Zonegran (zonisamide) eliminates binge eating in about half of people, average weight loss of 18 lbs

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Zonegran (zonisamide) reduces binge eating completely in about half of people given the drug and causes an average weight loss of about 18 pounds according to a recent study. Binge eating reduced by 80%

During three months of treatment, binge eating was reduced by 80 percent, from an average of 5 days per week to less than one day per week, and the number of episodes from 8 episodes per week to 1.1 episodes per week.

Complete remission in half the patients

In the 8 of 15 patients who completed the study, 7 had complete remission of their binge eating, and the other person a marked remission of 75 percent or more.

Weight loss: 18 lbs in three months for those who completed the study

The average weight loss for those just the patients who continued with the study for the entire three months—8 of the 15 patients—was 18 pounds, reducing their weight from an average of 234 pounds to 217 pounds.

During the three months of treatment, the average weight loss for all patients, including half the patients—7 of 15—who dropped out of the study, was 13 pounds, reducing the weight from an average of 234 pounds to 216 pounds.

Half withdrew due side effects or lack of response

Half the patients—7 of 15—withdrew from the study early due to side effects or lack of response.

One-fourth—4 of 15—withdrew due to side effects.

One—1 of 15—withdrew due to lack of response.

And 2 of 15 withdrew due to not following the protocol.

Side effects causing early withdrawal from the study

Of the 4 people who withdrew from the study due to side effects:

• 1 of the 4 people who withdrew early developed altered taste
• 1 of the 4 people who withdrew early developed depression
• 1 of the 4 people who withdrew early developed a panic attack
• 1 of the 4 people who withdrew early developed a serious adverse effect of kidney stones with urine accumulation in the upper urinary tract caused by a blockage of the urinary tract, and a kidney infection which occurred 3 weeks after starting on the drug

Side effects

Side effects for all subjects included:

• altered taste in half the patients (47%)
• fatigue in half the patients (47%)
• dry mouth in half the patients (47%)
• cognitive impairment in nearly half the patients (40%)
• insomnia in one-third of the patients (33%)
• drowsiness in one-third of the patients (33%)
• indigestion in one-third of the patients (33%)
• irritability in one-fourth of the patients (27%)
• headache in one-fourth of the patients (27%)
• memory impairment in one-fourth of the patients (27%)
• tingling in the extremities in one-fifth of the patients (20%)
• impaired concentration in one-eighth of the patients (13%)
• urinary tract infection in one-eighth of the patients (13%)
• panic attack in one-eighth of the patients (13%)
• depression in one-eighth of the patients (13%)

Kidney stones are a known side effect

Note: Kidney stones are a known side effect of the drug.

Dose: 100 mg per day increased to a maximum of 600 mg per day

People were started on 100 mg of Zonegran (zonisamide) per day for the first week.

The dosage was increased by 100 mg per day every week, as tolerated, to a maximum of 600 mg per day.

Average dose: 563 mg per day

The average dose for patients who completed the study was 563 mg per day.

If side effects, dose reduced by 100 mg per day

If a person experienced bothersome side effects, the dose was reduced by 100 mg per day.

The study involved 15 people—14 women and 1 man, all of whom were white—with binge eating disorder.

Half of them (8 of 15) had major depression—2 currently and 6 in the past.

Two of them had anxiety disorder.

How does it work? By serotonin or by altered taste

The authors of the paper suggest that Zonegran (zonisamide) may reduce binge eating by either correcting an abnormality in serotonin transmission, or perhaps by altered taste, indigestion or nausea.

Zonegran (zonisamide) has also been shown to increase dopamine release and inhibit glutamate release, both of which have been shown to reduce appetite.

Conclusion

Zonegran (zonisamide) seems to be quite effective at reducing binge eating in about half of people, but causes too many side effects in the other half of people.

The study excluded people with bipolar disorder and severe personality disorder, so the effectiveness in people with these conditions is not known.

REFERENCE

McElroy SL, Kotwal R, Hudson JI, Nelson E, Keck P. Zonisamide in the treatment of binge-eating disorder: an open-label, prospective trial. J Clin Psychiatry. 2004 Jan, 65(1):50-56.

AUTHOR’S CONTACT INFORMATION

Susan L. McElroy, M.D.
Division of Clinical Neuroscience
Department of Psychiatry
University of Cincinnati College of Medicine
P.O. Box 670559
231 Albert Sabin Way
Cincinnati, OH 45267-0559, USA
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Articles on the same subject can be found here:

• Binge Eating

• Zonegran (zonisamide)