Topiramate: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Topiramate | ||
| brand | | brand = Topamax (IR), Trokendi XR, Qudexy XR, Eprontia (oral solution); component of Qsymia (with phentermine) | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:Anticonvulsants|Anticonvulsant]], [[:Category:Migraine prophylactics|Migraine prophylactic]], [[:Category:Weight loss medicines|Weight loss medicine]], [[:Category:Sodium channel blockers|Sodium channel blocker]] | ||
| | | uses = <vote slug="partial-seizures-monotherapy-use">Partial-onset seizures (FDA, monotherapy and adjunct)</vote>, <vote slug="generalized-tonic-clonic-use">Primary generalized tonic-clonic seizures (FDA, ages 2+)</vote>, <vote slug="lennox-gastaut-use">Lennox-Gastaut syndrome (FDA adjunct)</vote>, <vote slug="migraine-prophylaxis-use">Migraine prophylaxis (FDA, adult)</vote>, <vote slug="alcohol-use-disorder-topiramate-use">Alcohol use disorder (off-label, evidence-supported)</vote>, <vote slug="binge-eating-disorder-use">Binge-eating disorder and bulimia nervosa (off-label)</vote>, <vote slug="weight-loss-use">Chronic weight management (Qsymia combination with phentermine, FDA)</vote> | ||
| uses | | starting_dose = Migraine: 25 mg PO at bedtime, titrate by 25 mg weekly to target 100 mg/day divided BID. Seizures: 25-50 mg/day, titrate weekly to 200-400 mg/day divided BID | ||
| starting_dose | | preparations = IR tablets 25, 50, 100, 200 mg; sprinkle capsules 15, 25 mg; Trokendi XR capsules 25, 50, 100, 200 mg; Qudexy XR capsules; Eprontia oral solution 25 mg/mL | ||
| preparations | | fda_max = 1600 mg/day (theoretical seizure dosing); practical use 400 mg/day for seizures, 100-200 mg/day for migraine prophylaxis | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = Anticonvulsant effect within days at therapeutic level; migraine prophylaxis effect emerges over 2-3 months | ||
| duration | | duration = 12-24 hours (IR BID); 24 hours (ER once-daily) | ||
| halflife | | halflife = ~21 hours<ref name="topamax-label">FDA Prescribing Information, Topamax (topiramate), Janssen, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020844s050lbl.pdf</ref> | ||
| bioavailability = ~80% (oral)<ref name="topamax-label" /> | |||
| pregnancy = '''Substantial teratogenic risk''' including cleft lip/palate, hypospadias, and growth restriction (pregnancy registry data clear); effective contraception and pre-pregnancy counseling are required in reproductive-age patients<ref name="topamax-label" /> | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance<ref name="topamax-label" /> | |||
| | | mechanism = <vote slug="topiramate-mech-claim">Multi-target anticonvulsant: voltage-gated sodium channel blocker in the inactivated state, GABA-A receptor potentiator at a non-benzodiazepine site, AMPA/kainate glutamate receptor antagonist, and weak carbonic anhydrase inhibitor. The carbonic anhydrase inhibition explains the characteristic adverse-effect cluster (paresthesias, metabolic acidosis, kidney stones, oligohidrosis with heat intolerance) and likely contributes to the cognitive slowing nicknamed "dopamax" in clinical lore.</vote> Weight loss is a class effect, the basis of the Qsymia combination with phentermine for chronic weight management. Carbonic-anhydrase-related '''acute angle-closure glaucoma''' is a rare but vision-threatening idiosyncratic reaction, typically within the first month<ref name="topamax-label" />. | ||
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[[Category: | == References == | ||
[[Category: | <references /> | ||
[[Category:Anticonvulsants]] | |||
[[Category:Migraine prophylactics]] | |||
[[Category:Weight loss medicines]] | |||
[[Category:Sodium channel blockers]] | |||
Latest revision as of 06:44, 23 May 2026
Topiramate
Topamax (IR), Trokendi XR, Qudexy XR, Eprontia (oral solution); component of Qsymia (with phentermine)
Experience
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Problems
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Summary
Common uses
Partial-onset seizures (FDA, monotherapy and adjunct)0, Primary generalized tonic-clonic seizures (FDA, ages 2+)0, Lennox-Gastaut syndrome (FDA adjunct)0, Migraine prophylaxis (FDA, adult)0, Alcohol use disorder (off-label, evidence-supported)0, Binge-eating disorder and bulimia nervosa (off-label)0, Chronic weight management (Qsymia combination with phentermine, FDA)0
Pharmacy
Starting dose
Migraine: 25 mg PO at bedtime, titrate by 25 mg weekly to target 100 mg/day divided BID. Seizures: 25-50 mg/day, titrate weekly to 200-400 mg/day divided BID
Preparations
IR tablets 25, 50, 100, 200 mg; sprinkle capsules 15, 25 mg; Trokendi XR capsules 25, 50, 100, 200 mg; Qudexy XR capsules; Eprontia oral solution 25 mg/mL
US FDA Max
1600 mg/day (theoretical seizure dosing); practical use 400 mg/day for seizures, 100-200 mg/day for migraine prophylaxis
Pharmacology
Routes
Oral
Onset
Anticonvulsant effect within days at therapeutic level; migraine prophylaxis effect emerges over 2-3 months
Duration
12-24 hours (IR BID); 24 hours (ER once-daily)
Half-life
~21 hours[1]
Bioavailability
~80% (oral)[1]
Pregnancy
Substantial teratogenic risk including cleft lip/palate, hypospadias, and growth restriction (pregnancy registry data clear); effective contraception and pre-pregnancy counseling are required in reproductive-age patients[1]
Purported mechanism
Multi-target anticonvulsant: voltage-gated sodium channel blocker in the inactivated state, GABA-A receptor potentiator at a non-benzodiazepine site, AMPA/kainate glutamate receptor antagonist, and weak carbonic anhydrase inhibitor. The carbonic anhydrase inhibition explains the characteristic adverse-effect cluster (paresthesias, metabolic acidosis, kidney stones, oligohidrosis with heat intolerance) and likely contributes to the cognitive slowing nicknamed "dopamax" in clinical lore.0 Weight loss is a class effect, the basis of the Qsymia combination with phentermine for chronic weight management. Carbonic-anhydrase-related acute angle-closure glaucoma is a rare but vision-threatening idiosyncratic reaction, typically within the first month[1].