Rufinamide

Actions

• Incompletely understood
• Might stabilize the Na+ channel inactive state

Metabolism

Hepatic

Enzymes involved

• Carboxylesterase-mediated hydrolysis
• No CYP involved.

Elimination

Renal ~91%

Half-life

6-10 hours

Plasma protein binding

35%

Important side-effects

Suicidal behavior and ideation

QT shortening.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).

Leukopenia.

Indications

Adjunctive treatment of seizures associated with Lennox-Gastaut Syndrome

Dosing recommendation

Start with 400 to 800 mg/day divided in two doses.

Increase by 400-800 mg every other day.

Maximum dose is 3200 mg/day divided in two doses.

Renal impairment

No adjustment is necessary in patients with moderate or severe impairment of renal function but dose adjustment in patients undergoing dialysis should be considered.

Hepatic impairment

Rufinamide is not recommended in patients with severe hepatic impairment (Child-Pugh score 10 to 15). Caution should be exercised in treating patients with mild (Child-Pugh score 5 to 6) to moderate (Child-Pugh score 7 to 9) hepatic impairment.