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  • Rufinamide
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Comment

Adjunctive therapy of Lennox Gastaut syndrome.  Potentially valuable drug based on efficacy in LGS trial.  Modest efficacy in partial-onset seizures.

FDA indications

Lennox-Gastaut syndrome - Seizure; Adjunct (4yo and up)

Mechanism

Limits excessive firing of sodium channel-dependent action potentials    

Usual dose

<30 kg: 200-1000 mg/day (200-600 with valproic acid co-medication)

30-50 kg: 400-1800 mg/day

50-70kg: 400--2400 mg/day

>70kg: 400--3200 mg/day

Higher doses have been used, up to 4800 mg/day 

Dose frequency

2x/day

Serum levels

Not usually done

Important interactions

Phenobarbital, carbamazepine, phenytoin, primidone and vigabatrin may cause a slight to moderate decrease in serum rufinamide levels. Valproic acid increases serum rufinamide levels. Rufinamide may slightly decrease the serum levels of carbamazepine and lamotrigine, and increase slightly those of phenytoin and phenobarbital. Rufinamide decreases the serum levels of oral contraceptive steroids and triazolam 

Important side effects

There have been case reports of hypersensitivity reactions. In early trials there was a one-percent incidence of status epilepticus in patients treated with this medication. There were no cases in placebo treated patients.

This medication can decrease that PR interval and is therefore relatively contraindicated in patients who have short QT syndrome, or myocardial disease. The reason for this is patients who have short QT syndrome have a higher risk of sudden death and atrial fibrillation when they're PR interval falls below certain thresholds.

Contraindications

Familial Short QT syndrome; may increase risk of sudden death and ventricular arrhythmias by shortening the QT interval

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