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Eisai Ltd

European Knowledge Centre, Mosquito Way, Hatfield, Hertfordshire, AL10 9SN
Telephone: +44 (0)845 676 1400
Fax: +44 (0)845 676 1486
WWW: http://www.eisai.co.uk
Medical Information e-mail: Lmedinfo@eisai.net
Out of Hours Telephone: +44 (0)845 676 1400

Before you contact this company: often several companies will market medicines with the same active ingredient. Please check that this is the correct company before contacting them. Why?

Summary of Product Characteristics last updated on the eMC: 08/10/2013
SPC Zonegran 25, 50, 100 mg Hard Capsules

When a pharmaceutical company changes an SPC or PIL, a new version is published on the eMC. For each version, we show the dates it was published on the eMC and the reasons for change.

Updated on 08/10/2013 and displayed until Current
Reasons for adding or updating:
  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 4.8 - Undesirable effects
  • Change to section 4.8 - Undesirable effects - how to report a side effect
  • Change to section 5.1 - Pharmacodynamic properties
  • Change to section 5.2 - Pharmacokinetic properties
  • Change to section 10 - Date of revision of the text
  • Change to section 4.1 - Therapeutic indications
Date of revision of text on the SPC:   02-Oct-2013
Legal Category:   POM
Black Triangle (CHM):   NO

Free-text change information supplied by the pharmaceutical company



Section 4.1: Addition of paediatric indication as adjunctive therapy.

Section 4.2: Addition of paediatric dosing information.

Section 4.4: Addition of warnings and precautions specifically related to the paediatric

Section 4.5: Addition of clarification of co-medication in the paediatric population.

Section 4.8: Addition of paediatric undesirable effects profile and information regarding reporting of suspected adverse reactions.

Section 5.1: Addition of paediatric pivotal study.

Section 10: Date of revision of text amended to 2nd October 2013.

 

Updated on 26/02/2013 and displayed until 08/10/2013
Reasons for adding or updating:
  • Change to section 4.8 - Undesirable effects
  • Change to section 10 - Date of revision of the text
Date of revision of text on the SPC:   13-Feb-2013
Legal Category:   POM
Black Triangle (CHM):   NO

Free-text change information supplied by the pharmaceutical company

Addition of very rare undesirable effect - Hypersensitivity-type Pneumonitis
Updated on 18/09/2012 and displayed until 26/02/2013
Reasons for adding or updating:
  • Change to section 10 date of revision of the text
  • Removal of Black Triangle
Date of revision of text on the SPC:   11-Sep-2012
Legal Category:   POM
Black Triangle (CHM):   NO

Free-text change information supplied by the pharmaceutical company

Confirmation from MHRA that Zonegran will no longer require a Black Triangle
Updated on 08/08/2012 and displayed until 18/09/2012
Reasons for adding or updating:
  • Change to section 4.8 - Undesirable Effects
Date of revision of text on the SPC:   23-Jul-2012
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

In section 4.8 (undesirable effects), alopecia has been added.
Updated on 06/07/2012 and displayed until 08/08/2012
Reasons for adding or updating:
  • Change to section 4.1 - Therapeutic indications
  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.8 - Undesirable Effects
  • Change to section 5 - Pharmacological Properties
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   27-Jun-2012
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company



The monotherapy indication was approved as a Type II line extension variation (addition of a new indication) to Zonegran SmPC Sections updated: 4.1, 4.4, 4.8 and 5.1.

 

Also section 1 and 3 of the PIL for the capsule were updated as well.

