Topiramate Valproate

Phenobarbital Phenytoin Topiramate Valproate Oxcarbazepine Topiramate Second-line Clobazam6 Gabapentin Levetiracetam Phenytoin Tiagabine... 

Phenobarbital Phenytoin Primidone Felbamate Lamotrigine Tiagabide Topiramate Valproate Zonisamide Clobazam Clonazepam Diazepam usually compensated by the effect of the added drug risk of toxicity when interfering drug is discontinued drug... 

A 20-year-old man taking topiramate, valproate, and phenytoin had acute mental changes with hyperchloremic metabolic acidosis (46). He had been receiving a modest dose of topiramate for 9 months. His mental status returned to normal within 48 hours of withdrawal. 

There appears to be no pharmacokinetic interaction between pregabalin and carbamazepine, gabapentin, lamotrigine, phenobarbital, phenytoin, topiramate, valproate, alcohol, lorazepam, or oxycodone. However, the impairment of cognitive and gross motor function caused by oxycodone was additive with pregabalin, and pregabalin may potentiate the effects of alcohol and lorazepam. 

Chakor RT, Bharote HS. Topiramate-valproate-induced encephalopathy in migraine. Headache September 2012 52(8) 1321-2. 

Myoclonic Not mentioned Lamotrigine Valproate Valproate Topiramate (children with severe myoclonic epilepsy of infancy) Second-line Clobazam6 Clonazepam Lamotrigine Levetiracetam Piracetam6 Topiramate... 

Carbamazepine, phenytoin, valproate, gabapentin, lamotrigine, levetiracetam, tiagabine, topiramate, zonisamide... 

Anticonvulsants. Several antiseizure medicines have been studied in the treatment of PTSD, and some results have been encouraging. Open label studies, first with carbamazepine (800-1200 mg/day) and later with valproate (500-2000 mg/ day), demonstrated overall improvement in PTSD patients, though not for intrusive recollections per se. Recent open label studies of gabapentin, lamotrigine, tiagabine, and topiramate have suggested these anticonvulsants might also be helpful for some PTSD symptoms. 

Mood stabilizers phenytoin, valproate, topiramate Sedative/anxiolytics diazepam, barbiturates Beta-blockers propranolol... 

At least three drugs are effective against absence seizures. Two are nonsedating and therefore preferred ethosuximide and valproate. Clonazepam is also highly effective but has disadvantages of dose-related adverse effects and development of tolerance. Lamotrigine and topiramate may also be useful. 

Specific myoclonic syndromes are usually treated with valproate an intravenous formulation can be used acutely if needed. It is nonsedating and can be dramatically effective. Other patients respond to clonazepam, nitrazepam, or other benzodiazepines, although high doses may be necessary, with accompanying drowsiness. Zonisamide and levetiracetam may be useful. Another specific myoclonic syndrome, juvenile myoclonic epilepsy, can be aggravated by phenytoin or carbamazepine valproate is the drug of choice followed by lamotrigine and topiramate. 

In a retrospective chart review, weight loss was assessed in 214 patients with psychiatric disorders taking topiramate (1128). Patients taking either lithium or valproate gained a mean (SD) of 6.3 (9.0) kg and 6.4 (9.0) kg respectively, whereas patients taking topiramate lost 1.2 (6.3) kg. Similar statistically significant results were found in the bone mass index. 

In two other cases the addition of topiramate was thought to have precipitated valproate-induced hyperammonemic encephalopathy (1172). Recovery occurred after withdrawal of valproate or topiramate. The authors suggested that topiramate may have contributed to the hyperammonemia by inhibiting carbonic anhydrase and cerebral glutamine synthetase. 

Chengappa KN, Chalasani L, Brar JS, Parepally H, Houck P, Levine J. Changes in body weight and body mass index among psychiatric patients receiving lithium, valproate, or topiramate an open-label, nonrandomized chart review. Clin Ther 2002 24(10) 1576-84. 

Valproate-induced hyperammonemic encephalopathy in the presence of topiramate. Neurology 2000 54(l) 230-2. 

For simple and complex partial seizures and secondary generalized tonic-clonic seizures, the first line drugs are - carbamazepine, valproate and phenytoin. Second line drugs include - acetazolamide, clobazam, clonazepam, ethosuximide, felbamate, gabapentin, lamotrigine, levetiracetam, oxacarbamazepine, primidone, tiagabine, topiramate and vigabactin. 

For atypical absence, tonic and clonic seizures, first line treatment is with valproate and second line with acetazolamide, carbamazepine, clobazam, clonazepam, ethosuximide, felbamate, lamotrigine, oxacarbamazepine, phenobarbitone, phenytoin, primidone or topiramate. 

In addition to phenytoin, carbamazepine, and lamotrigine, metabolically optimized analogs of these drugs, such as fosphenytoin and oxcarbazepine, show clinical promise. Other anticonvulsants that block sodium channels, among several mechanisms of action, include zonisamide, felbamate, topiramate, and valproate (Fig. 5). 

Hofer A, Fleischhacker WW, Hummer M. 2003. Worsening of psychosis after replacement of adjunctive valproate with topiramate in a schizophrenia patient. J Clin Psychiatry... 

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