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Rufinamide

USAGE:

  • Rufinamide is primarily used as adjunctive treatment for drug resistant seizures in Lennox-Gastaut syndrome, particularly for drop attacks.
  • It has also been used in other drug resistant epilepsies, for example: myoclonic astatic epilepsy, structural and genetic related epilepsies.

 

SIDE EFFECTS:   

Common side-effects:

  • Sleepiness
  • Vomiting
  • Headache
  • Dizziness
  • Fatigue
  • Nausea
  • Constipation
  • Diarrhoea
  • Blurred vision

 

Other notable side effects:

  • Less commonly: weight loss, insomnia, anxiety
  • Rarely: hypersensitivity reaction (fever, rash, lymphadenopathy, haematuria, deranged liver function tests)
  • All anticonvulsants are potentially teratogenic and this is often dose related (see section: Pregnancy and AEDs)
  • For a complete list of adverse effects, appropriate formularies should be consulted

 

 

DOSING:

  • The initiation and escalation dose depends upon age, weight, syndrome, seizure frequency and severity, and side effect profile.
  • Effective and safe doses vary. Unfortunately, a one dose regime does not fit all.
  • A Paediatric Neurologist should be consulted if there is uncertainty.

 

A commonly used regime is below:

  • Initial dose: 10mg/kg/day given in 2 divided doses
  • For escalation dosage, titration of 5-10 mg/kg/day per week or fortnight is reasonable to minimise side-effects.
  • A recommended maintenance dose is 20-45 mg/kg/day
  • Dosages per kilogram can only be used in children of weight approximately up to 30-40kgs. Consult appropriate formularies for higher weights and in the adult range.
  • These dosages are only a guideline and appropriate formularies should be consulted as needed.

 

 

 

PREPARATIONS:

  • Tablets: 200mg and 400mg tablets. These may be crushed and given with water.
  • Oral suspension: 40mg/mL

 

Weaning

  • Gradual reduction (over a minimum of a week) minimises the risk of increased seizure frequency or status epilepticus in patients with seizure disorders.

 

CONTRAINDICATIONS

  • SCN1A associated disorders.
  • Rufinamide can cause decrease of the QT interval. An ECG before starting treatment may be necessary and it should not be given to patients with a history of congenital short QT interval.

 

PRECAUTIONS:

  • Co-administration with Sodium Valproate decreases the clearance of Rufinamide therefore lower dosage of Rufinamide is recommended.
  • Conversely, co-administration with enzyme inducing drugs will tend to reduce plasma levels of Rufinamide and a higher dose of Rufinamide may be required.
  • Rufinamide has been associated with a drug hypersensitivity reaction and Stevens-Johnson syndrome. The majority of reported cases have occurred in children <12 years age and within the first 4 weeks of starting Rufinamide therapy.
  • Rufinamide enhances metabolism of oral contraceptives and potentially reduces their effectiveness.

 

Pregnancy

  • All anticonvulsants are potentially teratogenic and this is often dose related (see section: Pregnancy and AEDs)
  • There is limited data on the safety of Rufinamide in pregnancy.
  • Usage in pregnancy needs to be discussed with a neurologist

 

 

 

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This page was last modified in May 2018.