zonegran, question about/why it works

[krashleen]

I guess this question could be for Pharmacist Steve or Dr Steve.
I am on zonegran(generic) and I take 4 100mg capsules a day. I didn't think it was working, but when I stopped taking it, the burning pain in my back increased measurably, and I needed more narcotic medication to control my pain.

Why is that? I hadn't had any luck with the gabapentin, lyrica even though I have neuropathic pain in my hands/feet.

Anyone else on zonegran? Does it work as well for anyone else? It's in the anti-convulsant family and it helps with headaches, burning pain in my back.

thanks so much.

[Pharmacist.steve]

Mechanism of Action: The precise mechanism(s) by which zonisamide exerts its antiseizure effect is unknown.

This is from the package literature... because it works on seizures as does Neurontin... your doc has went off-label to see if it worked... apparently in your case.. it does

[krashleen]

You made me smile...Thanks Steve.

I knew that, but I was curious as to the 'whys'

[lobelsteve]

It likely has a modulating effect on voltage dependent sodium channels in the peripheral nad central neurons. THis limits the ability of the individual nerves to fire action potentials to let you know you hurt.

You still have the nociceptive input via neuropathic fibers, but the med helps make the impulse not reach the thalamus.

[krashleen]

Interesting.
so I did a search. Would depakote provide the same type of modulating effect? Just curious.

[Gymnast_Navy_Wife]

Hi--
Good Question about the Depakote.... I was on it 14 years for my seizures (just got off it in March), but never noticed that it did anything for the nerve pain. I think I may have some Allodynia as a side effect from the Depakote--- but thats one of those "debatelble" type things--as allodynia/nerve pain didn't develop till after I'd been on depakote a while and has not abated any since getting off it....

I'll be interested to see what the professionals and others on the boards have to say about it....

:) GNW

[BrokenBladder]

Krashleen,

I don't know anything about this medication but I know that my doctor has gone off label to try and help with some of my issues.

Good luck to you and I hope you get the pain relief you need.

[Kathi49]

Interesting thread. And I agree good question about Depakote. I was on it for awhile but, to me, it was worse than Neurontin in the way of SE's. GNW I would be interested too in seeing what anyone has to say about Allodynia.

[twotoejoe]

I've been on zonegran for about 9 months or so now. It seems to help the severe PN pain in my feet as much as anything. Along with 20mg oxycotin 3x daily, I get pretty decent relief most of the time. I've tried most everything else. First neurontin, then topomax which I was on for years. The topomax worked good, but when some of the newer meds came out, my pain doc wanted to give them a try. Then we tried Lyrica, cymbalta, keppra, and some others I can't remember. When I tried to go back on topomax, even though we gradually went up on the dose, it made me sick as a dog. I'm on 100mg 4x a day also.

[krashleen]

Well, I went to the PM doc a couple of days ago, and he said that the formulation of the depakote is different, different receptors in the brain, of course Pharmacist Steve and Dr Steve KNEW this, but I wondered nonetheless.

So, we stuck with the zonegran, generic. We upped by one 100mg capsule a day. I truly believe that this keeps my tolerance in check.
Like you twotoejoe, I am on the same amount of oxycontin, have PN along with back pain, neck pain, chiari HA's..and a cervical fusion from the skull to c-4.

Its not fun being in pain. But I love my doc. He is compassionate and wonderful and explains things fairly well to me.