Pharmacological action
Antiepileptic. It belongs to a class of sulfate-substituted monosaccharides.
Antiepileptic activity of the drug due to a number of its properties. Topiramate reduces the frequency of action potentials characteristic of the neuron in a state of persistent depolarization, indicating the dependence of the blocking action of the drug on sodium channels of the state of the neuron. Topiramate potentiates the activity of GABA in certain subtypes of GABA-receptors (including GABAA-receptor), and modulates the activity itself GABAA-receptor activation prevents kainate sensitivity of kainate / AMPK-receptors for glutamate, does not affect the activity of N-methyl -D-aspartate for NMDA-receptors. These effects are dose-related drug at a concentration of topiramate in plasma from 1 mm to 200 microns, with minimal activity in the range from 1 uM to 10 uM.
In addition, topiramate inhibits some isoenzymes of carbonic anhydrase activity, but this effect in topiramate weaker than that of acetazolamide, and, apparently, is not central to the antiepileptic activity of topiramate.
Indications
- Partial or generalized tonic-clonic seizures in adults and children older than 2 years (as monotherapy or in combination with other anticonvulsants);
- Seizures associated with Lennox-Gastaut syndrome, in adults and children older than 2 years (as a means of additional therapy).
Dosage regimen
When using Topamax as part of combination therapy with other anticonvulsants in adult patients the minimum effective dose is 200 mg / day. Average daily dose is 200-400 mg, number of intakes – 2 times / day. It is recommended to start treatment with doses of 25-50 mg 1 time per day at night for 1 week. This is followed by increasing the dose of 25-50 mg at intervals of 1 or 2 weeks before the selection of effective dose. Multiplicity reception – 2 times / day. If necessary, may increase to a maximum daily dose – 1600 mg. The criterion for selection of the dose is the clinical effect. In some patients the effect is achieved when receiving the drug 1 time / day.
When using Topamax as part of combination therapy with other anticonvulsants in children older than 2 years, the recommended total daily dose is from 5 to 9 mg / kg and was adopted in 2 hours. Selection of the starting dose of 25 mg / day (or less, the rate of 1-3 mg / kg body weight per day), take medication at night for 1 week. In the future, with weekly or biweekly intervals dose can be increased by 1-3 mg / kg, and take the drug in 2 hours. The selection of doses should be guided by clinical effect. The daily dose of 30 mg / kg of body weight is well tolerated.
Topamax can be taken without regard to meals. Tablets should not be divided.
In applying the drug Topamax as a means of monotherapy should take into account the possible impact of the abolition of concomitant anticonvulsant therapy (PST) to control the frequency of seizures. In cases where undesirable sharply cancel accompanying PST, gradually reduce the dose of drugs, reducing by 1 / 3 every 2 weeks. With the abolition of drugs that are inducers of hepatic microsomal enzymes, the concentration of topiramate in plasma will increase. In such situations, if clinically indicated dose of Topamax can be reduced.
Adults in the beginning of Topamax monotherapy should take 25 mg 1 time a day at bedtime for 1 week. Then increase the dose at intervals of 1-2 weeks at 25-50 mg / day (daily dose divided into 2 admission). If intolerance of such a treatment regimen increase the dose of lesser value, or over large intervals. The dose is selected depending on the clinical effect. The recommended dose is 100 mg / day, maximum daily dose – 500 mg. In some cases, a single agent to treat refractory epilepsy dose of topiramate is 1000 mg / day.
Children older than 2 years with monotherapy in the first week of treatment prescribed topiramate at a dose of 0.5-1 mg / kg body weight per day (daily dose divided into 2 admission). The value of dose and its rate of increase determined by the clinical efficacy and tolerability of therapy. On average, increase the dose at intervals of 1-2 weeks to 0.5-1 mg / kg / day. The recommended dosage range for topiramate monotherapy in children older than 2 years is 3-6 mg / kg / day. In newly diagnosed partial seizures dose can be up to 500 mg / day. The drug is taken 2 times a day.
