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Topamax (topiramate)

Indications

Topamax is indicated for:

• Epilepsy
  • Initial monotherapy for patients 2 years and older with partial onset or primary generalized tonic-clonic seizures.
  • Adjunctive therapy for adults and children (2 to 16 years) with partial onset seizures or primary generalized tonic-clonic seizures.
  • Adjunctive therapy for patients 2 years and older with seizures associated with Lennox-Gastaut syndrome.
• Migraine Prophylaxis
  • Prevention of migraines in patients 12 years and older.

Dosage and Administration

• Take Topamax tablets exactly as prescribed by your doctor.
• Swallow the tablets whole with water.
• Take the medication at the same time each day. If you miss a dose, take it as soon as you remember unless it’s almost time for the next dose. In that case, skip the missed dose and continue with your regular schedule.
• Do not chew, crush, or break the tablets.
• Do not abruptly stop taking Topamax without consulting your doctor.

Mechanism of Action

Topamax (Topiramate) works by stabilizing electrical activity in the brain. It blocks certain neurotransmitters and enhances others, which helps to control seizures and prevent migraines.

Contraindications

Topamax has no known contraindications.

Side Effects

Common Side Effects:

• Fatigue
• Drowsiness
• Dizziness
• Loss of appetite
• Weight loss
• Nausea
• Diarrhea
• Tingling sensations

Serious Side Effects:

• Acute myopia and secondary angle closure glaucoma (can lead to permanent visual loss).
• Visual field defects
• Oligohidrosis (reduced sweating) and hyperthermia
• Metabolic acidosis
• Suicidal thoughts or behavior
• Cognitive/neuropsychiatric adverse reactions (e.g., depression, mood problems)
• Fetal toxicity (birth defects such as cleft lip/palate)
• Hyperammonemia/encephalopathy
• Kidney stones
• Hypothermia (especially with concomitant valproic acid use)

Precautions 

• Visual Problems: Discontinue Topamax if you experience acute myopia or secondary angle closure glaucoma.
• Sweating and Body Temperature: Monitor for decreased sweating and increased body temperature, particularly in children.
• Metabolic Acidosis: Regularly check serum bicarbonate levels and consider dose reduction or discontinuation if needed.
• Suicidal Risk: Be aware of increased risk of suicidal behavior and ideation.
• Cognitive Effects: Use caution when operating machinery or driving; watch for depression and mood changes.
• Pregnancy: Avoid use during pregnancy due to risk of birth defects.
• Withdrawal: Gradually taper off Topamax rather than abruptly stopping it.
• Hyperammonemia: Check ammonia levels if symptoms of encephalopathy occur.
• Kidney Stones: Avoid use with other carbonic anhydrase inhibitors, drugs causing metabolic acidosis, or if on a ketogenic diet.
• Hypothermia: Monitor for hypothermia, especially if you are using valproic acid concurrently.

Storage Instructions

• Store Topamax tablets in tightly-closed containers.
• Keep at controlled room temperature between 59°F and 86°F (15°C to 30°C).

References

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020505s057_020844s048lbl.pdf