Rufinamide

How it works

It is thought to act by prolonging the inactive state of voltage-gated sodium channels, thereby limiting sustained, high-frequency neuronal firing.

Prescribing in practice

• It can shorten the QT interval, so it is contraindicated in familial short QT syndrome and used with caution alongside other drugs that affect cardiac repolarisation.
• Multi-organ hypersensitivity (drug reaction with eosinophilia and systemic symptoms) has been reported, typically early in treatment, and should prompt immediate discontinuation.
• Valproate increases rufinamide exposure, so co-prescription may require dose adjustment.

Monitoring

Monitor seizure frequency and watch for hypersensitivity features such as rash with fever, alongside the usual vigilance for behavioural change and suicidal ideation seen with antiseizure drugs.

Counselling the patient

• Take doses with food to aid absorption and tolerability.
• Report any rash, particularly with fever or swollen glands, without delay.
• Do not stop the medicine suddenly, as this can provoke seizures.

Evidence & guidelines

Rufinamide is licensed as adjunctive treatment for Lennox-Gastaut syndrome on the basis of randomised controlled trial evidence of reduced seizure frequency.