Topiramate
Commercial names and formulations:
Brand name: Topamax
Formulations: Capsules, Sprinkles
Years on the market:
In the US since 1996
How to store it?
Store at room temperature
What does the body do to the medication?
Can I take it with food?
Yes
How long does it take to get to the blood after I take it?
2-6 hours
How long does it take to start having a steady effect?
4 days
Can this medication be started at a high dose or it has to be started gradually?
Gradually
How long does it stay in the body?
Approximately 1 day
How is it eliminated?
Liver and then kidney
What does the medication do to the body?
Type of epilepsy that helps:
Partial and Generalized Epilepsy, used also for Infantile Spasms
FDA approved for:
Partial onset or primary generalized tonic-clonic seizures as a treatment alone for patients 10 and older, and in combination with other seizure medications for partial or primary generalized epilepsy in patients 2 and older, including those with Lennox-Gastaut syndrome
Common side effects:
• Skin: rash, acne
• Bones: none
• Blood: anemia
• Liver: liver damage
• Kidneys: none
• Stomach and intestines: diarrhea, constipation, abdominal pain, acid reflux, anorexia
• Heart: none
• Brain: numbness/tingling, dizziness, reduced sense of touch, lack of coordination, drowsiness, insomnia, difficulty with concentration, confusion, cognitive problems
• Mood: mood problems, depression, anxiety
• Others: weakness, leg pain, chest pain, dry mouth, increased muscle tone
Serious side effects:
Decreased vision, eye pain, glaucoma, kidney stones, and decreased sweating which could lead to over-heating
Risk of suicidal thoughts or behavior
What happens if I get too much of it (intoxication)?
Symptoms may include drowsiness, dizziness, slurred speech, blurred or double vision, confusion, lethargy, lack of coordination or decreased blood pressure.
What happens if I stop it suddenly (withdrawal)?
Topamax should be stopped gradually. Sudden withdrawal of Topamax could cause an increase in seizure frequency.
Who should not take this medication?
If you are allergic to the any of the ingredients in Topamax, you should not take this medication.
What is the average dose and how many times a day should be given?
Children: initial 1-3 mg/kg/day to total daily dose of 5-9 mg/kg/day, but higher doses may be needed when combined with other seizure medications.
Adults: initial 25-50 mg/day (in divided doses) to total daily dose 100-200 mg/day (in divided doses) , higher doses may be required when used in combination with other therapies.
Does the body get used to the medication?
Yes
Medications to be careful with:
Other AEDs that can increase the blood level of Topamax:
None anticipated
Other AEDs that can decrease the blood level of Topamax:
Phenobarbital, Phenytoin, Primidone, Carbamazepine
Other drug interactions:
Topamax reduces the efficacy of oral contraceptives at doses of greater than 200 mg per day
Blood work required?
CBC and CPM?
CPM is needed at baseline and periodically
How often?
Every 3 to 9 months, or more often after a large dose increase or change in health
Women’s health
Affects contraceptives?
Yes at doses over 200 mg per day
Affect fertility?
No
Are safe in pregnancy?
Topamax has been linked to an increased risk of birth defects and should be used with caution during pregnancy. Discuss with your medical provider.
Category
Pregnancy Category D
Can breastfeed?
The multiple benefits of breastfeeding need to be weighed against the probable small, but unknown, risks of the baby getting some amount of the medication. The baby needs to be watched closely for excessive sleepiness and poor feeding.
Affect bones (osteoporosis)?
No
Men’s health
Affects sexual performance?
No
Affects fertility?
No
Use other than epilepsy:
Migraine