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What is Topiramate
Topiramate is an oral antiepileptic drug (AED) used for partial-onset, generalized primary tonic-clonic seizures, and as an adjunct therapy in Lennox-Gastaut syndrome.
It is derived from the naturally occurring monosaccharide D-fructose and is structurally different from other AEDs. Unlike other AEDs, topiramate appears to block the spread of seizures rather than raise the seizure threshold.
Topiramate possesses more than one mechanism of action, which may explain why it can be effective in patients with various seizures that are refractory to other agents.
Topiramate continues to be studied as both add-on therapy and monotherapy in various refractory epilepsies in children and adults, including infantile spasms associated with West syndrome. It is also used for migraine prophylaxis in adult and pediatric patients.
There is some evidence of a role for topiramate treatment ‘off-label’ for eating disorders such as binge-eating disorder, for tics due to Tourette’s syndrome or other chronic tic disorders, or for substance abuse disorders such as alcohol dependence
Indications
- absence seizures
- alcohol dependence
- atonic seizures
- binge-eating disorder
- bipolar disorder
- bulimia nervosa
- cocaine dependence
- diabetic neuropathy
- infantile spasms
- Lennox-Gastaut syndrome
- migraine prophylaxis
- myoclonic seizures
- partial seizures
- short-lasting unilateral neuralgiform headache with conjunctival injection and tearing
- tonic-clonic seizures
- Tourette’s syndrome
For the treatment of partial seizures (monotherapy or adjuvant therapy)
Side Effects
- abdominal pain
- acne vulgaris
- acute cerebellar syndrome
- agitation
- alopecia
- amenorrhea
- anemia
- angina
- anorexia
- anxiety
- aphasia
- appetite stimulation
- arthralgia
- arthropathy
- asthenia
- ataxia
- AV block
- back pain
- bleeding
- blurred vision
- bradycardia
- breast discharge
- bronchospasm
- bullous rash
- candidiasis
- chest pain (unspecified)
- confusion
- conjunctivitis
- constipation
- cough
- cystitis
- dehydration
- delirium
- depression
- diabetes mellitus
- diarrhea
- diplopia
- dizziness
- drowsiness
- drug-induced body odor
- dysarthria
- dysgeusia
- dyskinesia
- dyspepsia
- dysphagia
- dysphonia
- dyspnea
- dystonic reaction
- ecchymosis
- edema
- EEG changes
- ejaculation dysfunction
- elevated hepatic enzymes
- emotional lability
- encephalopathy
- eosinophilia
- epistaxis
- erythema multiforme
- esophagitis
- euphoria
- fatigue
- fecal incontinence
- fever
- flatulence
- flushing
- gastritis
- gastroesophageal reflux
- gingival hyperplasia
- gingivitis
- glossitis
- growth inhibition
- hallucinations
- headache
- hearing loss
- hematoma
- hematuria
- hemorrhoids
- hepatic failure
- hepatitis
- hot flashes
- hyperammonemia
- hyperchloremic acidosis
- hyperemia
- hyperesthesia
- hyperglycemia
- hyperhidrosis
- hyperkinesis
- hyperlipidemia
- hypernatremia
- hypersalivation
- hypertension
- hyperthermia
- hyperthyroidism
- hypertonia
- hypertrichosis
- hypocalcemia
- hypoesthesia
- hypoglycemia
- hyponatremia
- hypophosphatemia
- hyporeflexia
- hypotension
- hypothermia
- impotence (erectile dysfunction)
- increased urinary frequency
- infection
- insomnia
- involuntary movements
- iritis
- irritability
- lacrimation
- laryngitis
- leukopenia
- leukorrhea
- libido decrease
- libido increase
- lymphadenopathy
- lymphocytosis
- lymphopenia
- mania
- melasma
- melena
- memory impairment
- menorrhagia
- menstrual irregularity
- metabolic acidosis
- migraine
- muscle cramps
- myalgia
- mydriasis
- myopia
- nausea
- nephrolithiasis
- nocturia
- nystagmus
- ocular hypertension
- ocular pain
- oligohidrosis
- oliguria
- orthostatic hypotension
- osteomalacia
- osteoporosis
- pallor
- pancreatitis
- pancytopenia
- paranoia
- paresthesias
- parosmia
- pemphigus
- peripheral neuropathy
- peripheral vasodilation
- pharyngitis
- phlebitis
- photophobia
- photosensitivity
- polycythemia
- polydipsia
- polyuria
- pruritus
- psychomotor impairment
- psychosis
- ptosis
- pulmonary embolism
- purpura
- rash
- rhinitis
- scotomata
- seborrhea
- secondary malignancy
- seizures
- sinusitis
- skin discoloration
- Stevens-Johnson syndrome
- stomatitis
- suicidal ideation
- syncope
- thrombocytopenia
- thrombocytosis
- thrombosis
- tinnitus
- toxic epidermal necrolysis
- tremor
- urinary incontinence
- urinary retention
- urticaria
- vaginal bleeding
- vertigo
- visual impairment
- vomiting
- weight gain
- weight loss
- xerophthalmia
- xerosis
- xerostomia
Monitoring Parameters
- serum bicarbonate
- serum creatinine/BUN
- serum electrolytes
Contraindications
- abrupt discontinuation
- ambient temperature increase
- autoimmune disease
- bleeding
- breast-feeding
- children
- chronic obstructive pulmonary disease (COPD)
- closed-angle glaucoma
- contraception requirements
- depression
- diabetes mellitus
- dialysis
- diarrhea
- driving or operating machinery
- emphysema
- encephalopathy
- females
- geriatric
- glaucoma
- growth inhibition
- hepatic disease
- hypertension
- increased intraocular pressure
- infants
- labor
- metabolic acidosis
- mitochondrial disease
- neonates
- nephrolithiasis
- ocular disease
- pregnancy
- renal disease
- renal failure
- renal impairment
- reproductive risk
