Topiramate (Topamax)

Topiramate (Trade name: Topamax) is an anticonvulsant used to treat epilepsy and prevent migraines. It is also used in the treatment of alcohol use disorder.

Pharmacokinetics of Topiramate

Topiramate: Cytochrome P450 Metabolism

Substrate of (Metabolized by)
Induces
Inhibits
  • Blocks Na+ channels
  • Increases GABA activity
  • Seizure disorders
  • Possibly for aggression, alcoholism, anger, impulsivity (off-label)

Dosing for Topiramate

Starting
Titration
Maximum
Taper
  • Topiramate comes in
  • Sedation, cognitive impairment can be significant (pejoratively called “Dopamax”), glaucoma
  • Weight loss
  • Topiramate increases the risk for nephrolithiasis (kidney stones) due to hypocitraturia and high urine pH[1][2]
    • However, it is not an absolute contraindication in patients with kidney stones[3]
  • Increases the risk for offspring to develop cleft palate in pregnancy