In patients also receiving carbamazepine or pheny-toin, zonisamide serum levels are decreased, suggesting that the metabolism of zonisamide is induced by other antiepileptic drugs.49,50

The pronounced inter-individual variation in kinetics, together with the drug interaction potential, indicate that monitoring of zonisamide may be useful.51 Favourable clinical responses have been observed at plasma levels of 20-30 mg/l52 and 7-40 mg/l in children with refractory seizures given zonisamide as add-on.53 There was, however, a considerable overlap between serum concentrations of responders and non-responders, as well as between serum levels associated with seizure control and side-effects.51

Again, more systematic studies designed to explore the concentration-effect relationship are needed.

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