In the appointment of the drug to patients with moderately or severely impaired renal function expressed should be aware that in order to achieve the equilibrium state of this category of patients may need 10-15 days, as opposed to 4-8 days in patients with normal renal function. Since topiramate is removed from plasma during hemodialysis, in the days of the meeting should be prescribed an additional dose equal to half the daily dose in 2 hours (before and after the procedure).
Repeal the drug should be gradual to minimize the possibility of increasing the frequency of seizures. It is recommended each week to reduce the dosage to 100 mg.
Side effects
From the side of the central nervous system and peripheral nervous system: nervousness, dizziness, headache, disturbances of speech and vision, diplopia, nystagmus, anorexia, psychomotor retardation, ataxia, fatigue, violation of concentration, confusion, paresthesia, somnolence, thought disorder, depression; additional children – personality disorder, increased saliva, hyperkinesia, rare – a perversion of taste, agitation, cognitive disorders, emotional lability, poor gait, apathy, psychotic symptoms, aggressive reaction, very rare – suicidal thoughts, additional children – hallucinations.
From the digestive system: the symptoms of dyspepsia, nausea, abdominal pain, diarrhea, dry mouth, rarely – increased activity of hepatic transaminases, hepatitis, liver failure.
The part of the organ of vision: 1 month after initiation of therapy may develop a syndrome characterized by myopia accompanied by increased intraocular pressure. It also noted a sharp decline in visual acuity and / or pain in the eyes, myopia, reducing the depth of the anterior chamber of the eye, congestion of the mucous membrane of the eye, increased intraocular pressure, and in some cases – mydriasis. A possible mechanism for the development of this syndrome is an increase supratsiliarnogo effusion, which leads to a shift forward of the lens and iris, and as a result of the development of secondary angle-closure glaucoma.
Dermatological reactions: erythema multiforme, pemphigus, Stevens-Johnson syndrome, toxic epidermal necrolysis in patients treated with Topamax in conjunction with other drugs that cause adverse reactions from the skin and mucous membranes.
Other: nephrolithiasis, weight loss, fatigue, leukopenia, oligogidroz (mainly in children), metabolic acidosis.
Contraindications
- Pregnancy;
- Lactation (breastfeeding);
- Children under 2 years;
- Hypersensitivity to the ingredients.
Pregnancy and lactation
There are no adequate and strictly controlled clinical trials the safety of Topamax during pregnancy was conducted. Nevertheless, the use of the drug during pregnancy is possible only when the anticipated benefits to the mother outweighs the potential risk to the fetus.
Derivation topiramate in breast milk has not been studied in controlled trials. A limited number of observations suggest that topiramate is excreted in breast milk. If necessary, use Topamax in lactation period should settle the question of termination of breastfeeding.
Cautions
Cancel Topamax should be gradual, to minimize the possibility of increasing the frequency of seizures. When conducting clinical trials of reduced dose of 100 mg 1 time per week.
When using Topamax may increase the risk of kidney stones and the appearance of related symptoms (renal colic, pain in the side and in the kidneys), particularly in patients with a predisposition to nephrolithiasis (the formation of stones in the past, a family history of nephrolithiasis, hypercalciuria) and considering the use of other drugs that promote the development of nephrolithiasis. To reduce the risk of nephrolithiasis should increase fluid intake.
In the application of topiramate may occur hyperchloraemic not associated with a deficit of anions, metabolic acidosis (eg, reducing the concentration of bicarbonate in plasma below the normal level in the absence of respiratory alkalosis). This decrease in concentration of serum bicarbonate is a consequence of inhibitory effect of topiramate on renal karboangidrazu. In most cases, reducing the concentration of bicarbonate occurs at the beginning of the drug, although this effect may occur in any period of topiramate treatment. The level of concentration reduction is usually weak or moderate (mean of 4 mmol / L when used in adult patients in a dose of 100 mg / day and about 6 mg / kg body weight / day when used in pediatric patients). In rare cases, patients had decreased concentrations below 10 mmol / liter. Some diseases or treatments that predispose to the development of acidosis (eg, kidney disease, severe respiratory diseases, status epilepticus, diarrhea, surgery, ketogenic diet, certain medications) may be additional factors contributing to bicarbonate-lowering effect of topiramate.
