Ethosuximide

Indications
 Oral
Absence seizures
Adult: Initially, 500 mg daily, may increase in steps of 250 mg at intervals of 4-7 days. Usual dose: 1-1.5 g daily. Optimum plasma concentration: 40-100 mg/L (300-700 micromol/L). Max: Up to 2 g in some patients. Strict supervision is recommended if dose >1.5 g daily.
Child: <6 yr: Initially, 250 mg daily, may increase gradually to usual dose of 20 mg/kg daily. ≥6 yr: Initially, 500 mg daily, may increase in steps of 250 mg at intervals of 4-7 days. Usual dose: 1-1.5 g daily. Max: <6 yr: Up to 1 g/day and ≥6 yr: 2 g/day .
Max Dosage:
Contraindications
 Hypersensitivity. Pregnancy and lactation.
Warnings / Precautions
 Hepatic or renal impairment, porphyria. Complete blood cell count, liver function tests, and urinalysis should be performed periodically. May increase the risk of grand mal seizures when used alone in mixed types of epilepsy. Avoid sudden withdrawal. May impair ability to drive or operate machinery.
Adverse Reactions
 Blood toxicities and disorders; headache, fatigue, lethargy, drowsiness, dizziness, ataxia, hiccup and mild euphoria; more rarely, psychotic states, rashes, hepatic and renal changes, and haematological disorders. SLE, erythema multiforme. Gum hypertrophy, swelling of tongue, irritability, hyperactivity, sleep disturbances, night terrors, inability to concentrate, aggressiveness, increased libido, myopia, vag bleeding.
Drug Interactions
 Isoniazid may increase the serum concentration of ethosuximide, leading to toxicity. Antipsychotics, antidepressants, MAOIs, and mefloquine may antagonise anticonvulsant effects of ethosuximide. Plasma conc of ethosuximide may be reduced by carbamazepine, phenobarbital, phenytoin, and primidone; and affected by valproate. Chloroquine or hydroxychloroquine may increase risk of convulsions. Isoniazid.
See Below for More ethosuximide Drug Interactions
Mechanism of Actions
 Ethosuximide is used mainly in the management of absence (petite mal) seizures. It is usually ineffective in the management of partial seizures with complex symptomatology or tonic-clonic seizures.
Absorption: Readily absorbed from the GI tract.
Distribution: Widely distributed throughout the body, but not significantly bound to plasma proteins.
Metabolism: Extensively hydroxylated in the liver to its principal metabolite which is inactive.
Excretion: Excreted in the urine mainly as metabolite, either free or conjugated.
Administration
 May be taken with or without food.
ATC Classification
 N03AD01 - ethosuximide ; Belongs to the class of succinimide derivatives antiepileptics.
Available As
  • Ethosuximide 250 mg
  • Ethosuximide 50 mg

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