Updated on 14/05/2012 and displayed until 06/07/2012
Reasons for adding or updating:
  • Change to section 4.8 - Undesirable Effects
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   30-Mar-2012
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

Section 4.8, Undesirable Effects
'Pruritis' changed from very rare to common
'Oedema peripheral' added as a common undesirable effect

Added in section 4.8
A pooled analysis of safety data on 95 elderly subjects has shown a relatively higher reporting frequency of oedema peripheral and pruritus compared to the adult population.
Updated on 03/02/2012 and displayed until 14/05/2012
Reasons for adding or updating:
  • Change to section 4.8 - Undesirable Effects
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   16-Jan-2012
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company



Two additional very rare undesirable effects have been added to section 4.8

 

Drug-induced hypersensitivity syndrome and drug rash with eosinophilia and systemic symptoms.

 

Updated on 07/12/2011 and displayed until 03/02/2012
Reasons for adding or updating:
  • Improved Electronic Presentation
Date of revision of text on the SPC:   20-Jun-2011
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

None provided
Updated on 05/12/2011 and displayed until 07/12/2011
Reasons for adding or updating:
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 9 - Date of first Authorisation/renewal of the Authorisation
Date of revision of text on the SPC:   21-Nov-2011
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

Section 4.5 - Removal of interactions with carbamazepine, phenobarbital, phenytoin, vigabatrin and primidone
Section 9 - Update of date of renewal
Other minor changes
Updated on 08/07/2011 and displayed until 05/12/2011
Reasons for adding or updating:
  • Change to section 4.4 - Special warnings and precautions for Use
Date of revision of text on the SPC:   20-Jun-2011
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

In section 4.4 the wording 'as osteopenia may develop' has been added to the paragraph regarding metabolic acidosis
Updated on 20/08/2010 and displayed until 08/07/2011
Reasons for adding or updating:
  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.6 - Pregnancy and Lactation
  • Change to section 5.1 - Pharmacodynamic Properties
Date of revision of text on the SPC:   27-Jul-2010
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

Slight changes and re-ordering of wording, no change in meaning following type IA variation
Updated on 15/04/2010 and displayed until 20/08/2010
Reasons for adding or updating:
  • Change to section 5.2 - Pharmacokinetic Properties
Date of revision of text on the SPC:   16-Mar-2010
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company



Additional wording in bold, deleted text crossed out:

Children and Adolescents (512-18 years): Limited data indicate that pharmacokinetics in children and adolescents dosed to steady state at 1, 7 or 12 mg/kg daily, in divided doses, are similar to those observed in adults, after adjustment for bodyweight.

Updated on 11/01/2010 and displayed until 15/04/2010
Reasons for adding or updating:
  • Change to section 2 - Qualitative and quantitative composition
  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.3 - Contraindications
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 4.6 - Pregnancy and Lactation
  • Change to section 4.7 - Effects on Ability to Drive and Use Machines
  • Change to section 9 - Date of first Authorisation/renewal of the Authorisation
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   21-Dec-2009
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company



In addition to minor formatting changes, please see below a summary of changes:

 

Section 2: Qualitative and quantitative composition

 

The following sentence has been added:

 

“100mg: Excipients: 0.002 mg of sunset yellow FCF (E110) and 0.147 mg of allura red AC (E129).”

 

Section 4.2: Posology and method of administration

 

Children and adolescents

 

The wording has been amended to read:

 

“Zonegran is not recommended for use in children below 18 due to insufficient data on safety and efficacy.” 

 

Section 4.3: Contraindications

 

The word “zonisamide has been changed to “the active substance”

 

Section 4.4: Special warnings and precautions for use

 

In the second paragraph, the word “medications” has been changed to “medicines”

In the fifth and eighth paragraphs, the word “drugs” has been changed to “medicinal products”

 

Section 4.5: Interaction with other medicinal products and other forms of interaction

 

In the second paragraph, the word “drugs” has been changed to “medicinal products”

Carbonic anhydrase inhibitors

The wording has been amended to read:

“Zonegran should be used with caution in patients treated concomitantly with carbonic anhydrase inhibitors such as topiramate, as there are insufficient data to rule out a possible pharmacodynamic interaction (see section 4.4).”

