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Published online by Cambridge University Press: 06 October 2020
THERAPEUTICS
Brands
• Banzel, Inovelon
Generic?
• No
Class
• Antiepileptic drug (AED)
Commonly Prescribed for
(FDA approved in bold)
• Adjunctive therapy for Lennox-Gastaut syndrome (LGS) in patients 4 years and older
• Tonic or atonic seizure
• Refractory bipolar disorder
How the Drug Works
• The exact mechanism is unknown but likely related to modulation of sodium channel activity and membrane stabilization. Rufinamide prolongs the inactive state of the sodium channel
How Long Until It Works
• Seizures: should decrease by 2 weeks
If It Works
• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated
If It Doesn't Work
• Increase to highest tolerated dose
• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Generally used adjunctively in combination with other AEDs for refractory epilepsy
Tests
• No regular blood tests are recommended
ADVERSE EFFECTS (AEs)
How the Drug Causes AEs
• CNS AEs are probably caused by effects on sodium channels
Notable AEs
• Somnolence, fatigue, coordination abnormalities, anorexia, nausea/vomiting, headache, dizziness, tremor, nasopharyngitis, influenza
Life-Threatening or Dangerous AEs
• Suicidal ideation
• Blood dyscrasias including leukopenia
• Bundle branch and first-degree AV block infrequently occurred in clinical trials but the relationship of this to rufinamide is unclear
• Multi-organ hypersensitivity syndrome
Weight Gain
• Unusual
Sedation
• Not unusual
What to Do About AEs
• Decrease dose
• Taking drug in fasting state will lower absorption and may reduce both AEs and effectiveness
Best Augmenting Agents to Reduce AEs
• Most AEs cannot be reduced by use of augmenting agent
DOSING AND USE
Usual Dosage Range
• Epilepsy: 1600–3200mg/day in adults
Dosage Forms
• Tablets: 200 or 400mg
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