topiramate (Rx)

Brand and Other Names:Topamax, Trokendi XR, more...Qudexy XR
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet (Topamax)

  • 25mg
  • 50mg
  • 100mg
  • 200mg

capsule, sprinkle (Topamax Sprinkle)

  • 15mg
  • 25mg

capsule, extended-release

  • 25mg (Trokendi XR, Qudexy XR)
  • 50mg (Trokendi XR, Qudexy XR)
  • 100mg (Trokendi XR, Qudexy XR)
  • 150mg (Qudexy XR)
  • 200mg (Trokendi XR, Qudexy XR)

Partial-Onset or Primary Generalized Tonic-Clonic Seizures

Monotherapy

  • Topamax, Topamax Sprinkles: 25 mg PO q12hr initially; may increase by 50 mg/day at weekly intervals to 200 mg PO q12hr
  • Trokendi XR, Qudexy XR: 50 mg PO qDay initially; may increase by 50 mg/day at weekly intervals for first 4 weeks, then 100 mg/day for weeks 5 to 6; target dose is 200-400 mg/day for partial onset seizures and 400 mg/day for generalized seizures

Adjunctive therapy

  • Topamax, Topamax Sprinkles: 25-50 mg/day PO initially; increase by 25-50 mg/day at weekly intervals to 100-200 mg q12hr for partial onset seizures and 200 mg q12hr
  • Trokendi XR, Qudexy XR: 25-50 mg PO qDay initially; increase by 25-50 mg/day at weekly intervals to achieve effective dose; not to exceed 200-400 mg/day

Lennox-Gastaut Syndrome

Indicated as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS)

Topamax, Topamax Sprinkles: 25-50 mg/day PO initially; increase by 25-50 mg/day at weekly intervals to 100-200 mg q12hr

Trokendi XR, Qudexy XR: 25-50 mg PO qDay initially; increase by 25-50 mg/day at weekly intervals to achieve effective dose; not to exceed 200-400 mg/day

Migraine Headache

Indicated for prophylaxis of migraine headache

Guide dose/titration rate by clinical outcome; if needed, use longer intervals between dose adjustments

Topamax

  • Titrate over 4 wk to achieve a dose of 50 mg PO BID
  • Week 1: 25 mg PO qHS
  • Week 2: 25 mg PO BID
  • Week 3: 25 mg PO in the morning and 50 mg HS
  • Week 4: 50 mg PO BID

Qudexy XR or Trokendi XR

  • Titrate over 4 wk to achieve a dose of 100 mg/day
  • Week 1: 25 mg PO qDay
  • Week 2: 50 mg PO qDay
  • Week 3: 75 mg PO qDay
  • Week 4: 100 mg PO qDay

Dosage Modifications

Renal impairment

  • CrCl <70 mL/min: Reduce dose by 50%
  • Hemodialysis: Cleared by hemodialysis at rate 4-6 times greater than normal; prolonged period of dialysis may decrease topiramate serum concentrations

Hepatic impairment

  • Clearance may decrease; monitor

Cluster Headache (Off-label)

Prophylaxis

Initial: 25 mg PO qDay for 7 days

Increase by 25 mg/day every week to no more than 200 mg/day

Alcoholism (Off-label)

Initial: 25 mg PO qDay week 1

May increase to maximum 300 mg/day by weeks 5-14; may divide 300 mg dose q8hr (case reports)

Maintenance: 200 mg/day divided q12hr or 300 mg/day divided q8hr

Injectable topiramate (Orphan)

Orphan designation for Captisol-enabled topiramate injection for the treatment of partial onset or primary generalized tonic-clonic seizures in hospitalized patients with epilepsy or those being treated in an emergency care setting who are unable to take oral topiramate

Orphan sponsor

  • Ligand Pharmaceuticals, Inc.; 11119 North Torrey Pines Road, Suite 200; La Jolla, CA 92037

Dosage Forms & Strengths

tablet (Topamax)

  • 25mg
  • 50mg
  • 100mg
  • 200mg

capsule, sprinkle (Topamax Sprinkle)

  • 15mg
  • 25mg

capsule, extended-release

  • 25mg (Trokendi XR, Qudexy XR)
  • 50mg (Trokendi XR, Qudexy XR)
  • 100mg (Trokendi XR, Qudexy XR)
  • 150mg (Qudexy XR)
  • 200mg (Trokendi XR, Qudexy XR)

Partial-Onset or Primary Generalized Tonic-Clonic Seizures

Monotherapy (Topamax, Topamax Sprinkles)

  • <2 years: Safety and efficacy not established
  • 2 to <10 years: 25 mg PO qHS for 1 week; titrate dose over 5-7 weeks to target daily maintenance dose (weight based) and divide into q12hr dosing schedule
  • Weight-based dosing
    • Up to 11 kg: 150 mg/day minimum; 250 mg/day maximum
    • 12-22 kg: 200 mg/day minimum; 300 mg/day maximum
    • 23-31 kg: 200 mg/day minimum; 350 mg/day maximum
    • 32-38 kg: 250 mg/day minimum; 350 mg/day maximum
    • >38 kg: 250 mg/day minimum; 400 mg/day maximum
  • ≥10 years
    • 25 mg PO q12hr initially
    • Titrate by increments of 50 mg/week up to 200 mg q12hr

Monotherapy (Trokendi XR)

