Dosage ; Initially 50mg OD x 1/52 then increased
in steps of 50mg daily at weekly intervals and taken in 2 divided doses.
Usual dose-200mg-400mg daily in 2 divided dose.
| Topiramate | |
|---|---|
| Drug Indication | Adjunctive therapy in partial epilepsy with or without secondary generalization not adequately controlled by other common anti-epileptics; primary generalized tonic-clonic seizure; seizure associated with Lennox-Gastaut syndrome. |
| Precautions | Taper off over at least one week, reduce dose in elderly and patients with renal failure; pregnancy. |
| Contra-Indications | Breastfeeding. |
| Side Effects | Somnolence; GI disturbances; dizziness; ataxia; rhinitis; amblyopia; nystagmus; headache. |
| Dosage | Initially 50mg OD x 1/52 then increased in steps of 50mg daily at weekly intervals and taken in 2 divided doses. Usual dose-200mg-400mg daily in 2 divided dose. |
| Special Information | A sulfamate-substituted monosaccharide. |
| Pregnancy Category | Category B3 |
| Pregnancy Category Description | Drugs which have been taken by only a small number of pregnant women and women of child-bearing age with no any established rise in the frequency of malformations or other direct or indirect detrimental effects on the foetus having been noted. Studies in animals show evidence of an increased occurrence of foetal damage, the significance of which is uncertain in human |
| Drug Category | DRUGS ACTING ON CNS |
| Drug Sub-Category | Anticonvulsants |
| Topiramate More info
Dosing: Adult Note: Do not abruptly discontinue therapy; taper dosage gradually to prevent rebound effects. (In clinical trials, adult doses were withdrawn by decreasing in weekly intervals of 50-100 mg/day gradually over 2-8 weeks for seizure treatment, and by decreasing in weekly intervals by 25-50 mg/day for migraine prophylaxis.) Epilepsy, monotherapy: Partial onset seizure and primary generalized tonic-clonic seizures: Oral: Initial: 25 mg twice daily; may increase weekly by 50 mg/day up to 100 mg twice daily (week 4 dose); thereafter, may further increase weekly by 100 mg/day up to the recommended maximum of 200 mg twice daily Canadian labeling: Oral: Initial: 25 mg once daily (in evening); may increase to 25 mg twice daily in weeks 2 or 3 and up to 50 mg twice daily by weeks 3 or 4; may further increase weekly in increments of 50 mg/day up to recommended maximum of 200 mg twice daily Epilepsy, adjunctive therapy: Partial onset seizures: Oral: Initial: 25 mg once or twice daily for 1 week; may increase weekly by 25-50 mg/day until response; usual maintenance dose: 100-200 mg twice daily. Doses >1600 mg/day have not been studied Primary generalized tonic-clonic seizures: Oral: Use initial dose as listed above for partial onset seizures, but use slower initial titration rate; titrate upwards to recommended dose by the end of 8 weeks; usual maintenance dose: 200 mg twice daily. Doses >1600 mg/day have not been studied. Canadian labeling: Oral: Initial: 25 mg once or twice daily; may increase weekly by 50 mg/day up to the recommended dose of 100-200 mg twice daily (maximum recommended dose: 800 mg/day; doses >400 mg/day have shown no additional benefit) Migraine prophylaxis:Oral: Initial: 25 mg once daily (in evening); may increase weekly by 25 mg/day up to the recommended dose of 100 mg/day given in 2 divided doses. Doses >100 mg/day have shown no additional benefit. Cluster headache prophylaxis (unlabeled use): Oral: Initial: 25 mg/day, titrated at weekly intervals in 25 mg increments, up to 200 mg/day (Pascual, 2007) Diabetic neuropathy (unlabeled use): Oral: Initial: 25 mg/day, titrated at weekly intervals in 25-50 mg increments to target dose of 400 mg daily in 2 divided doses (Raskin, 2004; Thienel, 2004) Dosing: Pediatric (For additional information see "Topiramate: Pediatric drug information" ) Note: Do not abruptly discontinue therapy; taper dosage gradually to prevent rebound effects. Epilepsy monotherapy: Partial onset seizure and primary generalized tonic-clonic seizure: Children ≥10 years: Oral: Refer to adult dosing. Canadian labeling: Children ≥6 years: Refer to adult dosing. Epilepsy, adjunctive therapy: Partial onset seizure or seizure associated with Lennox-Gastaut syndrome: Children 2-16 years: Oral: Initial: 25 mg (1-3 mg/kg/day) once daily (in evening); may increase every 1-2 weeks in increments of 1-3 mg/kg/day up to the recommended maximum of 5-9 mg/kg/day in 2 divided doses Adolescents ≥17 years: Refer to adult dosing. Primary generalized tonic-clonic seizure: Children 2-16 years: Oral: Use initial dose listed above for partial onset seizures, but use slower initial titration rate; titrate to the recommended maintenance dose of 6 mg/kg/day by the end of 8 weeks Adolescents ≥17 years: Refer to adult dosing. Canadian labeling: Children 2-16 years: Oral: Initial: 25 mg (1-3 mg/kg/day) once daily (in evening); may increase every 1-2 weeks in increments of 1-3 mg/kg/day up to the recommended maximum of 5-9 mg/kg/day in 2 divided doses Adolescents ≥17 years: Refer to adult dosing. Dosing: Geriatric Most older adults have creatinine clearances <70 mL/minute/1.73 m2; obtain a serum creatinine and calculate creatinine clearance prior to initiation of therapy. An initial dose of 25 mg/day may be recommended, followed by incremental increases of 25 mg at weekly intervals until an effective dose is reached; refer to adult dosing for titration schedule. |