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Zonisamide serum concentrations during pregnancy.

Arne Reimers1, Grethe Helde2, Noémi Becser Andersen3

  • 1Dept. of Clinical Pharmacology, St. Olavs University Hospital, Trondheim, Norway; Dept. of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Epilepsy Research
|May 12, 2018
PubMed
Summary

Zonisamide (ZNS) serum concentrations can decrease by over 40% during pregnancy, potentially worsening seizure control in women with epilepsy. Regular monitoring and dose adjustments are recommended.

Keywords:
Antiepileptic drugEliminationEpilepsyPharmacokineticsPregnancySerum concentrationZonisamide

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Area of Science:

  • Pharmacology
  • Neurology
  • Obstetrics

Background:

  • Epilepsy management during pregnancy presents unique challenges.
  • Antiepileptic drugs (AEDs) require careful monitoring in pregnant individuals.

Purpose of the Study:

  • To investigate changes in zonisamide (ZNS) serum concentration during pregnancy.
  • To assess the impact of these changes on seizure control in women with epilepsy.

Main Methods:

  • Retrospective analysis of zonisamide serum concentrations and dose ratios in pregnant women with epilepsy.
  • Comparison of non-pregnant and pregnant values across six hospitals in Norway and Denmark.
  • Collection of seizure control and obstetrical data.

Main Results:

  • Mean ZNS serum concentration decreased to 58.6% of non-pregnant values, with concentration/dose ratios falling to 55.1%.
  • Lowest concentrations were observed between gestational months six and nine, with significant interindividual variability (24-81%).
  • Four of ten previously seizure-free patients experienced breakthrough seizures.

Conclusions:

  • Zonisamide serum concentrations can significantly decrease during pregnancy, necessitating therapeutic drug monitoring.
  • Interindividual variability in ZNS levels may impact seizure control, highlighting the need for dose adjustments.
  • Findings support the use of regular monitoring and dose adjustments for ZNS and other AEDs in pregnant women with epilepsy.