ETHOSUXIMIDE

Absorption

Bioavailability following oral administration is 93%.

Toxicity

Acute overdoses may produce nausea, vomiting, and CNS depression including coma with respiratory depression.

Chemical properties

White to Off-White Solid

Originator

Zarontin,Parke Davis,US,1960

The Uses of ETHOSUXIMIDE

cholinergic

The Uses of ETHOSUXIMIDE

Ethosuximide is an anticonvulsant drug that is used in minor forms of epilepsy.

The Uses of ETHOSUXIMIDE

Anticonvulsant.

Background

An anticonvulsant especially useful in the treatment of absence seizures unaccompanied by other types of seizures.

Indications

For the treatment of petit mal epilepsy.

Definition

ChEBI: A dicarboximide that is pyrrolidine-2,5-dione in which the hydrogens at position 3 are substituted by one methyl and one ethyl group. An antiepileptic, it is used in the treatment of absence seizures and may be used for myoclonic seizures, but is ineffect ve against tonic-clonic seizures.

Manufacturing Process

α-Ethyl-α-methylsuccinimide is known in the prior art as a chemical entity, having been prepared according to the method described by Sircar, J. Chem. Soc., 128:600 (1927), and characterized in J. Chem. Soc., 128:1254 (1927).
In its manufacture, methyl ethyl ketone is condensed with ethylcyanoacetate to give ethyl-2-cyano-3-methyl-2-pentenoate. That, in turn, adds HCN to give ethyl-2,3-dicyano-3-methyl pentanoate. Saponification and decarboxylation gives 2-methyl-2-ethyl succinonitrile. Heating with aqueous NH3 gives the diamide which loses NH3 and cyclizes to ethosuximide.

brand name

Epileo Petitmal (Eisai), Pemal (Benzon), Petnidan (Desitin Arzneimittel), Suxilep (Parke – Davis, Jenapharm), Suxinutin/Zarontin (Parke – Davis).

Therapeutic Function

Anticonvulsant

Biological Functions

It is now generally accepted that the specific antiepileptic action of ethosuximide (and the older agent trimethadione, no longer employed) against absence epilepsy is its ability to reduce the low-threshold calcium current (LTCC) or T (transient) current. These currents underlie the 3-Hz spike wave discharges that are characteristic of absence epilepsy. A blockade of T-calcium current is likely also to be a mechanism used by valproic acid.
The only clinical use for ethosuximide (Zarontin) is in the treatment of absence epilepsy. If absence attacks are the only seizure disorder present, ethosuximide alone is effective. If other types of epilepsy are present, ethosuximide can be readily combined with other agents.
For the most part, ethosuximide is a safe drug. Most of the side effects are dose related and consist of nausea, gastrointestinal irritation, drowsiness, and anorexia. A variety of blood dyscrasias have been reported, but serious blood disorders are quite rare.

General Description

Ethosuximide is considered the prototypical anticonvulsantneeded for treating patients with absence seizures.Ethosuximide and the N-dealkylated active metabolite ofmethsuximide work by blocking the lowthresholdT-type calcium channels, thereby reducing thehyperexcitability of thalamic neurons that is specifically associatedwith absence seizure.

Biochem/physiol Actions

Ethosuximide is an anticonvulsant drug and an antagonist for T-type calcium channel. It is known to prevent spike wave discharges, characterized in absence seizures.

Pharmacokinetics

Used in the treatment of epilepsy. Ethosuximide suppresses the paroxysmal three cycle per second spike and wave activity associated with lapses of consciousness which is common in absence (petit mal) seizures. The frequency of epileptiform attacks is reduced, apparently by depression of the motor cortex and elevation of the threshold of the central nervous system to convulsive stimuli.

Clinical Use

Although ethosuximide is the drug of choice for treatment of simple absence seizures, it is not effective against partial complex or tonic-clonic seizures and may increase the frequency of grand mal attacks. Thus, it must be administered in combination with other AEDs when treating persons with mixed seizure types. Ethosuximide is a substrate for both CYP3A4 and CYP2E1. The major metabolite for ethosuximide is 3-(1-hydroxyethyl) succinimide, which is inactive and excreted unconjugated into the urine Several additional metabolites have been characterized recently. Approximately 20% of an oral dose is excreted unchanged.
Although ethosuximide is thought to be the least toxic of the succinimides, it can cause gastrointestinal disturbances and dose-related CNS effects, such as drowsiness, dizziness, ataxia, sleep disturbances and depression. Idiosyncratic hypersensitivity reactions include severe rashes, leukopenia, agranulocytosis (some fatal), systemic lupus erythematosus, and parkinsonian-like symptoms. In addition to being less toxic than trimethadione, ethosuximide offers a wider range of protection against different kinds of absence seizures.

Synthesis

Ethosuximide, 3-ethyl-3-methypyrrolidine-2,5-dione (9.3.4) is synthesized from methylethylketone and cyanoacetic ester, which are condensed in Knoevanagel reaction conditions. Then hydrogen cyanide is added to the resulting product (9.3.1). After acidic hydrolysis and decarboxylation of synthesized dinitrile (9.3.2), 2-methyl-2-ethylsuccinic acid (9.3.3) is formed. Reacting this product with ammonia gives the diammonium salt, and heterocyclization into the ethosuximide (9.3.4) takes place during subsequent heating [8,9].

Drug interactions

Potentially hazardous interactions with other drugs
Antibacterials: concentration increased by isoniazid
. Antidepressants: lower convulsive threshold; avoid with St John’s wort.
Antiepileptics: concentration possibly reduced by carbamazepine, fosphenytoin, phenytoin and phenobarbital; concentration of fosphenytoin and phenytoin possibly increased; concentration increased by valproate.
Antimalarials: anticonvulsant effect antagonised by mefloquine.
Antipsychotics: lower convulsive threshold.
Orlistat: possible increased risk of convulsions.

Metabolism

Ethosuximide is extensively hydroxylated in the liver to its principal metabolite which is reported to be inactive. Ethosuximide is excreted in the urine mainly in the form of its metabolites, either free or conjugated, but about 12-20% is also excreted unchanged.

Metabolism

Hepatic, via CYP3A4 and CYP2E1.