Zonisamide (Zonegran)
Anticonvulsant (glutamate modulation, GABA-ergic; blocks voltage-dependent sodium channels)
- Alcohol3
- SE-weight loss3
- Binge eating3
- Serious rash risk
Features
Dosing
Start 100 mg/d, raise by 100 mg/d every 2 weeks for 8 weeks based on response, max 500 mg/d.
Management
May not work for alcohol use disorder (mixed studies).
TOLERABILITY: Often not well tolerated. Fatigue, concentration problems, dyscoordination, dizzy.
RISKS: decreased sweating (hyperthermia, especially in children), severe Stevens Johnson rash, motor vehicle accidents (coordination).
EMR Text
Binge eating
Zonisamide use based on a randomized controlled trial in binge eating disorder (McElroy SL et al, J Clin Psychiatry. 2006;67(12):1897-1906).
Zonisamide risks, including serious rash and hyperthermia, reviewed with patient.
Weight
Zonisamide use based on a randomized controlled trial for antipsychotic induced weight gain, and other trials in obesity (Ghanizadeh A et al, Schizophr Res. 2013;147(1):110-115).
Zonisamide risks, including serious rash and hyperthermia, reviewed with patient.
Alcohol
Zonisamide use based on a randomized controlled trial where it reduced drinking in alcohol use disorder (Arias AJ et al, J Clin Psychopharmacol. 2010;30(3):318-322).
Zonisamide risks, including serious rash and hyperthermia, reviewed with patient.