In children, chronic metabolic acidosis can lead to slower growth. Effect of topiramate on growth and possible complications associated with the skeletal system have not been studied systematically in children and adults.
In connection with the foregoing, in the treatment of topiramate is recommended to conduct the necessary studies, including determination of the concentration of bicarbonate in serum. In the event of metabolic acidosis and its persistence, it is recommended to reduce the dose or stop taking topiramate.
If you have a syndrome, including myopia associated with angle-closure glaucoma, the treatment includes discontinuation of Topamax (as soon as the doctor deems it possible) and appropriate measures aimed at lowering intraocular pressure. Typically, these measures lead to normalization of intraocular pressure.
If while taking the drug Topamax patient decreases body weight, you should adjust the power regime.
Patients with impaired hepatic function topiramate should be used with caution because of possible reduction in clearance of the drug.
Patients taking Topamax should abstain from alcohol.
During treatment Topamax does not recommend the use of other drugs that have an inhibitory effect on the CNS.
Use in Pediatrics
The drug is approved for use in children older than 2 years.
Effects on ability to drive vehicles and management mechanisms
Precautions should be prescribed to patients involved in potentially hazardous activities that require increased attention and quickness of psychomotor reactions, because drug can cause drowsiness and dizziness.
Overdose
Symptoms: may increase manifestations described side effects.
Treatment: gastric lavage, if necessary, carry symptomatic therapy. Application of activated carbon is not shown, because For in vitro experiments showed that activated charcoal does not adsorb topiramate. Effective way of removing topiramate from the body is hemodialysis.
Drug Interactions
In an application with carbamazepine, valproic acid, phenobarbital, primidone Topamax no effect on the values of their equilibrium concentrations in plasma. The simultaneous use of Topamax in some cases led to increased concentrations of phenytoin, which is connected, apparently, with inhibition of isoenzyme (CYP 2Cmeph).
Phenytoin and carbamazepine, while the application with Topamax reduce the concentration of topiramate in plasma. Addition or removal of phenytoin or carbamazepine on the background of treatment Topamax may require changes in dose of the latter.
With simultaneous use of valproic acid has no effect on the concentration of topiramate in plasma.
In the study on simultaneous application of a single dose Topamax AUC of digoxin decreased by 12%.
In an application with Topamax oral contraceptive containing norethindrone and ethinyl estradiol, Topamax had no significant effect on the clearance of norethindrone, but the plasma clearance estrogen component increases significantly. Thus, while receiving Topamax with oral contraceptives their effectiveness may be reduced.
Drug interaction hydrochlorothiazide and topiramate in healthy volunteers evaluated the separate and joint appointment of hydrochlorothiazide (25 mg) and topiramate (dose 96 mg). The results showed that while receiving topiramate and hydrochlorothiazide is topiramate Cmax increased by 27% and AUC topiramate by 29%. The clinical significance of these studies have not identified. Appointment of hydrochlorothiazide in patients receiving topiramate, may require dosage adjustment last. Pharmacokinetic parameters of hydrochlorothiazide have not been significant change with concomitant topiramate therapy.
Drug interaction pioglitazone and topiramate in healthy volunteers evaluated the separate and joint appointment of agents. It was found pioglitazone reduced AUC by 15%, Cmax was unchanged. These changes were not statistically significant. Also, for the active gidroksimetabolita pioglitazone revealed lower Cmax and AUC by 13% and 16% respectively, and for the active ketometabolita revealed reduction and Cmax, and AUC by 60%. The clinical significance of these data is unclear. In a joint appointment patients Topamax and pioglitazone, should pay special attention to careful study of diabetic status of these patients.
