Drug Index

Topiramate

 
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Mechanism :

The precise mechanisms by which topiramate exerts its anticonvulsant and migraine prophylaxis effects are unknown; however, preclinical studies have revealed four properties that may contribute to topiramate's efficacy for epilepsy and migraine prophylaxis. Electrophysiological and biochemical evidence suggests that topiramate, at pharmacologically relevant concentrations, blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABA-A receptor, antagonizes the AMPA/kainate subtype of the glutamate receptor, and inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV


Indication :

• Partial seizures

• Generalised tonic-clonic seizures

• Absence-Atonic seizures

• Lennox-Gastaut syndrome

• Migraine


Contraindications :

Contraindicated in patients with a history of hypersensitivity to any component of this product. Ensure adequate hydration to avoid nephrolithiasis. Acute myopia and glaucoma may occur rarely.


Dosing :

2 to <10 years: 25 mg (1-3 mg/kg/day) at bedtime for a week, orally. Increase dose by 1-3 mg/kg/day at 1-2 week intervals, divided 12 hourly to 5-9 mg/kg/day (Max: 250 mg/day in children weighing <11 kg, 300 mg/day in children between 12-22 kg, 350 mg/day in children weighing >23 kg).

>10 years: 200 mg/dose PO 12 hourly. Start with 25 mg PO BD and then increase weekly.


Adverse Effect :

Anorexia, somnolence, decrease in serum bicarbonate, nervousness, paresthesia, psychomotor slowing, abnormal vision, confusion, decreased memory, speech disorder, nausea, fatigue, ataxia. Chronic adverse effects include reduced appetite, anorexia and behavioural changes.


Interaction :

Phenytoin: May increase plasma phenytoin levels.
Digoxin: May decrease digoxin levels.
Oral Contraceptives: May decrease the effectiveness of oral contraceptives, advise patients to use other measures.
Carbamazepine and Phenytoin: may decrease topiramate levels.


07/17/2019 20:44:34 Topiramate
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