Precautions and warnings

If you have kidney or liver problems, are pregnant, or are breastfeeding, use caution with this medicine. It may make it unsafe to drive or use machines. Drink enough fluids to prevent kidney stones, especially if you are at higher risk. Your doctor will check your blood bicarbonate levels before and during treatment. Do not stop taking this medicine suddenly; reduce the dose by 100 mg each week. If your vision becomes blurry or you have eye pain, get medical help right away. Watch for signs of less sweating and higher body temperature, especially in hot weather. Make sure you stay well-hydrated before and during physical activity or when it’s warm.

Drug Interactions

Taking topiramate along with certain antiepileptic drugs (like phenytoin, carbamazepine, or phenobarbital) can lower the amount of topiramate in your blood. It may also increase the levels of phenytoin. Using topiramate with carbonic anhydrase inhibitors (such as acetazolamide) raises the risk of kidney stones. The chance of drowsiness or sedation goes up if topiramate is taken with alcohol or other drugs that depress the central nervous system. Using topiramate together with valproic acid can increase the risk of high ammonia levels in the blood and brain problems (encephalopathy). Women on combined oral contraceptives might have a higher risk of contraceptive failure when taking topiramate.

Contraindications

Do not use this medication if you are allergic to any of its ingredients.

Mode of actions

Topiramate is a type of medication known as a sulfamate-substituted monosaccharide, but exactly how it works is not fully understood. It may help in several ways, such as blocking certain sodium channels in the brain, increasing the effects of the calming chemical GABA, blocking certain glutamate receptors, and inhibiting an enzyme called carbonic anhydrase.

Dosage & Administration

Adult: PO Adjunct in seizures associated w/ Lennox-gastaut syndrome Initial: 25 mg at night for 1 wk, then increase slowly. Usual: 200-400 mg/day in two divided doses. Max: 800 mg/day.

Epilepsy Monotherapy: Initial: 25 mg at night for 1 wk, then increase slowly. Usual: 100-400 mg/day in two divided doses. Max: 400 mg/day. Adjunct: Initial: 25 mg at night for 1 wk, then increase slowly. Usual: 200-400 mg/day. Max: 800 mg/day.

Migraine prophylaxis >16 yr: Initial: 25 mg at night for 1 wk, then increase slowly. Usual: 50-100 mg/day in 2 divided doses.

Child: (Age 2 - 16 Years): Partial Seizures, Primary Generalized Tonic-Clonic Seizures, or Lennox-Gastaut Syndrome - The recommended total daily dose of Topiramate as adjunctive therapy is approximately 5 to 9 mg/kg/day in two divided doses. Titration should begin at 25 mg (or less, based on a range of 1 to 3 mg/kg/day) nightly for the first week. The dosage should then be increased at 1 or 2 weeks intervals by increments of 1 to 3 mg/kg/day (administered in two divided doses), to achieve optimal clinical response.

Migraine: The recommended total daily dose of Topiramate as treatment for prophylaxis of migraine headache is 100 mg/day administered in two divided doses.

Pregnancy & Lactation

This medicine is not allowed during pregnancy. Do not use it if you are pregnant. It can be absorbed through the skin and lungs caused can damage your unborn child’s organs and cause congenital disabilities. Strict effective birth control during treatment and for six months after stopping this medicine. If you do become pregnant, stop taking this medicine and discuss your doctor right away.

There is no specific information on whether this medicine passes into breast milk or not. Considering the possible risks for the children, breastfeeding while using this medicine is not recommended and at least two weeks after the last dose. Consult your doctor before breastfeeding.

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