Yes

Anticonvulsant, Succinimide

Management of absence (petit mal) seizures

C

Hypersensitivity to ethosuximide

Use with caution in patients with hepatic or renal disease; abrupt withdrawal of the drug may precipitate absence status; ethosuximide may increase tonic-clonic seizures in patients with mixed seizure disorders; ethosuximide must be used in combination with other anticonvulsants in patients with both absence and tonic-clonic seizures

Central nervous system: Ataxia, drowsiness, sedation, dizziness, lethargy, euphoria, headache, irritability, hyperactivity, fatigue, night terrors, disturbance in sleep, inability to concentrate, aggressiveness, mental depression, paranoid psychosis

Dermatologic: Stevens-Johnson syndrome, SLE, rash, hirsutism

Endocrine & metabolic: Increased libido

Gastrointestinal: Weight loss, gastric upset, cramps, epigastric pain, diarrhea, nausea, vomiting, anorexia, abdominal pain

Genitourinary: Vaginal bleeding, microscopic hematuria

Hematologic: Leukopenia, agranulocytosis, pancytopenia, eosinophilia

Ocular: Myopia

Miscellaneous: Hiccups

Acute overdose can cause CNS depression, ataxia, stupor, coma, hypotension. Chronic overdose can cause skin rash, confusion, ataxia, proteinuria, hepatic dysfunction, and hematuria. Treatment is supportive. Hemoperfusion and hemodialysis may be useful.

CYP3A3/4 enzyme substrate; CYP3A3/4 enzyme inducer

Isoniazid may inhibit hepatic metabolism of ethosuximide with a resultant increase in ethosuximide serum concentrations

Ethosuximide may elevate phenytoin levels

Valproate acid has been reported to both increase and decrease ethosuximide levels

Increases the seizure threshold and suppresses paroxysmal spike-and-wave pattern in absence seizures; depresses nerve transmission in the motor cortex

Serum half-life:

Children: 30 hours

Adults: 50-60 hours

Time to peak serum concentration:

Capsule: Within 2-4 hours

Syrup: <2-4 hours

Oral:

Children >6 years and Adults: Initial: 250 mg twice daily; increase by 250 mg as needed every 4-7 days up to 1.5 g/day in 2 divided doses; usual maintenance dose: 20-40 mg/kg/day in 2 divided doses

Increase dietary intake of folate; may be administered with food or milk; alcohol: additive CNS depression has been reported with succimides; avoid or limit alcohol

Take with food or milk to avoid GI upset

May cause sedation, euphoria, insomnia, or hallucinations; may rarely cause depression

Barbiturates and carbamazepine may decrease the clinical effects of ethosuximide

No information available to require special precautions

No effects or complications reported

Take exactly as directed (do not increase dose or frequency or discontinue without consulting prescriber). While using this medication, do not use alcohol and other prescription or OTC medications (especially pain medications, sedatives, antihistamines, or hypnotics) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience drowsiness, dizziness, or blurred vision (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea, vomiting, loss of appetite, or dry mouth (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); constipation (increased exercise, fluids, or dietary fruit and fiber may help). Wear identification of epileptic status and medications. Report CNS changes, mentation changes, or changes in cognition; muscle cramping, weakness, tremors, or changes in gait; persistent GI symptoms (cramping, constipation, vomiting, anorexia); rash or skin irritations; unusual bruising or bleeding (mouth, urine, stool); worsening of seizure activity, or loss of seizure control. Pregnancy precautions: Inform prescriber if you are or intend to be pregnant.

Monitor CBC, platelets, liver enzymes, trough ethosuximide serum concentration; observe patient for excess sedation; maintain serum levels; monitor for bruising and bleeding

Capsule: 250 mg

Syrup (raspberry flavor): 250 mg/5 mL (473 mL)

Marbury TC, Lee CS, Perchalski RJ, et al, "Hemodialysis Clearance of Ethosuximide in Patients With Chronic Renal Disease," Am J Hosp Pharm, 1981, 38(11):1757-60.

Marquardt ED, Ishisaka DY, Batra KK, et al, "Removal of Ethosuximide and Phenobarbital by Peritoneal Dialysis in a Child," Clin Pharm, 1992, 11(12):1030-1.