Home Drug Guide Paramethadione

Drug Guide

Generic Name

Paramethadione

Brand Names Paradione

Classification

Therapeutic: Anticonvulsant

Pharmacological: Im ido-dione derivative, sodium channel blocker

FDA Approved Indications

  • Partial seizures
  • Generalized tonic-clonic seizures

Mechanism of Action

Paramethadione stabilizes neuronal membranes and inhibits repetitive firing by blocking sodium channels, thereby reducing seizure activity.

Dosage and Administration

Adult: Initial dose: 30 mg/kg/day divided into 2-3 doses. Adjust based on response and tolerability.

Pediatric: Starting dose typically 15-20 mg/kg/day in divided doses, titrated up as needed.

Geriatric: Use with caution; start at lower doses and titrate slowly due to decreased hepatic function and comorbidities.

Renal Impairment: Adjust dose based on renal function; specific guidelines not well established.

Hepatic Impairment: Use with caution; hepatic metabolism may be reduced.

Pharmacokinetics

Absorption: Well absorbed orally

Distribution: Widely distributed, crosses the blood-brain barrier

Metabolism: Primarily hepatic, via conjugation and oxidation

Excretion: Renally excreted mainly as conjugates

Half Life: Approximately 20-40 hours, allowing for once or twice daily dosing

Contraindications

  • Hypersensitivity to paramethadione or other hydantoins
  • Bone marrow depression
  • Porphyria

Precautions

  • Use with caution in hepatic dysfunction, pregnancy, and lactation; careful monitoring required.

Adverse Reactions - Common

  • Drowsiness (Common)
  • Dizziness (Common)
  • Gastrointestinal upset (Common)

Adverse Reactions - Serious

  • Blood dyscrasias (aplastic anemia, leukopenia, thrombocytopenia) (Rare)
  • Hepatotoxicity (Rare)
  • Stevens-Johnson syndrome (Rare)

Drug-Drug Interactions

  • Valproic acid (may increase levels)
  • Other anticonvulsants (additive CNS depression)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor seizure control, side effects, blood counts, liver function tests.

Diagnoses:

  • Impaired skin integrity due to allergic reactions
  • Risk for bleeding due to blood dyscrasias

Implementation: Administer with food to minimize gastrointestinal upset. Regularly monitor blood counts and liver function.

Evaluation: Assess seizure frequency and side effects; adjust dosage accordingly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of allergic reactions, bleeding, or liver problems.
  • Avoid alcohol and CNS depressants; inform about potential drowsiness.

Special Considerations

Black Box Warnings:

  • Serious blood dyscrasias and hepatotoxicity, though rare.

Genetic Factors: None specifically established.

Lab Test Interference: May cause false positive for urinary ketones.

Overdose Management

Signs/Symptoms: Drowsiness, nystagmus, coma, seizures.

Treatment: Supportive care; activated charcoal if recent ingestion; hemodialysis may be considered in severe cases.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions, check expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.