Dosing and titration of zonisamide
The recommended initial daily dose of zonisamide is 100 to 200 mg for adults and 2 to 4 mg/kg per day for children. Because steady state is reached within 14 days, dosages should be increased at 2-week intervals to a target maintenance dose of 400 to 600 mg/day in adults and 4 to 8 mg/kg per day in children. These amounts are usually given in two divided doses, but some patients may take zonisamide once a day. Higher dosages may be tolerable and necessary in selected patients. Serum concentrations of 10-40 mcg/mL are usually achieved.
A blood level of approximately 10-40 mcg/mL is generally considered to be therapeutic (lower for seniors), but adjustments should depend on clinical response.
