ganaxolone

Contraindicated in:

None.

Use Cautiously in:

All patients (may ↑ risk of suicidal thoughts/behaviors);
Severe hepatic impairment (↓ dose);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children <2 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

EENT: nasal congestion

GI: ↑salivation

Neuro: sedation, SUICIDAL THOUGHTS/BEHAVIOR

Resp: gait disturbance, upper respiratory tract infection

Misc: fever

Interactions ⬆ ⬇

Drug-drug:

Use with benzodiazepines or other CNS depressants, including opioids, nonbenzodiazepine sedative/hypnotics, anxiolytics, muscle relaxants, and alcohol, could potentiate sedation.
Strong CYP3A inducers, including rifampin, and moderate CYP3A inducers may ↓ levels and effectiveness; consider ↑ ganaxolone dose.

Availability ⬆ ⬇

Oral suspension cherry flavor: 50 mg/mL

Route/Dosage ⬆ ⬇

PO (Adults and Children ≥2 yr and >28 kg): 150 mg 3 times daily for 7 days (Days 1–7); then 300 mg 3 times daily for 7 days (Days 8–14); then 450 mg 3 times daily for 7 days (Days 15–21); then 600 mg 3 times daily (Day 22 and thereafter).
PO (Adults and Children ≥2 yr and ≤28 kg): 6 mg/kg 3 times daily for 7 days (Days 1–7); then 11 mg/kg 3 times daily for 7 days (Days 8–14); then 16 mg/kg 3 times daily for 7 days (Days 15–21); then 21 mg/kg 3 times daily (Day 22 and thereafter).

Hepatic Impairment

PO (Adults and Children ≥2 yr and >28 kg): Severe hepatic impairment: 50 mg 3 times daily for 7 days (Days 1–7); then 100 mg 3 times daily for 7 days (Days 8–14); then 150 mg 3 times daily for 7 days (Days 15–21); then 200 mg 3 times daily (Day 22 and thereafter).

Hepatic Impairment

PO (Adults and Children ≥2 yr and ≤28 kg): Severe hepatic impairment: 2 mg/kg 3 times daily for 7 days (Days 1–7); then 3.66 mg/kg 3 times daily for 7 days (Days 8–14); then 5.33 mg/kg 3 times daily for 7 days (Days 15–21); then 7 mg/kg 3 times daily (Day 22 and thereafter).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Although not fully understood, thought to be related to positive allosteric modulation of GABA-A receptors.

Therapeutic effects:

Reduction in frequency of major motor seizures.

Classifications ⬆ ⬇

Therapeutic Classification: anticonvulsants

Pharmacologic Classification: gamma aminobutyric acid gaba enhancers

Pharmacokinetics ⬆ ⬇

Absorption: Extent of absorption following oral administration unknown. Extent of absorption ↑ by high-fat meal.

Distribution: Unknown.

Protein Binding: 99%.

Metabolism/Excretion: Metabolized by the CYP3A4/5, CYP2B6, CYP2C19, and CYP2D6 isoenzymes. Primarily excreted in the feces (55%; 2% as unchanged drug), with 18% excreted in the urine.

Half-Life: 34 hr.

Contr. Subst. Schedule ⬆ ⬇

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–3 hr	8 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Take missed dose as soon as remembered. If it is close to the time of next dose, omit and take at normal time. Do not take two doses at same time or extra doses.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient about effects on impaired judgment, thinking, and motor skills, and to be cautious while driving until known response of medication.
Instruct patient and caregiver to notify health care professional immediately if changes in mood or suicidal thoughts or behaviors occur.
Advise patient not to discontinue medication without consulting health care professional.
Advise patient about the potential for medication abuse and physical dependence.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Health care providers are encouraged to enroll patients exposed to ganaxolone during pregnancy in the North American Antiepileptic Drug (NAAED) Pregnancy Registry (1-888-233-2334 or http://www.aedpregnancyregistry.org/).

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Indications ⬇

Contraind./Precautions ⬆ ⬇