Ethosuximide interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  4 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Conditions

Conditions in which Ethosuximide needs care, as documented in this source.

• Hematologic Diseases

  Major

  Hematologic toxicities, some with fatal outcome, have been associated with the use of succinimide anticonvulsants. Leukopenia, agranulocytosis, aplastic anemia, thrombocytopenia, pancytopenia, and eosinophilia have been reported. Therapy with succinimide anticonvulsants should be administered cautiously in patients with preexisting blood dyscrasias and/or bone marrow suppression. Complete blood counts, including platelets, should be performed prior to initiating therapy and periodically during therapy. Marked depression of blood counts may be indication for withdrawal of succinimide therapy.

  6 sources

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. Seip M "Aplastic anemia during ethosuximide medication. Treatment with bolus- methylprednisolone." Acta Paediatr Scand 72 (1983): 927-9
  3. Massey GV, Dunn NL, Heckel JL, Myer EC, Russell EC "Aplastic anemia following therapy for absence seizures with ethosuximide." Pediatr Neurol 11 (1994): 59-61
  4. "Product Information. Zarontin (ethosuximide)." Parke-Davis (2001):
  5. "Product Information. Milontin (phensuximide)." Parke-Davis (2001):
  6. "Product Information. Celontin (methsuximide)." Parke-Davis

• Liver Diseases

  Major

  Succinimide anticonvulsants have produced morphological and functional changes in the liver of animals. In humans, abnormalities in liver and renal function studies have been reported. Therapy with succinimide anticonvulsants should be administered with extreme caution in patients with known hepatic or renal diseases. Periodic urinalysis and liver function tests are recommended for all patients treated with these drugs.

  6 sources

  1. Silverman SH, Gribetz D, Rausen AR "Nephrotic syndrome associated with ethosuccimide." Am J Dis Child 132 (1978): 99
  2. Coulter DL "Ethosuximide-induced liver dysfunction." Arch Neurol 40 (1983): 393-4
  3. Korinthenberg R, Wehrle L, Zimmerhackl LB "Renal tubular dysfunction following treatment with anti-epileptic drugs." Eur J Pediatr 153 (1994): 855-8
  4. "Product Information. Zarontin (ethosuximide)." Parke-Davis (2001):
  5. "Product Information. Milontin (phensuximide)." Parke-Davis (2001):
  6. "Product Information. Celontin (methsuximide)." Parke-Davis

• Lupus Erythematosus, Systemic

  Major

  Cases of systemic lupus erythematosus (SLE) have been reported in association with the use of succinimide anticonvulsants, primarily ethosuximide. Some of the patients recovered promptly following discontinuation of the drug, while others continued to have active disease long after. Therapy with succinimide anticonvulsants should be administered cautiously in patients with a history of SLE.

  9 sources

  1. Teoh PC, Chan HL "Lupus-scleroderma syndrome induced by ethosuximide." Arch Dis Child 50 (1975): 658-61
  2. Beernink DH, Miller JJ 3d "Anticonvulsant-induced antinuclear antibodies and lupus-like disease in children." J Pediatr 82 (1973): 113-7
  3. Alter BP "Systemic lupus erythematosus and ethosuccimide." J Pediatr 77 (1970): 1093-5
  4. Dabbous IA, Idriss HM "Occurrence of systemic lupus erythematosus in association with ethosuccimide therapy. Case report." J Pediatr 76 (1970): 617-20
  5. Livingston S, Rodriguez H, Greene CA, Pauli LL "Systemic lupus erythematosus. Occurrence in association with ethosuximide therapy." JAMA 203 (1968): 731-2
  6. Singsen BH, Fishman L, Hanson V "Antinuclear antibodies and lupus-like syndromes in children receiving anticonvulsants." Pediatrics 57 (1976): 529-34
  7. "Product Information. Zarontin (ethosuximide)." Parke-Davis (2001):
  8. "Product Information. Milontin (phensuximide)." Parke-Davis (2001):

  Show all 9 sourcesShow fewer sources

  9. "Product Information. Celontin (methsuximide)." Parke-Davis

• Depressive Disorder

  Moderate

  Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

  16 sources

  1. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals (2002):
  2. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  3. "Product Information. Dilantin (phenytoin)." Parke-Davis (2001):
  4. "Product Information. Cerebyx (fosphenytoin)." Parke-Davis (2001):
  5. "Product Information. Mysoline (primidone)." Elan Pharmaceuticals (2001):
  6. "Product Information. Lyrica (pregabalin)." Pfizer U.S. Pharmaceuticals Group (2005):
  7. "Product Information. Sabril (vigabatrin)." Lundbeck Inc (2009):
  8. "Product Information. Potiga (ezogabine)." GlaxoSmithKline (2011):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Qsymia (phentermine-topiramate)." Vivus Inc (2012):
  10. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  11. "Product Information. Briviact (brivaracetam)." UCB Pharma Inc (2016):
  12. "Product Information. Diacomit (stiripentol)." Biocodex USA (2018):
  13. "Product Information. Epidiolex (cannabidiol)." Greenwich Biosciences LLC (2018):
  14. "Product Information. Xcopri (cenobamate)." SK Life Science, Inc. (2020):
  15. "Product Information. Fintepla (fenfluramine)." Zogenix, Inc (2020):
  16. "Product Information. Ztalmy (ganaxolone)." Marinus Pharmaceuticals, Inc (2022):

• Diseases requiring dialysis

  Moderate

  Ethosuximide has been shown to be removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

  1 source

  1. Marbury TC, Lee CSC, Perchalski RJ, Wilder BJ "Hemodialysis clearance of ethosuximide in patients with chronic renal disease." Am J Hosp Pharm 38 (1981): 1757-60