Home Drug Guide Rufinamide

Drug Guide

Generic Name

Rufinamide

Brand Names Banzel

Classification

Therapeutic: Anticonvulsant, Antiepileptic

Pharmacological: Sodium channel blocker

FDA Approved Indications

  • Lennox-Gastaut Syndrome

Mechanism of Action

Rufinamide prolongs the inactive state of voltage-gated sodium channels, stabilizing neuronal membranes and reducing excitability, thereby decreasing seizure activity.

Dosage and Administration

Adult: Initial dose is usually 45 mg/kg/day divided into two doses; the dose can be titrated up to a maximum of 3,200 mg/day based on response and tolerability.

Pediatric: Dosing is weight-based; initial dose of 10-45 mg/kg/day divided twice daily, titrated based on efficacy and tolerability.

Geriatric: Use with caution; start at lower doses and titrate slowly due to potential comorbidities and concomitant medications.

Renal Impairment: Adjust dose in patients with renal impairment; consultation with a nephrologist is advised.

Hepatic Impairment: Use with caution; no specific dose adjustment guidelines established.

Pharmacokinetics

Absorption: Well absorbed with an oral bioavailability of approximately 55%.

Distribution: Binding to plasma proteins is low (~20%).

Metabolism: Metabolized primarily via hydrolysis and oxidation; CYP3A4 involvement is minimal.

Excretion: Excreted mainly via the urine; unchanged and metabolites.

Half Life: Approximately 6 to 10 hours.

Contraindications

  • Hypersensitivity to rufinamide.
  • Severe hepatic impairment.

Precautions

  • Risk of QT shortening; monitor ECG periodically.
  • Teens and children with a history of familial short QT syndrome are at higher risk of arrhythmias.
  • Monitor for signs of hypersensitivity reactions, including rash, fever, lymphadenopathy, and eosinophilia.

Adverse Reactions - Common

  • Dizziness (Frequent)
  • Somnolence (Frequent)
  • Nausea (Frequent)
  • Vomiting (Frequent)
  • Fatigue (Frequent)

Adverse Reactions - Serious

  • QTC shortening leading to arrhythmias (Rare)
  • Serious hypersensitivity reactions (Rare)
  • Liver enzyme elevations (Rare)

Drug-Drug Interactions

  • Combination with other drugs that prolong QT interval may increase risk of arrhythmias.
  • CYP3A4 inducers or inhibitors can alter rufinamide levels.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for seizure frequency and adverse reactions, especially cardiological and hypersensitivity responses.

Diagnoses:

  • Risk for injury related to seizures or adverse drug effects.
  • Knowledge deficit regarding medication use.

Implementation: Administer with food to reduce gastrointestinal upset; Monitor ECG periodically; Educate about adherence and side effects.

Evaluation: Efficacy in seizure control; monitor for adverse reactions and drug interactions.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any signs of rash, fever, hypersensitivity, or cardiac symptoms.
  • Avoid abrupt discontinuation.
  • Be aware of potential side effects like dizziness and somnolence.
  • Use additional contraceptive methods if applicable, as per prescribing info.

Special Considerations

Black Box Warnings:

  • None specifically for rufinamide, but caution with arrhythmogenic risk due to QT effects.

Genetic Factors: Patients with familial short QT syndrome are at increased risk of arrhythmias.

Lab Test Interference: May influence ECGs by causing QT shortening.

Overdose Management

Signs/Symptoms: Dizziness, drowsiness, ataxia, possibly seizures.

Treatment: Supportive care; activated charcoal if recent ingestion; cardiac monitoring for arrhythmias; no specific antidote.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable at room temperature for up to 24 months.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.