topamax
topamax side effects
topamax and pregnancy
topamax dosage for weight loss
weight loss on topamax
topamax weight loss
topamax withdrawal
topamax and weight
what is topamax
topamax migraine split dosage 75-100 mg
topamax drug interactions
topamax for obesity
topamax migraine split dosage
numbness in fingers topamax
topamax warnings
topamax 100m versus 100 mg dosage
side effects of topamax
topamax side effects over time
topamax and weight loss
topamax bipolar
side effects topamax
topamax induced gastroenteritis
topamax for weight loss
topamax 25 mg
generic topamax
topamax for migraines
topamax generic
topamax generic available
topamax long term weight problems
permanent topamax side effects
does taking topamax with butterbur work
topamax attention deficit side affects
topamax most common side effects
side effects of the drug topamax
topamax skin burning
is topamax and imitrex compatible
generic topamax in the usa
topamax leptin
topamax and swelling
topamax skin stinging heat
topamax website
migraine topamax
topamax and alcohol
topamax weight
topamax precautions
topamax bulimia
topamax skin stinging sunlight
wellbutrin xl and topamax
stopping topamax
topamax esophagitis
topamax tics children
topamax fibromyalgia
topamax as weight loss drug
snorting topamax
phenobarbital compared to topamax
topamax and trileptal
topamax price
topamax warfare
topamax depression
how to identify topamax
topamax used for pain
topamax dystonia
topamax forum
topamax medication
topamax glaucoma
topamax 50mg
topamax without a prescription
how does topamax work
topamax hair loss
withdrawal from topamax
topamax 25mg
shooting up topamax
topamax trigeminal neuralgia
topamax made headaches worse
topamax blood clots
topamax help you loss weight
topamax withdrawal symptoms
topamax and birth defects
topamax and depression
topamax and hair loss
topamax taken along with lamictal
topamax migraines
does topamax make you lose weight
topamax cause melasma
topamax for nerve pain
topamax anxiety
genaric topamax
does topamax cause weight loss
taking topamax univasc tapazole
topamax alcohol
topamax forums
half life of topamax
cost of topamax without insurance
topamax and restless leg syndrome
synthesis of topamax
medicine topamax side of effect
topamax discovery
topamax eczema
topamax effects
side affects of topamax
topamax pregnancy
topamax sex
tegretol and topamax interactions
topamax free trial
topamax prescribing information
what is topamax used for
topamax pseudotumor cerebri
topamax studies for epilepsy
topamax discussion
topamax used for
topamax pharmacology
nuva ring and topamax
vitamin b12 deficiency and topamax
weight loss success with topamax
narcolepsy topamax
topamax and kidney stones
angle closure glaucoma from topamax
symptoms of topamax withdrawal
wellbutrin topamax
topamax side affects
topamax dosage
how to get off topamax
different uses for topamax
topamax fedex
topamax suicidal ideation
free topamax
pcos and topamax
does topamax medicine cause bad breath
low dose topamax interactions with yasmin
prader willi syndrome and topamax
topamax generic in united states
topamax dangers
vicatin and topamax
topamax heavy bleeding
topamax and diarrhea
topamax sprinkle coupon
topamax help headaches
topamax coupon
topamax side effect
topamax financial assistance
topamax and migraines faq
topamax use in gastroenterology
how is topamax absorbed
topamax online
topamax and eating disorders
topamax be used for weight loss
topamax wellbutrin
topamax and alcoholism
taking topamax with univasc
topamax package insert
common side effects of topamax
topamax coupons rebates
topamax for pain
topamax and side effects
topamax no prescription
topamax viagra
topamax for restless legs
topamax joint pain
topamax and side effects and women
atypical facial pain topamax
dosage headaches topamax
topamax for alcoholism
topamax kindey stones
topamax epilepsy child
topamax and flu like symptoms
zonagram vs topamax
topamax getting high on
topamax for ocd
symptom of topamax
drug interactions topamax
can topamax affect my heart
can you overdose on topamax
topamax memory loss
topamax headaches and weightloss
side effects of topamax 50 mg
topamax welbutrin xl
longtern side effects of topamax
topamax with memory loss
topamax and depresssion
