopping around in the middle of the night. Given Zonegran’s heavy hit on cognitive functions, high rate of SUDEP, and relative novelty as a mood stabilizer, you’re far better off exhausting all the other usual options before turning to this one. Yeah, Zonegran is better than the typical antipsychotics, Mysoline, Felbatol or relying solely upon benzodiazepines for mood stabilization. So if you’re taking Zonegran for bipolar, you stand a small but significant chance of it failing on you with a spectacularly nasty rebound effect. Zonegran has multiple mechanisms of action, including blocking sodium channels, reducing voltage-dependent, transient inward T-type calcium channels, increasing GABA release, blocking potassium evoked glutamate-mediated synaptic excitation, and weakly inhibiting carbonic annhydrase. It is in the sulfa family of drugs and therefore should not be used by patients allergic to sulfa drugs. Freakiest rare side effects: fecal incontinence and facial paralysis. The initial dose for Zonegran is 100 mg a day. After two weeks that may be increased to 200 mg. If required it may be increased by 100 mg a day every two weeks to 400 mg a day. Zonegran is rated for up to 600 mg a day for severe seizures. The half-life of Zonegran is 63 hours. Not available in Canada. Elan.

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