In the fifth paragraph, the first mention of the word “drugs” has been changed to “substances” and the second mention to “medicinal products”

 

Section 4.6: Pregnancy and lactation

 

In the third paragraph, the word “drug” has been changed to “medicinal product”

 

Section 4.7: Effects on ability to drive and use machines

 

The wording has been amended to read:

 

“No studies on the effects on the ability to drive and use machines have been performed. However, given that some patients may experience drowsiness or difficulty with concentration, particularly early in treatment or after a dose increase, patients must be advised to exercise caution during activities requiring a high degree of alertness, e.g., driving or operating machines.”

 

 

The date of renewal of the authorisation and revision of text has been updated to 21 December 2009

 

Updated on 20/07/2009 and displayed until 11/01/2010
Reasons for adding or updating:
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.8 - Undesirable Effects
  • Change to section 6. 5 - Nature and Contents of Container
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   01-Jul-2009
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

Section 4.4 Special warnings and precautions for use

Additon of the following information:

Hyperchloraemic, non-anion gap, metabolic acidosis (i.e. decreased serum bicarbonate below the normal reference range in the absence of chronic respiratory alkalosis) is associated with Zonegran treatment. This metabolic acidosis is caused by renal bicarbonate loss due to the inhibitory effect of zonisamide on carbonic anhydrase. Such electrolyte imbalance has been observed with the use of Zonegran in placebo-controlled clinical trials and in the post-marketing period. Generally, zonisamide-induced metabolic acidosis occurs early in treatment although cases can occur at any time during treatment.  The amounts by which bicarbonate is decreased are usually small – moderate (average decrease of approximately 3.5 mEq/ L at daily doses of 300 mg in adults); rarely patients can experience more severe decreases. Conditions or therapies that predispose to acidosis (such as renal disease, severe respiratory disorders, status epilepticus, diarrhoea, surgery, ketogenic diet, or drugs) may be additive to the bicarbonate lowering effects of zonisamide.

           

The risk of zonisamide induced metabolic acidosis appears to be more frequent and severe in younger patients. Appropriate evaluation and monitoring of serum bicarbonate levels should be carried out in patients taking zonisamide who have underlying conditions which might increase the risk of acidosis, in patients who are at an increased risk of adverse consequences of metabolic acidosis and in patients with symptoms suggestive of metabolic acidosis. If metabolic acidosis develops and persists, consideration should be given to reducing the dose or discontinuing Zonegran (by gradual discontinuation or reduction of a therapeutic dose). If the decision is made to continue patients on Zonegran in the face of persistent acidosis, alkali treatment should be considered.


Section 4.8 Undesirable effects

Addition of 'Renal tubular acidosis' as a 'very rare' metabolism and nutrition disorders.


Section 6.5 - Nature of packaging

 

The composition of the immediate packaging materials of the finished product is being changed from a PVC/PCTFE/Aluminium to PVC/PVDC/Aluminium foil blister. This section of the SmPC now states:

25 mg:   PVC/PVDC/Aluminium foil blisters, packs of 14, 28, 56 and 84 hard capsules.
50 mg:   PVC/PVDC/Aluminium foil blisters, packs of 14, 28, 56 and 84 hard capsules.
100 mg: PVC/PVDC/aluminium foil blisters, packs of 28, 56, 84, 98 and 196 hard capsules.

Section 10 Date of revision of text

Updated to: July 2009

Updated on 17/04/2009 and displayed until 20/07/2009
Reasons for adding or updating:
  • Change to section 10 date of revision of the text
  • Change to MA holder contact details
Date of revision of text on the SPC:   01-Mar-2009
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company



 

Section 7: Marketing authorisation

 

The MA address has been updated to:

 

Eisai Limited, European Knowledge Centre, Mosquito Way, Hatfield, Herts, AL10 9SN, UK

 

Section 10: Date of revision of text

 

