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Zonisamide Disease Interactions

There are 11 disease interactions with zonisamide:

Major

Carbonic Anhy. Inhibitors (Includes Zonisamide) ↔ Bone Marrow Depression/Blood Dyscrasias

Severe Potential Hazard, Moderate plausibility

Applies to: Bone Marrow Depression/Low Blood Counts, History - Blood Dyscrasias

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.

References

  1. McWhae JA, Chang J, Lipton JH "Drug-induced fatal aplastic anemia following cataract surgery." Can J Ophthalmol 27 (1992): 313-5
  2. Lubeck MJ "Aplastic anemia following acetazolamide therapy." Am J Ophthalmol 69 (1970): 684-5
  3. Rentiers PK, Johnston AC, Buskard N "Severe aplastic anemia as a complication of acetazolamide therapy." Can J Ophthalmol 5 (1970): 337-42
View all 9 references
Major

Carbonic Anhydrase Inhibitor Anticonvulsants (Includes Zonisamide) ↔ Oligohidrosis/Hyperthermia

Severe Potential Hazard, Moderate plausibility

Applies to: Fever

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.

References

  1. "Product Information. Zonegran (zonisamide)" Elan Pharmaceuticals, S. San Francisco, CA.
  2. 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
Major

Carbonic Anhydrase Inhibitors (Includes Zonisamide) ↔ Severe Liver Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease, Cirrhosis

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.

References

  1. Margo CE "Acetazolamide and advanced liver disease." Am J Ophthalmol 101 (1986): 611-2
  2. "Product Information. Diamox (acetazolamide)." Lederle Laboratories, Wayne, NJ.
  3. Maren TH "Acetazolamide and advanced liver disease ." Am J Ophthalmol 102 (1986): 672-3
Major

Sulfonamides (Includes Zonisamide) ↔ Hematologic Toxicity

Severe Potential Hazard, Moderate plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

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 or glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, while chronic hemolytic anemia may occur with prolonged use. 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.

References

  1. "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories, Nutley, NJ.
  2. 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
  3. 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
View all 25 references
Major

Sulfonamides (Includes Zonisamide) ↔ Hypersensitivity Reactions

Severe Potential Hazard, Moderate plausibility

Applies to: Allergies, Asthma, HIV Infection

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 balantitis. Sulfonamide therapy should be stopped at once if a rash develops.

References

  1. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D "Sulfasalazine hepatotoxicity." Am J Gastroenterol 79 (1984): 401-2
  2. Pisanty S, Brayer L "Erythema multiforme-like eruption due to sulfadiazine." J Dent Med 20 (1965): 154-7
  3. Valcke Y, Pauwels R, Van der Straeten M "Bronchoalveolar lavage in acute hypersensitivity pneumonitis caused by sulfasalazine." Chest 92 (1987): 572-3
View all 53 references
Major

Zonisamide (Includes Zonisamide) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Depression

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.

Moderate

Antiepileptics (Includes Zonisamide) ↔ Suicidal Tendency

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression, Psychosis

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 across multiple indications in either monotherapy or adjunctive therapy for a median treatment duration of 12 weeks (up to a maximum of 24 weeks) showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. The estimated rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% for 16,029 placebo-treated patients, representing an increase of approximately one case for every 530 patients treated. There were four suicides in AED-treated patients and none in placebo-treated patients, although the number is too small to establish any causal relationship. The increased risk of suicidal thoughts or behavior was observed as early as one week after starting AEDs and persisted for the duration of treatment assessed. The risk did not vary substantially by age (5 to 100 years) in the clinical trials analyzed. Therapy with 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. For clinically significant or persistent symptoms, a dosage reduction or treatment withdrawal should be considered. If patients have symptoms of suicidal ideation or behavior, treatment should be discontinued.

Moderate

Carbonic Anhydrase Inhibitor Anticonvulsants (Includes Zonisamide) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

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.

Moderate

Carbonic Anhydrase Inhibitors (Includes Zonisamide) ↔ Metabolic Acidosis

Moderate Potential Hazard, Moderate plausibility

Applies to: Acidosis, Renal Dysfunction, Chronic Obstructive Pulmonary Disease, Diarrhea

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.

References

  1. Cowan RA, Hartnell GG, Lowdell CP, Baird IM, Leak AM "Metabolic acidosis induced by carbonic anhydrase inhibitors and salicylates in patients with normal renal function." Br Med J (Clin Res Ed) 289 (1984): 347-8
  2. 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
  3. Berthelsen P "Cardiovascular performance and oxyhemoglobin dissociation after acetazolamide in metabolic alkalosis." Intensive Care Med 8 (1982): 269-74
View all 10 references
Moderate

Zonisamide (Includes Zonisamide) ↔ Nephrolithiasis

Moderate Potential Hazard, Moderate plausibility

Applies to: Dehydration, Nephrolithiasis, History - Nephrolithiasis

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.

References

  1. "Product Information. Zonegran (zonisamide)" Elan Pharmaceuticals, S. San Francisco, CA.
Moderate

Zonisamide (Includes Zonisamide) ↔ Seizures

Moderate Potential Hazard, Moderate plausibility

Applies to: Seizures

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.

zonisamide drug Interactions

There are 675 drug interactions with zonisamide

zonisamide alcohol/food Interactions

There is 1 alcohol/food interaction with zonisamide

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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