zonegran and Acetazolamide extended release Interactions

Interactions between zonegran(zonisamide) and Acetazolamide extended release (acetaZOLAMIDE)

acetaZOLAMIDE and zonisamide (Major Drug-Drug)

GENERALLY AVOID: Concomitant use of topiramate or zonisamide with carbonic anhydrase inhibitors may increase the risk of kidney stone formation. Topiramate and zonisamide are themselves weak carbonic anhydrase inhibitors, and agents in this class can promote stone formation by reducing urinary citrate excretion and increasing urinary pH. Coadministration with other carbonic anhydrase inhibitors may also potentiate the risk of oligohidrosis and hyperthermia associated occasionally with the use of topiramate and zonisamide, particularly in pediatric patients. Carbonic anhydrase inhibitors can alter electrolyte and fluid balance and predispose patients to heat-related disorders, especially in hot weather. Oligohidrosis and hyperthermia are sometimes associated with serious sequelae but may be preventable by prompt recognition of symptoms and appropriate treatment.

MANAGEMENT: Use of topiramate or zonisamide with other carbonic anhydrase inhibitors should be avoided or otherwise approached with caution. Increased fluid intake is recommended to increase urinary output, which lowers the concentration of substances involved in stone formation. Patients, particularly pediatric patients, should be monitored closely for evidence of decreased sweating and increased body temperature, especially in warm or hot weather. Proper hydration before and during vigorous activities or exposure to warm temperatures is recommended. Patients (or their guardians or cavegivers) should contact their physician immediately if they develop signs or symptoms of kidney stones such as sudden back pain, abdominal pain and/or blood in the urine, of if they are not sweating as usual, with or without a fever.