- status asthmaticus
- status epilepticus
- suicidal ideation
- surgery
- thrombocytopenia
- visual disturbance
Interactions
- Abacavir; Dolutegravir; Lamivudine
- Abciximab
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Tramadol
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alprazolam
- Amiloride; Hydrochlorothiazide, HCTZ
- Aminosalicylate sodium, Aminosalicylic acid
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amphetamines
- Anagrelide
- Anticholinergics
- Antithrombin III
- Anxiolytics; Sedatives; and Hypnotics
- Apixaban
- Aprepitant, Fosaprepitant
- Argatroban
- Aripiprazole
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Atovaquone; Proguanil
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Barbiturates
- Benazepril; Hydrochlorothiazide, HCTZ
- Benzodiazepines
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bivalirudin
- Boceprevir
- Bosentan
- Brexpiprazole
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Bumetanide
- Bupivacaine; Lidocaine
- Bupropion
- Bupropion; Naltrexone
- Buspirone
- Canagliflozin; Metformin
- Candesartan; Hydrochlorothiazide, HCTZ
- Captopril; Hydrochlorothiazide, HCTZ
- Carbamazepine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbonic anhydrase inhibitors
- Cariprazine
- Celecoxib
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorothiazide
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpromazine
- Choline Salicylate; Magnesium Salicylate
- Cilostazol
- Citalopram
- Clomipramine
- Clonazepam
- Clorazepate
- Cobicistat
- Cobimetinib
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colchicine; Probenecid
- Conjugated Estrogens; Medroxyprogesterone
- Dabigatran
- Dapagliflozin; Metformin
- Dapsone
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Desipramine
- Desirudin
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Diazepam
- Dichlorphenamide
- Diclofenac
- Diclofenac; Misoprostol
- Dienogest; Estradiol valerate
- Diflunisal
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diltiazem
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Dipyridamole
- Dolutegravir
- Dolutegravir; Lamivudine
- Dolutegravir; Rilpivirine
- Doravirine
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Doxepin
- Doxorubicin
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Dronedarone
- Droperidol
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Edoxaban
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Enalapril; Hydrochlorothiazide, HCTZ
- Eprosartan; Hydrochlorothiazide, HCTZ
- Eptifibatide
- Ertugliflozin; Metformin
- Esomeprazole; Naproxen
- Estazolam
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estrogens
- Ethacrynic Acid
- Ethanol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Etodolac
- Etonogestrel
- Ezogabine
- Famotidine; Ibuprofen
- Felbamate
- Fenoprofen
- Flibanserin
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- food
- Fosinopril; Hydrochlorothiazide, HCTZ
- Furosemide
- Gefitinib
- Glimepiride; Pioglitazone
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Heparin
- Homatropine; Hydrocodone
- Hydantoins
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydroxychloroquine
- Hydroxyprogesterone
- Hydroxyzine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Imatinib
- Imipramine
- Indomethacin
- Isavuconazonium
- Ivabradine
- Ketoprofen
- Ketorolac
- Lacosamide
- Lamotrigine
- Lansoprazole; Naproxen
- Lepirudin
- Leuprolide; Norethindrone
- Levetiracetam
- Levonorgestrel
- Lidocaine
- Lidocaine; Prilocaine
- Linagliptin
- Linagliptin; Metformin
- Lithium
- Loop diuretics
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lorazepam
- Low Molecular Weight Heparins
- Lumateperone
- Lurasidone
- Magnesium Salicylate
- Maprotiline
- Maraviroc
- Meclofenamate Sodium
- Medroxyprogesterone
- Mefenamic Acid
- Mefloquine
- Meloxicam
- Meperidine; Promethazine
- Mesoridazine
- Mestranol; Norethindrone
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methenamine
- Methenamine; Sodium Acid Phosphate
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Midazolam
- Molindone
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nisoldipine
- Nonsteroidal antiinflammatory drugs
- Norethindrone
- Norgestrel
- Nortriptyline
- Ombitasvir; Paritaprevir; Ritonavir
- Oxaprozin
- Oxazepam
- Oxycodone
- Paroxetine
- Pazopanib
- Pemoline
- Pentosan
- Perampanel
- Perindopril; Amlodipine
- Perphenazine
- Perphenazine; Amitriptyline
- Phenothiazines
- Phenylephrine; Promethazine
- Pioglitazone
- Piroxicam
- Prasugrel
- Pregabalin
- Probenecid
- Prochlorperazine
- Progesterone
- Progestins
- Promethazine
- Protriptyline
- Quazepam
- Ramelteon
- Rilpivirine
- Ritonavir
- Rivaroxaban
- Rofecoxib
- Romidepsin
- Rufinamide
- Salicylates
- Salsalate
- Segesterone Acetate; Ethinyl Estradiol
- Sertraline
- Simeprevir
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Solifenacin
- Sufentanil
- Sulindac
- Telithromycin
- Temazepam
- Terbinafine
- Thiethylperazine
- Thioridazine
- Thrombin Inhibitors
- Tiagabine
- Ticagrelor
- Ticlopidine
- Tirofiban
- Tolmetin
- Tolterodine
- Tolvaptan
- Torsemide
- Tramadol
- Tretinoin, ATRA
- Triazolam
- Tricyclic antidepressants
- Trifluoperazine
- Trimipramine
- Trospium
- Ulipristal
- Valdecoxib
- Valproic Acid, Divalproex Sodium
- Vemurafenib
- Vorapaxar
- Warfarin
- Zonisamide
