Succinimides
The succinimides, ethosuximide and methsuximide,
are used to manage absence seizures. Ethosuximide is considered the drug of
choice for absence seizures.
The succinimides are readily absorbed from the GI tract and me-tabolized
in the liver and excreted in urine. Metabolites are believed to be inactive. The elimination half-life of ethosuximide is about
60 hours in adults and 30 hours in children.
Ethosuximide’s exact mechanism of action is
unknown. It’s thought to inhibit an enzyme necessary for the formation of gamma-hydroxybutyrate, which has been associated
with the induction of absence seizures.
In addition to being the drug of choice for
treating absence seizures, ethosuximide may
also be used in combination with valproic acid for hard-to-control
absence seizures.
Ethosuximide isn’t
protein-bound, so displacement reactions can’t occur. Carbamazepine may induce the metabolism of
ethosux- imide. Valproic acid may inhibit the
metabolism of ethosuximide only if the metabolism is near saturation. (See Adverse reactions to succinimides.)
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