ZONISAMIDE

(for veterinary information only)

BRAND NAME: ZONEGRAN

AVAILABLE AS
25 MG, 50 MG, 100 MG
CAPSULES

BACKGROUND

Seizure control in dogs and cats is usually straight forward with most patients being predictably responsive to phenobarbital but this is not always the case. Some animals cannot be adequately controlled with only one medication or there may be reasons why phenobarbital is not an appropriate choice. For these patients, there are several other medications that can be used either to supplement the phenobarbital or or even as a replacement for phenobarbital. Zonisamide is one such medication.

HOW THIS MEDICATION IS USED

Zonisamide can be used in either cats or dogs for control of seizures. It is typically used twice daily in dogs, usually as a supplement to phenobarbital. Zonisamide has very long-lasting activity in cats and can be used once daily, although, use in the cat is still new and the full potential for side effects is still being worked out.

In dogs, serum zonisamide blood levels are frequently monitored one to two weeks after starting zonisamide or after any dosage adjustment. Usually the test is timed against medication administration so as to get the lowest drug levels of the day.

If zonisamide is used in combination with phenobarbital and seizures have recurred, it is recommended that levels be examined 3-4 hours after zonisamide administration as well as within 1 hour of the next scheduled dose. This allows for examination of both the highest and lowest zonisamide blood levels of the day.

SIDE EFFECTS

The most common side effect is sedation/drowsiness and there is concern that tolerance can develop (which means that as time goes by, a higher dose is required to achieve the same effect.

Vomiting and appetite loss were the next most common reactions after sedation. Some individuals require dose adjustment for this side effect.

Case studies have been published where liver damage was reported in 2 dogs. Another case report involved a dog that developed a condition called "renal tubular acidosis." Because zonisamide is relatively new to veterinary use, the risk of these serious conditions is unknown but because of these cases, relevant blood testing is recommended prior to starting zonisamide as well as periodically throughout therapy.

Zonisamide may reduce thyroid levels.

INTERACTIONS WITH OTHER DRUGS

Phenobarbital has the ability to "induce" liver enzymes which means that other drugs can be removed from the body faster than they would in the absence of phenobarbital. Since zonisamide and phenobarbital are commonly used together, an increase in the zonisamide dosing is generally needed to offset the faster zonisamide removal.

When zonisamide is used in combination with carbonic anhydrase inhibitors (such as acetazolamide or dorsolamide - common glaucoma medications), there is an increased risk for kidney stones and for the previously mentioned "renal tubular acidosis."

CONCERNS AND CAUTIONS

Zonisamide should not be used in pregnancy as it can cause cardiovascular damage in the unborn.

Zonisamide can be given with or without food.

Zonisamide should not be abruptly discontinued or rebound seizures could occur.

Listlessness, appetite loss, vomiting or yellow pigment changes in the eyes should be reported to the prescribing veterinarian at once.

Short version (to help us comply with "Lizzie's Law")

Page posted: 5/9/2017
Page last updated: 3/3/2022