topamax and atenalol
topamax anxiety disorders
topamax and teeth
topamax as a weight loss drug
where to buy topamax in us
topamax face burning eye burning
felbatol gabitril lamictal keppra topamax trileptal
topamax face burning
depakote and topamax used together
topamax and weight gain
topamax when generic
topamax effects on animals
topamax neuralgia
topamax for alcoholics
topamax seizure 1600
tapering off topamax
discount topamax
topamax and birth control
does topamax help with alcohol cravings
is there a generic topamax
topamax 50 mg
how does topamax cause weight loss
topamax and other anti-seizure drugs
topamax blocks
contraindications of topamax
topamax side effects to parkinson’s disease
topamax night eating
topamax and oral contraceptive effectiveness
topamax made my headaches worse
illegal use of topamax
topamax zanaflex zonegran
difference between lamictal and topamax
symptoms of topamax
topamax lawsuit
topamax alcoholism
topamax lowers libido
metabolic acidosis topamax
how topamax weight loss
topamax toprol drug interaction
topiramate topamax
neutropenia topamax
topamax hydrocodone
topamax gabaergic inhibition
topamax and dogs
topamax seroquel for occipital neuralgia
topamax gout
topamax dosage migraine
topamax 100mg
side effects topamax permanent
imitrex interaction with topamax
topamax recall
topamax dosing
topamax botox
fast weight loss with topamax
topamax can cause dementia messageboard
topamax blog back pain
topamax abuse
topamax withdrawls
50 mg topamax
topamax and headache side effects
topamax for bipolar disorder
topamax faq
tapering onto topamax
topamax change in taste
topamax dose for weight loss
topamax and weight loss side effects
topamax and insomnia
topamax buy in usa
topamax surgery warnings
topamax migraine
secondary angle closure glaucoma from topamax
amitriptyline in combination with topamax
getting high on topamax
dosage loss topamax weight
topamax toporal drug interaction
diet pills that work like topamax
depakote with topamax bipolar
topamax for depression
lithium with topamax bipolar
topamax truth behind drug
topamax split in half
topamax for trigeminal neuralgia
topamax and marijuana use
topamax and bi polar
can topamax cause high blood pressure
partial onset seizures and topamax studies
topamax low blood pressure
excedrin topamax
topamax and memory
pseudotumor cerebri 50 mg topamax blogs
forum withdrawal topamax
is topamax for migraines taken daily
use of topamax for migraine prevention
topamax prices
topamax effets
topamax expiration dating shelf life
topamax patent expiration
topamax split dosage
topamax verses lacitol
lyrica combined with topamax
topamax and klonapin
topamax with aspirin
topamax and crying jags
seizures from overdosing topamax
trileptal used with topamax bipolar
topamax is a
topamax studies
topamax photo
topamax causes headache
side effects of topamax topiramate
topamax slowing of eeg
seizure med closest to topamax
depakote topamax
topamax and lamictal epilepsy treatment
comman side effects of topamax
topamax headaches
what is the drug topamax for
topamax anti-anxiety
topamax and seizures
after topamax i still forget
lexapro topamax
topamax and suicide
topamax reaction with beer
accidental overdose of topamax in dogs
purchase topamax
topamax 25 mg sprinkle caps
topamax message boards
have you lost weight using topamax
topamax drug
topamax maximum dosage
topamax attention side affects
topamax hearing loss
topamax risk benefits
topamax on line pharmacy
topamax for neuropathic back pain
topamax for neck pain
topamax ingredients
topamax taste variances
any withdrawl coming off topamax
topamax and core body temperature regulation
info on topamax
topamax neuropathic pain
topamax climax
topamax all side effects rare infrequent
topamax cease side effects
water retension after topamax
zonisamide and topamax and weight loss
topamax rebate
topamax as a mood stabilizer
cost of topamax
topamax ejaculation
topamax sulfa allergy
combining clomipramine with topamax
wallgreen drug drug topamax
depression topamax treatment zoloft
topamax comparison
topamax and rsd
excessive weight loss with topamax
topamax for epilepsy
topamax to help bipolar disorder
topamax made me
topamax prednisone interaction
topamax binge eating
