From the FDA Drug Label
Zonisamide may cause kidney stones: back pain, stomach pain, or blood in your urine may mean you have kidney stones. Do not take zonisamide if you are allergic to medicines that contain sulfa. The antiepileptic drug that should be avoided in a patient with refractory complex partial seizures, kidney stones, and a sulfa allergy is:
- C Zonisamide (Zonigran), due to the patient's sulfa allergy and the increased risk of kidney stones associated with zonisamide 1, 1.
From the Research
Zonisamide (Zonigran) should be avoided in a patient with refractory complex partial seizures, kidney stones, and a sulfa allergy. This medication is a sulfonamide derivative, which poses a significant risk for patients with sulfa allergies, potentially causing severe allergic reactions 2, 3. Additionally, zonisamide increases the risk of kidney stone formation, making it particularly problematic for patients with a history of nephrolithiasis 2, 3. For this patient, alternative antiepileptic medications such as levetiracetam, lamotrigine, or carbamazepine would be more appropriate choices for managing refractory complex partial seizures. These alternatives do not contain sulfa components and have lower risks of kidney stone formation. The selection of a specific alternative should be based on the patient's complete medical history, concomitant medications, and seizure characteristics to ensure optimal efficacy and safety 4. Some key points to consider when choosing an alternative antiepileptic medication include:
- The patient's history of hypertension, depression, glaucoma, irritable bowel syndrome, and kidney stones
- The patient's allergies to penicillin and sulfas
- The potential for drug interactions with other medications the patient is taking
- The efficacy and safety profile of the alternative medication 5, 6. It is essential to weigh the benefits and risks of each alternative medication and select the one that best meets the patient's individual needs.