Topiramate side effects

Topiramate Topamax Suspension 300 mg/5 mL Tablet 25, 100, 200 mg Doses should be slowly adjusted up and down according to response and adverse effects (e.g., 150-300 mg twice daily and increase by 300-600 mg/day at weekly intervals) 50-200 mg/day in divided doses drug-drug interactions than carbamazepine, but causes more gastrointestinal side effects and hyponatremia Evidence is limited regarding efficacy Not recommended for the... 

The newer AEDs were first approved as adjunctive therapy for patients with refractory partial seizures. To date, lamotrigine, topiramate, and oxcarbazepine have received FDA approval for use in monotherapy in patients with partial seizures. Felbamate has monotherapy approval but causes significant side effects. 

Topiramate is recently approved by the FDA for migraine prophylaxis. Dose is initiated at 25 mg/day and increased slowly to minimize side effects, which may include paresthesias, fatigue, anorexia, diarrhea, weight loss, difficulty with memory, and nausea. Kidney stones, acute myopia, acute angle-closure glaucoma, and oligohidrosis have been infrequently reported. 

Fritz N, Glogau S, Hoffmann J, Rademacher M, Eiger CE, Helmstaedter C. Efficacy and cognitive side effects of tiagabine and topiramate in patients with epilepsy. Epilepsy Behav 2005 6(3) 373-81. 

Topiramate (Topamax). Topiramate is used primarily as an adjunct to other medications in adults with partial seizures. This drug appears to limit seizure activity through several complimentary mechanisms including inhibition of sodium channel opening, blockade of excitatory amino acid receptors, and stimulation of GABA receptors.2,41 Primary side effects include sedation, dizziness, fatigue, and ataxia. 

Topiramate can be described as a broad-spectrum neurotherapeutic agent with multiple modes of action, and its weight-loss promoting activity came to attention in trials of therapy for epilepsy [104], and explored further in animal experiments [105, 106], It has also been successfully used in the treatment of obesity associated with eating disorders [107, 108], As specific weight-loss therapy in one short-term [109] and one long-term study [110] in non-diabetics without co-morbid neuropsychiatric conditions, topiramate has been shown to produce a modest dose-related benefit compared to placebo, and with a reasonable side-effect profile. 

Side effects. Many of the side effects reported to occur with topiramate have been found in patients receiving other antiepileptic drugs concurrently. Such side effects as ataxia, confusion, dizziness, fatigue, somnolence, memory disturbance, depression and agitation appear to be less frequent in those patients receiving topiramate as a monotherapy. Weight loss has been reported in many patients this effect may be due to drug induced anorexia. Topiramate has proven efficacious in the treatment of severe epilepsy. 

Lathers CM, Schraeder PL, Claycamp HG. Clinical pharmacology of topiramate versus lamotrigine versus pheno-barbital comparison of efficacy and side effects using odds ratios. J Clin Pharmacol 2003 43 491-503. 

Ojemann LM, Crawford CA, Dodrill CB, Holmes MD, Kutsy R, Wilensky AJ. Language disturbances as a side effect of topiramate and zonisamide therapy. Epilepsia 1999 40(Suppl 7) 66. 

Eighty-five percent of the 86 cases of mostly bilateral acute angle-closure glaucoma reported to the National Registry of Drug-Induced Ocular Side Effects by 2003 were noted to have occurred within the first 2 weeks of treatment initiation. Topiramate is considered to have certain OADRs in the form of abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. 

Longin E, Teich M, Koelfen W, Konig S. Topiramate enhances the risk of valproate-associated side effects in three children. Epilepsia 2002 43(4) 451. ... 

The traditional treatment of tonic-clonic seizures is phenytoin or phenobarbital however, the use of carbamazepine and valproic acid is increasing because these AEDs have a lower incidence of side effects and equal efficacy. Valproic acid generally is considered the drug of first choice for atonic seizures and for juvenile myoclonic epilepsy. Lamotrigine and perhaps topiramate and zonisamide may be alternative agents for these seizure types. 

The most common side-effects of topiramate are paresthesia (27%), headache (21%), fatigue (20%), dizziness (14%), somnolence (1 3%), anorexia (11%), and weight loss (11 %). Less common side-effects, but with important clinical implications, are depression (7%), difficulty with concentration (7%), and confusion (5%). " As with other anhydrase inhibitors, topiramate has been associated with kidney-stone formation, and the incidence of nephrolithiasis is estimated to be 2-4 times higher than that expected in a similar untreated population. Many of the central nervous system effects of topiramate, including cognitive complaints, can be managed by gradual introduction and dose escalation. ... 

The anticonvulsant topiramate has also been reported to be effective in reducing binge and purge frequencies in comparison with placebo. However, bothersome side-effects such as paresthesias, impaired cognition, and renal calculi may lessen its usefulness. Naltrexone is a possible adjunct in patients who are refractory to SSRIs, especially those with comorbid alcoholism and/or self-injurious behavior. ... 

Commonly prescribed medications to prevent migraines are amitriptyline, divaproex sodium, propranol, timolol, topiramate, bupropion, cyproheptadine, diltiazem, doxepin, fluvoxamine, ibuprofen, imipramine, and methysergide. Methysergide is particularly effective. However, there are side effects that might make this dmg less tolerable. 

Meral C, Aydinoz S. Simple dosage inaccuracy might be the cause of serious side effects of topiramate. Chn Toxicol (Phila) 2009 47(7) 691. 

Psychiatric A 58-year-old man with fronto-temporal lobar degeneration and associated overeating and binging behavior had resolution of his abnormal eating while taking topiramate 50 mg/day [168 ]. Appetite suppression, which has previously been associated with topiramate use, was in this case a useful side effect of the drug. 

Sweat glands A 32-year-old man on topiramate developed hypohydrosis and subsequent hyperthermia [171 ]. Hypohydrosis is a rare but recognized adverse effect of topiramate that is typically reported in children, possibly due to incomplete development of autonomic mechanisms or changes in surface area as compared to mass or blood volume. Hypohydrosis as a side effect of topiramate has rarely been reported in adults. The mechanism by which topiramate causes hypohydrosis remains unclear. 

Drug-drug interactions In a placebo-controlled study evaluating the combination of topiramate and nortriptyline for headache prophylaxis, 44 patients were given topiramate 100 mg/day and nortriptyline 30 mg/day, while 17 took topiramate 100 mg/day plus placebo [174 ]. Side effects reported by those taking both medications, as opposed to topiramate alone, included dry mouth (18%), somnolence (9%), hair loss (2.3%), heartburn (2.3%), dry mouth (4.5%), and memory disturbance (6.8%). 

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