does topamax treat pyschosis
glaucoma topamax
probiotics topamax
topamax efficacy dose
topamax combinned with cymbalta
depakote with topamax
topamax and chronic pain
topamax and leg pain
topamax scheduled drug
topamax and marijuana
topamax and potassium deficiency
topamax reaction
does topamax interact with dostinex
topamax diabetic neuropathy
abruptly stopping topamax
topamax and migraine
depakote topamax reaction
major depressive disorder topamax
migrains topamax
topamax and hypothermia
syptoms of topamax
topamax eye problems
topamax and low white count
topamax and lamictal combination therapy
topamax withdrawl symptoms
depo provera and topamax interactions
can topamax cause irregular heart rhythm
sudafed topamax
topamax patient on-line firum
partial onset seizures and topamax
all uses for topamax
topamax side effects mood
topamax tremor
zonegran vs topamax
topamax and calcium channel blockers
topamax and bone loss
allergic reaction to beer on topamax
topamax heart failure
topamax and going to dentist
topamax assist card
severe mood problems of topamax
how to decrease topamax side effects
bipolar topamax dose
suicidal thoughts topamax
topamax children dose
sexual side effects topamax permanent
topamax muscle tension decreasing
topamax scar
testamonies of topamax users
topamax for dogs
topamax interactions with yasmin
is topamax habit forming
topamax and dental work
topamax and eatingdisorders
mixing topamax and marijuana
zonisamide vs topamax
pregnant while taking topamax
lexapro topamax gad
can topamax prevent migraines
common uses of topamax
topamax kidney stones
is topamax safe with oxycodone
topamax and migranes
bi-polar disorder topamax
topamax wellbutin
other uses for topamax
topamax multiple sclerosis
how to wean off topamax
topamax aggressiveness
generic topamax 50mg
lexapro and topamax
topamax and zoloft
missing a dosage of topamax seizure
drug interaction of sarafem and topamax
topamax fweight loss
can topamax cause panic attacks
topamax and apathy
topamax amytriptyline propranalol
topamax fda migraine
topamax off label drug use
topamax blindness
withdrawal from topamax forum
topamax nerve pain
tmj and topamax
topamax versus zonegran
topamax hell
topamax interaction with lexapro
daniel smith topamax
mood problems on topamax
using topamax for ocd
trileptal topamax
topamax topiramate leg swelling
topamax memory
topamax treatment for bi polar
topamax coke
topamax medicine uses
topamax to prevent cluster headaches
candian phar topamax
topamax low latency inhibition
topamax paresthesia
combine kava kava with topamax
topamax and phen
spitting topamax tablet
medicine topamax
topamax media news
topamax and cancer
migraine medication topamax
headaches topamax
side effects of medication topamax
problems with topamax
topamax 100
topamax capsule pictures
weight loss with topamax
topamax discount card
topamax epilepsy
dosing of topamax
topamax and yasmin
misdiagnosis lawsuit topamax
will i lose weight on topamax
is topamax used in cancer treatments
topamax and body temperature regulation
topamax fda patent
topamax 50
long term side effects topamax
topamax patient comments
class action topamax
topamax versus lacitol
dosages for topamax
topamax uses of
topamax research
topamax purchase
side affects topamax weight loss
metabolic acidosis topamax prevention
dosing periods for topamax
topamax and back pain
topamax cost
uqam topamax
drug topamax side effects
topamax for migraine
free topamax powered by phpbb
50 mg topamax ih
withdrawal topamax forum
side effects for topamax
topamax for seizures
can topamax cause glaucoma
topamax prescription coupon
topamax price costco
topamax for sale
topamax and oxycodone
topamax and anxiety
topamax com
topamax russian orphans stabalize mood
topamax side effects eyes
side effect of topamax
topamax where to buy
uses for topamax
topamax losing weight
topamax drug info
topamax with lexapro
side effect from topamax
topamax fluid in body
topamax used for depression
le topamax pour la d pression
topamax side effects and headaches
medicine and topamax
topamax uses
free topamax to try
topamax with abilify
topamax withdrawl
topamax hypokalemia
sulpha drugs topamax
topamax chat
topamax prescription
topamax pregnancy category
ih 50 mg topamax
topamax pills