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