(Legend)

Generic Name

• Topiramate
  T½ = 21 h
  Pregnancy category C

Trade Name

• Topamax
• Qudexy XR
• Topamax Sprinkle
• Trokendi XR

Dose Range/Adult Daily Dose

• Range: 50–400 mg/d (maximum dose: 1600 mg/d)
  Start: 50 mg/d po, increase 50 mg/wk up to 200 mg bid

Use/Common Side Effects (CSE)

• Use: Seizures, migraines; Off label: Adjunct treatment in bipolar disorder.
  CSE: Dizziness, drowsiness, impaired memory/concentration, nervousness, diplopia, nystagmus, nausea, weight loss, ataxia, paresthesias, INCREASED SEIZURES, SUICIDE ATTEMPT

Geriatric & Dose Considerations

• Adjust dose ↓ for renal/hepatic impairment. Dosage reduction recommended if CCr <70 mL/min/1.73 m² for adults and geriatric population

Classification

• Anticonvulsant/mood stabilizer

Assessment Cautions

• Contraindicated: Lactation. Topiramate has not been shown to be as effective as monotherapy in bipolar disorder, may be efficacious as adjunctive treatment. Concomitant use with valproic acid associated with hyperammonemia (with or without encephalopathy). Monitor for alterations in LOC, cognitive function, lethargy, vomiting.