Zonisamide and nortriptyline interactions

Hello all,

I have been trialing drugs for MAV for around 6 months. I switched from Topamax to Zonisamide because the side effects were too difficult to handle. I trialed Topamax 100mgs for around 2.5 months and had numerous side effects that were intolerable, although it did relieve some of my vertigo, but it also seemed to give me a headache and dizziness. The Zonisamide provides a little less extreme side effects, but I still have some cognitive ones at 100mg, although tolerable if it gets me to where I need to be.

I have read some things on the forum that Dr. Silver recommends people discontinue a med or reduce the dose to a tolerable level if they are having cognitive side effects. What is the medical reason for that?

Also, I have sense added nortriptyline 10mgs this week, and am supposed to titrate up to 30mg over the next few weeks b/c I am unable to tolerate a higher dose of zonisamide beyond 100mgs. I am getting similar benefits from it as Topa, but with less intense side effects, which was my doctor’s goal. However, I am having an issue with the Nori - I took it at the same time as the Zons. at night over the last four days and just realized that it has counteracted the benefits from my zonisamide. I called my pharmacist yesterday and she said to take it at least few hours apart. Yesterday I took it 5 hours apart and today I still do not notice much difference, i.e., benefits from Zons. have been negligible. The pharmacist said the medicines do not counter indicate each other, although they may amplify some of the reduced sweating, overheating side effects from one another.

I plan to take the Nori in the morning tomorrow and the Zons. tonight, spacing them out as much as possible. Does anyone have any experience with this type of issue with these two meds or Topa and Nori, or have read about someone else having this experience on this forum?


Hi Chris,
I too am taking Zonegran. Currently at 150mg daily. My neurologist wants me at 200mg, but I think I’ll have to go back to 100mg as the sore throat I’m getting is ridiculous! I’m also over heating as you mentioned. Why is it you cannot go past the 100mg? Also how is the Zonegran helping your vertigo? I’m interested to hear.

I take Sandomigran at night too and wonder as you do should I be taking them separately. I’ll take them a few hours apart.
I have tried Topamax and also found the side effects too much for me. Although I haven’t tried Nort but have heard good things.