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Succinamides

Succinamides

Definition

Succinamides are a sub-class of anticonvulsants , indicated for the treatment of seizures associated with epilepsy .

Purpose

Although there is no known cure for epilepsy, succinamides are used to control and prevent absence (petit mal) seizures associated with the disorder. Succinamides are most often used in conjunction with other anticonvulsant medications to control other types of seizures (such as other generalized tonic-clonic or grand mal seizures) as part of a comprehensive course of treatment for epilepsy and other disorders.

Description

Succinamides are sold under several names, including ethosuximide (Zarontin) and celontin. Zarontin is the only succinamide that is regularly used in the United States today, as celontin has a higher rate of side effects. Zarontin effectively controls partial seizures, but in some individuals may actually increase the likelihood of generalized seizures. It is often, therefore, prescribed in combination with other anticonvulsants to minimize the chances of generalized seizures.

Recommended dosage

Succinamides are taken orally and are available in tablet or suspension form. For the treatment of epilepsy, succinamides may be taken by both adults and children. Succinamides are prescribed by physicians in varying dosages, but typical total daily dosages range from 250mg to 1.5g.

When beginning a course of treatment that includes succinamides, most physicians recommend a gradual dose-increasing regimen. Patients typically take a reduced dose at the beginning of treatment. The prescribing physician will determine the proper initial dosage, and then will periodically raise the patient's daily dosage until seizure control is achieved.

A double dose of any succinamide should not be taken together. If a daily dose is missed, take it as soon as possible. However, if it is within four hours of the next dose, then skip the missed dose. Physicians typically direct patients to gradually taper their daily dosages when ending treatment that includes succinamides. Stopping the medicine suddenly may cause seizures to return, occur more frequently, or become more severe.

Precautions

A physician should be consulted before taking succinamides with certain non-prescription medications. Persons should avoid alcohol and CNS depressants (medicines that can make one drowsy or less alert, such as antihistimines, sleep medications, and some pain medications) while taking succinimides or any other anticonvulsants. They can exacerbate the side effects of alcohol and other medications. Succinamides are not habit-forming.

A course of treatment including succinamides may not be appropriate for persons with gastrointestinal disorders, stroke , anemia, mental illness, diabetes, high blood presure, angina (chest pain), irregular heartbeats, or other heart problems.

Succinamides may not be suitable for persons with a history of liver or kidney disease. In rare cases, succinamides may cause abnormalities in the blood and abnormal liver or kidney function. Periodic blood, kidney, and liver function tests are advised for all patients using the medicine. To check for rare blood disorders and symptoms of infection, periodic blood tests may be necessary while taking succinamides.

Before beginning treatment with succinamides, patients should notify their physician if they consume a large amount of alcohol, have a history of drug use, are pregnant, nursing, or plan on becoming pregnant. Although succinamides have not been associated with problems during pregnancy, other anticonvulsant medications may cause birth defects. Patients are often advised to use effective birth control while taking succinamides in combination with other anticonvulsants. Women who become pregnant while taking succinamides should contact their physician immediately.

Side effects

Patients should discuss with their physicians the risks and benefits of treatment including succinamides before taking the medication. Succinamides are usually well tolerated, but may case a variety of usually mild side effects. Diziness, nausea, and drowsiness are the most frequently reported side effects. Most side effects do not require medical attention, and usually diminish with continued use of the medication. Possible side effects include:

  • unusual tiredness or weakness
  • clumsiness
  • hiccups
  • loss of appetite
  • nausea, vomiting, stomach cramps

If any symptoms persist or become too uncomfortable, the prescribing physician should be consulted.

Other, uncommon side effects of succinamides can be serious or could indicate an allergic reaction. Patients who experience any of the following symptoms should immediately contact a physician:

  • nightmares and sleeplessness
  • rash or bluish patches on skin
  • persistent nosebleed
  • ulcers or white spots on lips
  • extreme mood or mental changes
  • shakiness or unsteady walking
  • severe unsteadiness or clumsiness
  • speech or language problems
  • difficulty breathing
  • chest pain
  • irregular heartbeat
  • faintness or loss of consciousness
  • severe cramping
  • persistant, severe headaches
  • persistant sore throat, fever, or pain

Interactions

Succinamides may have negative interactions with some antihistimines, antidepressants, antibiotics, and monoamine oxidase inhibitors (MAOIs). Other medications such as Diazepam (Valium), phenobarbital (Luminal, Solfoton), nefazodone, metronidazole, and certain anesthetics may react with succinamides.

Resources

BOOKS

Weaver, Donald F. Epilepsy and Seizures: Everything You Need to Know. Toronto: Firefly Books, 2001.

OTHER

"Ethosuximide Oral." Medline Plus. <http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682327.html> (May 1, 2004).

"Zarontin." RxMed. <http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20Z)/ZARONTIN.html> (May 1, 2004).

ORGANIZATIONS

American Epilepsy Society. 342 North Main Street, West Hartford, CT 06117-2507. <http://www.aesnet.org>.

Epilepsy Foundation. 4351 Garden City Drive, Landover, MD 20785-7223. (800) 332-1000. <http://www.epilepsyfoundation.org>.

Adrienne Wilmoth Lerner

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