TOPIRAMATE

Indications & Dose:

Adjunctive therapy for partial onset seizure treatment in adults

• BY MOUTH

Adult; Initially 25mg daily for one week (lower dose may be used) then increased in steps of 50mg daily at weekly intervals and taken in 2 divided doses; usual dose 200-400mg daily in 2 divided dosesmax. 800mg daily 

Children:2-16 years, initially 25mg at night for one week then increased in steps of 1-3mg/kg daily according to response at intervals of 1-2 weeks and taken in 2 divided doses; recommended dose range 5-9mg/kg daily in 2 divided doses.

Note. If patient cannot tolerate titration regimen recommended above then smaller steps or longer interval between steps may be used.

Migraine prophylaxis

•  BY MOUTH

Adult: Initially 25 mg once daily for 1 week, dose to be taken at night, then increased in steps of 25 mg every week; usual dose 50–100 mg daily in 2 divided doses;maximum 200 mg per day

CAUTIONS Avoid in acute porphyrias p. 930 . risk of metabolic acidosis . risk of nephrolithiasis— ensure adequate hydration

BREAST FEEDING Manufacturer advises avoid— present in milk.

HEPATIC IMPAIRMENT Use with caution in moderate to severe impairment—clearancemay be reduced.

RENAL IMPAIRMENT

In adults Half usual starting and maintenance dose if eGFR      less than 70 mL/minute/1.73m2— reduced clearance and longer time to steady-state plasma concentration.

In children Half usual starting and maintenance dose if estimated glomerular filtration less than 70 mL/minute/1.73m2—reduced clearance and longer time to steady-state plasma concentration. Use with caution

Contraindications:

Side Effects:

Cautions:

Precautions:

Interaction:

Drugs

Phenytoin, carbamazepine, valproic acid: Lowers topiramate concentrations

Ethinyl estradiol: Increased clearance of estrogen 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Ataxia, cognitive dysfunction (83% in 1 study), dizziness, nystagmus, paresthesia, sedation, visual disturbances

GI: Constipation, decreased appetite, diarrhea, dyspepsia, nausea, weight loss

GU: Breast pain, dysmenorrhea, kidney stones

HEME: leukopenia 

Patient And Carer Advice: