Rufinamide | Epilepsy clinician handbook
- 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 atonic epilepsy, structural and genetic related epilepsies.
Possible side effects
- Somnolence and fatigue
- Nausea and vomiting
- Headache
- Dizziness
- Diplopia, blurred vision
- Constipation, diarrhoea
Other notable side effects:
- Less commonly: weight loss, insomnia, anxiety
- Rarely: hypersensitivity reaction (fever, rash, lymphadenopathy, haematuria, deranged liver function tests)
- Decreases QTc interval, therefore patients with coexisting short QT syndrome or family history thereof may be at risk
- All anti-seizure medications are potentially teratogenic and this is often dose related (see section: AED Prescribing - Pregnancy)
- For a complete list of adverse effects, appropriate formularies should be consulted.
Interactions and precautions
- SCN1A-associated disorders (as rufinamide is a sodium channel drug).
- Rufinamide can decrease 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 (see formularies).
- 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.
Weaning
Gradual reduction (over a minimum of a week) minimises the risk of increased seizure frequency or status epilepticus in patients with seizure disorders.
Pregnancy
- All anti-seizure medications are potentially teratogenic and this is often dose related.
- 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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