Topiramate

DEA Class;  Rx

Common Brand Names; Topamax, Trokendi XR, Qudexy XR, Eprontia

Hypersensitivity

Extended release: Within 6 hr of alcohol intake; patients with metabolic acidosis that are taking metformin concomitantly

• Decrease in serum bicarbonate (7-67%)
• Dizziness (4-29%)
• Fatigue (9-16%)
• Ataxia (6-16%)
• Nervousness (9-18%)
• Paresthesia (1-11%)
• Psychomotor slowing (3-13%)
• Abnormal vision (2-13%)
• Anorexia (4-24%)
• Confusion (4-11%)
• Decreased memory (2-12%)
• Nausea (6-10%)
• Speech disorder (2-13%)
• Injury (14%)
• Abdominal pain (6-10%)
• Weight loss (4-9%)
• Diplopia (1-10%)
• Mood problems (<6%)
• Pharyngitis (6%)
• Tremor (3-9%)
• Abnormal gait (3-8%)
• Apathy (1%)
• Asthenia (1-5%)
• Dry mouth (2%)
• Menorrhagia (1-2%)
• Skin disorder (2-3%)
• Taste change (2%)
• Edema (2%)
• Hypertension (1-2%)
• Syncope (1%)
• Bradycardia (1%)
• Pallor (1%)
• Angina
• Erythema
• Hepatic failure
• Hyperthermia
• Hypokalemia
• Neuropathy
• Toxic epidermal necrolysis

Kidneys stones reported with therapy; increased fluid intake increases urinary output, lowering the concentration of substances involved in stone formation; hydration is recommended to reduce new stone formation; increased ratio of urinary calcium/citrate increases risk of kidney stones and/or nephrocalcinosis

Use caution with alcohol use

Monitor closely for decreased sweating and increased body temperature; oligohydrosis reported with use; monitor during strenuous exercise

Concomitant use of drugs that predispose patients to heat-related disorders (such as carbonic anhydrase inhibitors and anticholinergics)

Coadministration with valproic acid increases risk of hyperammonemia (with or without encephalopathy)

Visual field defects reported independent of elevated IOP; reversible upon discontinuation

Rapid titration rate, dose, and higher initial dose associated with higher incidence of neuropsychiatric disorder in both epilepsy and migraine patients; also associated with higher incidences of cognitive-related dysfunction

Monitor serum bicarbonate at baseline and then periodically; may also monitor serum chloride, ammonia, and phosphorus

When discontinuing drug, gradually withdraw to decrease risk of seizure or increased seizure frequency

Increased risk in suicidal thoughts/behavior reported; monitor patients for notable changes in behavior and notify healthcare provider if symptoms occur

Use caution when operating heavy machinery

Hypothermia reported with and without hyperammonemia during topiramate treatment with concomitant valproic acid use; consideration should be given to stopping topiramate or valproate in patients who develop hypothermia

There is pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drug during pregnancy

Topiramate is excreted in human milk; effects of topiramate exposure in breastfed infants or on milk production are unknownare unknown; developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for extended release formulation and any potential adverse effects on the breastfed infant from extended release formulation or from the underlying maternal condition