Topiramate

Indications
Oral
Adjunct for seizures associated with the Lennox-gastaut syndrome
Adult: Initially, 25 mg at night for 1 wk, thereafter increase in steps of 25-50 mg at intervals of 1-2 wk until effective dose is achieved. Doses >25 mg/day should be taken in 2 divided doses. Usual dose: 200-400 mg daily. Max: 800 mg daily.
Child: 2-16 yr: Initially, 25 mg nightly for the 1st wk increased at intervals of 1-2 wk by increments of 1-3 mg/kg daily according to response. Daily doses of >25 mg should be taken in 2 divided doses. Usual dose: 5-9 mg/kg daily. Max: 30 mg/kg/day.
Renal impairment: Moderate to severe: Doses should be halved. Haemodialysis: Supplemental dose equal to about ½ of the daily dose should be given in divided doses (at the start and finish of haemodialysis).
Hepatic impairment: Dosage adjustment may be needed.
Oral
Epilepsy
Adult: Monotherapy: Initially, 25 mg at night for 1 wk, thereafter increase in steps of 25-50 mg at intervals of 1-2 wk. Doses >25 mg/day should be taken in 2 divided doses. Usual dose: 100-400 mg daily. Max: 400 mg daily. Adjunctive treatment: Initially, 25 mg at night for 1 wk, thereafter increase in steps of 25-50 mg at intervals of 1-2 wk until effective dose is achieved. Doses >25 mg/day should be taken in 2 divided doses. Usual dose: 200-400 mg daily. Max: 800 mg daily.
Child: 10-16 yr: Initially, 0.5-1 mg/kg at night for the 1st wk, increased at intervals of 1-2 wk by increments of 0.5 to 1 mg/kg daily. Usual dose: 3-6 mg/kg daily. Daily doses >25 mg should be taken in 2 divided doses. Max: 16 mg/kg/day.
Renal impairment: Moderate to severe: Doses should be halved. Haemodialysis: Supplemental dose equal to about ½ of the daily dose should be given in divided doses (at the start and finish of haemodialysis).
Hepatic impairment: Dosage adjustment may be needed.
Oral
Prophylaxis of migraine
Adult: >16 yr: Initially 25 mg daily at night for 1 wk, increased in steps of 25-mg at wkly intervals. Usual dose: 50-100 mg daily in 2 divided doses. Daily doses >25 mg should be taken in 2 divided doses.
Renal impairment: Moderate to severe: Doses should be halved. Haemodialysis: supplemental dose equal to about ½ of the daily dose should be given in divided doses (at the start and finish of haemodialysis).
Hepatic impairment: Dosage adjustment may be needed.
Contraindications
Lactation.
Warnings / Precautions
Renal or hepatic impairment, pregnancy. May impair ability to drive or operate machinery. Maintain adequate hydration to reduce the risk of renal calculi especially in predisposed patients. Measure serum bicarbonate at baseline and periodically during treatment. Avoid abrupt withdrawal; decrease dose by 100 mg daily at wkly intervals. Seek immediate medical attention if blurred vision or eye pain. Monitor closely for decreased sweating and increased body temperature, especially in hot weather. Ensure proper hydration before and during activities or exposure to warm temperatures.
Adverse Reactions
Confusion, dizziness, drowsiness, generalised slowing of mental and physical activity, difficulty with concentrations, ataxia, paresthesia, anorexia, weight loss, abnormal vision, metabolic acidosis, mood or mental changes, behavioural disturbances, depression, fatigue, agitation, nervousness, anxiety, oligohidrosis, hyperthermia and hyperammonaemic encephalopathy.
Overdose Reactions
Symptoms: Convulsions, drowsiness, speech disturbances, blurred vision, diplopia, impaired mental status, lethargy, abnormal co-ordination, stupor, hypotension, abdominal pain, agitation, metabolic acidosis, dizziness and depression. Management: Empty stomach by emesis or gastric lavage and activated charcoal if recent ingestion. Treatment is supportive and keep patient well hydrated. Haemodialysis is useful in drug removal.
Drug Interactions
Coadmin with antiepileptic drugs e.g. phenytoin, carbamazepine, phenobarbital decreases plasma concentration of topiramate. Possible increase in phenytoin levels. Increased risk of renal stone formation with carbonic anhydrase inhibitors e.g. acetazolamide. Increased risk of CNS depression with CNS depressants and alcohol. Increased risk of hyperammonaemia and encephalopathy with valproic acid. Increased risk of contraceptive failure in women taking combined oral contraceptives.
See Below for More topiramate Drug Interactions
Mechanism of Actions
Topiramate is a sulfamate-substituted monosaccharide with precise mechanism of action unknown. It may be due to various mechanisms e.g. blocking of voltage-dependent sodium channels; augmenting the activity of γ-aminobutyric acid (GABA) at GABA-A receptor; antagonising AMPA/kainate glutamate receptors; inhibiting carbonic anhydrase.
Absorption: Readily absorbed from the GI tract (oral); peak plasma concentrations after 2 hr. Bioavailability unaffected by food.
Distribution: Protein-binding: 9-17%. Volume of distribution in man is double that in woman. Crosses the placenta, distributed into breast milk.
Metabolism: Not extensively metabolised.
Excretion: Excreted by urine (as unchanged drug and metabolites); elimination half-life: 21 hr. Children has a higher clearance and shorter elimination half-life than adults.
Administration
May be taken with or without food.
Storage Conditions
Oral: Store at 15-30°C.
ATC Classification
N03AX11 - topiramate ; Belongs to the class of other antiepileptics.
Storage
Oral: Store at 15-30°C.
Available As
  • Topiramate 100 mg
  • Topiramate 200 mg
  • Topiramate 25 mg
  • Topiramide 25 mg
  • Topiramate 50 mg
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    One Response to Topiramate

    1. April 3, 2014 at 9:24 am #

      Nuromate 50mg is very strong…
      give me a solution for overdose..

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