The date of revision of text has been updated to March 2009

Updated on 19/02/2009 and displayed until 17/04/2009
Reasons for adding or updating:
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.8 - Undesirable Effects
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   11-Feb-2009
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company



Changes to the Zonegran Summary of Product Characteristics (SmPC) February 2009

 

Section 4.4 - Special warnings and precautions for use’

 

Addition of the following statement regarding suicide ideation and behaviour:

 

Suicidal ideation and behaviour have been reported in patients treated with anti-epileptic agents in several indications. A meta-analysis of randomised placebo-controlled trials of anti-epileptic drugs has also shown a small increased risk of suicidal ideation and behaviour.  The mechanism of this risk is not known and the available data do not exclude the possibility of an increased risk for Zonegran. 

 

Therefore patients should be monitored for signs of suicidal ideation and behaviours and appropriate treatment should be considered.  Patients (and caregivers of patients) should be advised to seek medical advice should signs of suicidal ideation or behaviour emerge.

 

Section 4.7 - Undesirable effects

 

Addition of Toxic epidermal necrolysis as a very rare side effect to the skin and subcutaneous tissue disorders section of the undesirable effects.

 

 

Section 10 – Date of revision of text

 

Date of revision updated to 02/2009

Updated on 15/07/2008 and displayed until 19/02/2009
Reasons for adding or updating:
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.8 - Undesirable Effects
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   31-Mar-2008
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company



Zonegran SmPC changes – March 2008

 

4.4         Special warnings and precautions for use

 

There has been additional text added to the warning regarding immune based adverse reactions associated with medicinal products containing a sulphonamide:

 

Zonegran is a benzisoxazole derivative, which contains a sulphonamide group. Serious immune based adverse reactions that are associated with medicinal products containing a sulphonamide group include rash, allergic reaction and major haematological disturbances including aplastic anaemia, which very rarely can be fatal.

 

4.8         Undesirable effects

 

Addition of information regarding  Zonegran being a benzisoxazole derivative:

 

It should be noted that Zonegran is a benzisoxazole derivative, which contains a sulphonamide group. Serious immune based adverse reactions that are associated with medicinal products containing a sulphonamide group include rash, allergic reaction and major haematological disturbances including aplastic anaemia, which very rarely can be fatal (see Section 4.4).

 

Change from > to ≥ in the definition of frequencies of adverse event for very common, common, uncommon and rare

 

very common

1/10

common

1/100 < 1/10

uncommon

1/1,000 < 1/100

rare

1/10,000 < 1/1,000

very rare

< 1/10,000 including isolated reports

 

 

 

There have been the following changes to the adverse event table:

 

Addition of ecchymosis as a common blood and lymphatic system disorder.

 

Deletion of insomnia and psychotic disorder as uncommon psychiatric disorders.

 

Addition of affect lability, anxiety, insomnia, psychotic disorder as common sychiatric Disorders.

 

 Addition of bradyphrenia, nystagmus, paraesthesia and tremor as common nervous system disorders.

 

Addition of status epilepticus as a very rare nervous system disorder.

 

Addition of constipation and dyspepsia as common gastrointestinal disorders.

 

Addition of nephrolithiasis as a common renal and urinary disorder.

 

Deletion of nephrolithiasis as an uncommon renal and urinary disorder.

 

Renal failure insufficiency changed to renal failure as a very rare renal and urinary disorders.

 

Addition of fatigue and influenza-like illness as common general disorders and administration site conditions.

 

Addition of decreased bicarbonate as a very common investigations adverse reaction.

 

Addition of blood creatinine increased as a very rare investigations adverse reaction.

 

Addition of information on special populations:

 

Additional information on special populations:

 

Review of post-marketing data suggests that patients aged 65 years or older report a higher frequency than the general population of the following events: Stevens-Johnson syndrome (SJS) and Drug Induced Hypersensitivity syndrome (DIHS).

