Partial-Onset or Primary Generalized Tonic-Clonic Seizures
- Topamax, topiramate (generic)
- Start 25 mg PO bid x 1 wk, increase 50 mg/day qwk until 100 mg bid; then increase 100 mg/day qwk until 200 mg bid ; doses > 400 mg/day rarely more effective
- Qudexy XR, Trokendi XR
- Start 50 mg PO qd x 1wk, increase by 50 mg/day at weekly intervals for first 4 weeks, then 100 mg/day for weeks 5 to 6; target dose is 400 mg PO qd
- Topamax, topiramate (generic)
- Start 25-50 mg/day x 1 wk; increase 25-50 mg/day qwk until 100-200 mg PO bid; doses > 400 mg/day rarely more effective
- Qudexy XR, Trokendi XR
- Start 25-50 mg PO qd x 1wk, increase by 25-50 mg/day at weekly intervals to achieve effective dose; not to exceed 200-400 mg/day for partial onset seizures or 400 mg/day for generalized tonic-clonic seizures
- Topamax, topiramate (generic)
- Start 25-50 mg/day x 1 wk; increase 25-50 mg/day qwk until 100-200 mg PO bid, doses > 400 mg/day rarely more effective
- Qudexy XR, Trokendi XR
- ECAPS: Start 25-50 mg PO qd initially; increase by 25-50 mg/day at weekly intervals to achieve effective dose; not to exceed 200-400 mg/day for partial onset seizures or 400 mg/day for generalized tonic-clonic seizures
Migraine prophylaxis
- Start 25 mg PO qd x 1 wk, then increase 25 mg/day qwk until 100 mg/day (divided bid) is reached
- Max: 200 mg/day
Partial-Onset or Primary Generalized Tonic-Clonic Seizures
- Topamax, topiramate (generic)
- Start 25 mg PO bid x 1 wk, increase 50 mg/day qwk until 100 mg bid; then increase 100 mg/day qwk until 200 mg bid, doses > 400 mg/day rarely more effective
10 yrs (Extended release capsule)- Start 50 mg PO qd x 1wk ; increase by 50 mg/wk for first 4 weeks, then 100 mg/wk for weeks 5 to 6; target dose is 400 mg PO qd
- 2-16 yrs Topamax, topiramate (generic)
- Start 1-3 mg/kg/day PO qhs x 1 wk; increase 1-3 mg/kg/day q1-2 wks until 5-9 mg/kg/day PO divided bid
- Trokendi XR
- Start 25 mg PO qhs for first week (based on 1-3 mg/kg/day); increase dose by 1-3 mg/kg once daily at 1-2 week intervals to 5-9 mg/kg PO qd
- Qudexy XR
- Start 25 mg PO qhs for first week (based on 1-3 mg/kg/day); increase dose by 1-3 mg/kg once daily at 1-2 week intervals to 5-9 mg/kg PO qd
- Topamax, topiramate (generic)
- Start 1-3 mg/kg/day PO qhs x 1 wk; increase 1-3 mg/kg/day q1-2 wks until 5-9 mg/kg/day PO divided bid
- Trokendi XR
- Start 25 mg PO qhs for first week (based on 1-3 mg/kg/day); increase dose by 1-3 mg/kg once daily at 1-2 week intervals to 5-9 mg/kg PO qd
- Qudexy XR
- Start 25 mg PO qhs for first week (based on 1-3 mg/kg/day); increase dose by 1-3 mg/kg once daily at 1-2 week intervals to 5-9 mg/kg PO qd
- Start 25 mg PO qd x 1 wk, then increase 25 mg/day qwk until 100 mg/day (divided bid) is reached
- Max: 200 mg/day
Note:
- Safety and efficacy <12 years not established
200 mg/day produce relatively low levels in infant serum. Monitor breastfed infant for drowsiness, adequate weight gain, and developmental milestones, (especially in exclusively breastfed infants or if mother taking combinations of anticonvulsant/psychotropic drugs). This information is based upon LactMed database (available at 
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