Anyone have experience prescribing Zonegran for neuropathic pain? I have a patient with MS complaining of significant thoracic spine pain, with bilateral radicular features, not clearly localized to a single dermatome. MRI was not very helpful, as they were not able to establish IV access for contrast, so no clear documentation of MS lesions in the thoracic spine. Otherwise negative for any significant pathology, such as compression fracture. Failed thoracic ESI in past (not by me). Has failed many meds, including gabapentin, amitriptyline, Lyrica, etc. He is on baclofen 40mg total per day, with no clinically significant spasticity (I assume the baclofen is keeping it under control), so not in need of intrathecal baclofen. TENS helps a little, but not when pain is severe. We thought we had some success with clonidine 0.2mg BID initially, but maybe more of a placebo effect, as benefit was short lived. His PCP casually suggested trying Zonegran. Another option at this point woud be Tegretol, but that would require CBC monitoring. I looked up Zonegran and it seems there is a risk of metabolic acidosis, so bicarb monitoring is suggested, although I don't know how often, and whether or not this is necessary? Thoughts? Thanks!
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Zonegran (zonisamide)
- Thread starter ctts
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Anyone have experience prescribing Zonegran for neuropathic pain? I have a patient with MS complaining of significant thoracic spine pain, with bilateral radicular features, not clearly localized to a single dermatome. MRI was not very helpful, as they were not able to establish IV access for contrast, so no clear documentation of MS lesions in the thoracic spine. Otherwise negative for any significant pathology, such as compression fracture. Failed thoracic ESI in past (not by me). Has failed many meds, including gabapentin, amitriptyline, Lyrica, etc. He is on baclofen 40mg total per day, with no clinically significant spasticity (I assume the baclofen is keeping it under control), so not in need of intrathecal baclofen. TENS helps a little, but not when pain is severe. We thought we had some success with clonidine 0.2mg BID initially, but maybe more of a placebo effect, as benefit was short lived. His PCP casually suggested trying Zonegran. Another option at this point woud be Tegretol, but that would require CBC monitoring. I looked up Zonegran and it seems there is a risk of metabolic acidosis, so bicarb monitoring is suggested, although I don't know how often, and whether or not this is necessary? Thoughts? Thanks!
Had a few patients on this in fellowship that failed the above that you mentioned including topamax.
Never really did Bicarb monitoring. We generally start and maintain patients on such low doses anyways.