 

10.   DATE OF REVISION OF THE TEXT  

 

Date of revision of text changed to:

 

31 March 08

 

 

 

Updated on 06/02/2008 and displayed until 15/07/2008
Reasons for adding or updating:
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   10/2007
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

  

Section 4.4 - Special warnings and precautions for use

Minor textual changes

Section 4.5 - Interaction with other medicinal products and other forms interactions

Effect of Zonegran on cytochrome P450 enzymes

2B6, 2C8, added

New information on interaction studies of zonisamide with drugs that are P-gp substrates:

P-gp substrate  An in vitro study shows that zonisamide is a weak inhibitor of P-gp (MDR1) with an IC50 of 267 µmol/L and there is the theoretical potential for zonisamide to affect the pharmacokinetics of drugs which are P-gp substrates.  Caution is advised when starting or stopping zonisamide treatment or changing the zonisamide dose in patients who are also receiving drugs which are P-gp substrates (e.g. digoxin, quinidine).

Updated on 14/05/2007 and displayed until 06/02/2008
Reasons for adding or updating:
  • Change to section 2 - Qualitative and quantitative composition
  • Change to section 4.4 - Special warnings and precautions for Use
  • Change to section 4.6 - Pregnancy and Lactation
  • Change to section 4.8 - Undesirable Effects
  • Change to section 6. 5 - Nature and Contents of Container
  • Change to section 6. 6 - Instructions for use, handling and disposal
  • Change to section 10 date of revision of the text
Date of revision of text on the SPC:   03/2007
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

Section 2 - QUALITATIVE AND QUANTITATIVE COMPOSITION

Changed to: For a full list of excipients, see section 6.1.

 

Section 4.4 - Special warnings and precautions for use

The following statement: “Serious rashes have occurred in association with Zonegran therapy, including cases of Stevens‑Johnson syndrome” has been moved from the 4th paragraph to the start of this section in bold type in a box. Also the word ‘isolated’ has been removed.

   

Section 4.6- Pregnancy and lactation

This section now reads: (new information in bold)

Zonegran must not be used during pregnancy unless clearly necessary, in the opinion of the physician, and only if the potential benefit is considered to justify the risk to the foetus…

 

Specialist advice should be given to women who are likely to become pregnant in order to consider the optimal treatment during pregnancy. Women of childbearing potential should be given specialist advice regarding possible effects of Zonegran on the foetus and the risk should be discussed with the patient in relation to the benefits before starting treatment.  The risk of birth defect is increased by factor 2 to 3 in the offspring of mothers treated with an antiepileptic medication. The most frequently reported are cleft lip, cardiovascular malformations and neural tube defect. Multiple antiepileptic drug therapy may be associated with a higher risk of congenital malformations than monotherapy.

 

Women of childbearing potential must use adequate contraception during treatment with Zonegran, and for one month after discontinuation.

 

Section 4.8- Undesirable effects

“Suicidal ideation” has moved from “very rare” to “uncommon”

 

The following have been added to the “uncommon” section:

“Anger”, “Aggression” & “Suicidal attempt”

 

“Abnormal pain” is now “abdominal pain”

 

Section 6 - PHARMACEUTICAL PARTICULARS

Section 6.5 - Nature and contents of container:

An 84 pack size has been added to each strength

 

The title has changed to the following:

Section 6.6 - Special precautions for disposal

 

Section 10: Date of revision of the text

This has changed to the 29th March 2007

Updated on 24/07/2006 and displayed until 14/05/2007
Reasons for adding or updating:
  • Change to section 6. 3 - Shelf Life
Date of revision of text on the SPC:   05/2006
Legal Category:   POM
Black Triangle (CHM):   YES

Free-text change information supplied by the pharmaceutical company

Section 6.3 - The shelf life has changed from 2 years to 3 years
Updated on 16/06/2005 and displayed until 24/07/2006
Reasons for adding or updating:
  • New SPC for new product

Active Ingredients/Generics