Comparative Pharmacology
Head-to-head clinical analysis: VALPROIC ACID versus ZONISADE.
Peer-Reviewed Evidence
Head-to-head clinical analysis: VALPROIC ACID versus ZONISADE.
VALPROIC ACID vs ZONISADE
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Increases GABA concentration in the brain by inhibiting GABA transaminase and succinic semialdehyde dehydrogenase; also blocks voltage-gated sodium channels and T-type calcium channels.
Zonisamide is a sulfonamide anticonvulsant. Its precise mechanism of action is unknown, but it is believed to inhibit voltage-sensitive sodium channels and reduce T-type calcium currents, thereby stabilizing neuronal membranes and suppressing neuronal hypersynchronization. It may also modulate GABA and glutamate neurotransmission.
Initial: 10-15 mg/kg/day orally (divided 2-3 times), increase by 5-10 mg/kg/week; maintenance: 30-60 mg/kg/day. IV infusion: same oral dose, rate ≤20 mg/min.
100-200 mg orally every 8 hours; maximum 600 mg/day.
None Documented
None Documented
Clinical Note
moderateValproic acid + Fluticasone propionate
"The risk or severity of adverse effects can be increased when Valproic acid is combined with Fluticasone propionate."
Clinical Note
moderateValproic acid + Sulfisoxazole
"The metabolism of Sulfisoxazole can be decreased when combined with Valproic acid."
Clinical Note
moderateValproic acid + Cyclosporine
"The metabolism of Cyclosporine can be decreased when combined with Valproic acid."
Clinical Note
moderateValproic acid + Fluconazole
Terminal elimination half-life is 9–16 hours in adults; shorter in children (6–9 hours) and longer in neonates (20–30 hours), elderly, or hepatic impairment (up to 18 hours).
Terminal elimination half-life: 63-69 hours in adults; allows once-daily dosing; steady-state achieved in 14-21 days
Primarily hepatic metabolism (>95%), with less than 3% excreted unchanged in urine. Minor fecal excretion (~5%).
Renal: approximately 62% (35% unchanged, 27% as glucuronide conjugate); fecal: 3%; biliary: negligible
Category D/X
Category C
Anticonvulsant
Anticonvulsant
"The metabolism of Fluconazole can be decreased when combined with Valproic acid."