  • <6 years: Safety and efficacy not established
  • 6-10 years
    • 25 mg/day nightly for the first week; based upon tolerability, the dosage can be increased to 50 mg/day in the second week, and then increased by 25-50 mg/day each subsequent week as tolerated
    • Minimum and maximum weight based maintenance dosage ranges listed below
    • ≤11 kg: 150-250 mg/day
    • 12-22 kg: 200-300 mg/day
    • 23-31 kg: 200-350 mg/day
    • 32-38 kg: 250-350 mg/day
    • ≥38 kg: 250-400 mg/day
  • ≥10 years
    • 50 mg PO qDay initially; may increase by 50 mg/week for first 4 weeks, then 100 mg/week for weeks 5 to 6; target dose is 400 mg PO qDay
    • Week 1: 50 mg/day
    • Week 2: 100 mg/day
    • Week 3: 150 mg/day
    • Week 4: 200 mg/day
    • Week 5: 300 mg/day
    • Week 6: 400 mg/day

Monotherapy (Qudexy XR)

  • <2 years: Safety and efficacy not established
  • 2 to <10 years
    • 25 mg PO qHS initially during the first week; based upon tolerability, the dosage can be increased to 50 mg/day in the second week, and then increased by 25-50 mg/day each subsequent week, as tolerated
    • Titration to the minimum maintenance dose should be attempted over 5-7 weeks
    • Based upon tolerability and clinical response, additional titration to a higher dose (up to the maximum maintenance dose) can be attempted in weekly increments by 25-50 mg/day, up to the maximum recommended maintenance dose for each range of body weight
    • Up to 11 kg: 150 mg/day (minimum); 250 mg/day (maximum)
    • 12-22 kg: 200 mg/day (minimum); 300 mg/day (maximum)
    • 23-31 kg: 200 mg/day (minimum); 350 mg/day (maximum)
    • 32-38 kg: 250 mg/day (minimum); 350 mg/day (maximum)
    • >38 kg: 250 mg/day (minimum); 400 mg/day (maximum)
  • ≥10 years
    • 50 mg PO qDay initially
    • Titrate to target dose by increasing 50 mg/week for first 4 weeks, and then 100 mg/week for weeks 5 to 6
    • Ttarget dose is 400 mg PO qDay

Adjunctive therapy (Topamax, Topamax Sprinkles)

  • <2 years: Safety and efficacy not established
  • 2-16 years: 25 mg PO qHS initially for first week (based on 1-3 mg/kg/day); increase dose by 1-3 mg/kg/day PO divided q12hr at 1-2 week intervals to 5-9 mg/kg/day divided q12hr  
  • ≥17 years: 25-50 mg/day PO initially; increase by 25-50 mg/day at weekly intervals to 100-200 mg q12hr for partial onset seizures and 200 mg q12hr for generalized tonic/clonic seizures

Adjunctive therapy (Trokendi XR)

  • <6 years: Safety and efficacy not established
  • ≥6 years: 25 mg PO qHS initially 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 once daily

Adjunctive therapy (Qudexy XR)

  • <2 years: Safety and efficacy not established
  • ≥2 years: 25 mg PO qHS initially 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 once daily

Lennox-Gastaut Syndrome

Adjunctive therapy (Topamax, Topamax Sprinkles)

  • <2 years: Safety and efficacy not established
  • 2-16 years: 25 mg PO qHS initially for first week (based on 1-3 mg/kg/day); increase dose by 1-3 mg/kg/day PO divided q12hr at 1-2 week intervals to 5-9 mg/kg/day divided q12hr
  • ≥17 years: 25-50 mg/day PO initially; increase by 25-50 mg/day at weekly intervals to 100-200 mg q12hr for partial onset seizures and 200 mg q12hr for generalized tonic/clonic seizures

Adjunctive therapy (Trokendi XR)

  • <6 years: Safety and efficacy not established
  • ≥6 years: 25 mg PO qHS initially 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 once daily

Adjunctive therapy (Qudexy XR)

  • <2 years: Safety and efficacy not established
  • ≥2 years: 25 mg PO qHS initially 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 once daily

Migraine Headache

Indicated for prophylaxis of migraine headache

<12 years: Safety and efficacy not established

Guide dose/titration rate by clinical outcome; if needed, use longer intervals between dose adjustments

≥12 years

  • Topamax
    • Titrate over 4 wk to achieve a dose of 50 mg PO BID
    • Week 1: 25 mg PO qHS
    • Week 2: 25 mg PO BID
    • Week 3: 25 mg PO in the morning and 50 mg HS
    • Week 4: 50 mg PO BID
  • Qudexy XR or Trokendi XR
    • Titrate over 4 wk to achieve a dose of 100 mg/day
    • Week 1: 25 mg PO qDay
    • Week 2: 50 mg PO qDay
    • Week 3: 75 mg PO qDay
    • Week 4: 100 mg PO qDay

Dosage Modifications

Renal impairment

  • CrCl <70 mL/min: Reduce dose by 50%
  • Hemodialysis: Cleared by hemodialysis at rate 4-6 times greater than normal; prolonged period of dialysis may decrease topiramate serum concentrations
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Interactions

Interaction Checker

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              Serious - Use Alternative (24)

              • calcium/magnesium/potassium/sodium oxybates

                calcium/magnesium/potassium/sodium oxybates, topiramate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • dihydroergotamine

                topiramate will decrease the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • dihydroergotamine intranasal

                topiramate will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • dronedarone

                topiramate will decrease the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • ergotamine

                topiramate will decrease the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • erythromycin base

                topiramate will decrease the level or effect of erythromycin base by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • erythromycin ethylsuccinate

                topiramate will decrease the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • erythromycin lactobionate

                topiramate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • erythromycin stearate

                topiramate will decrease the level or effect of erythromycin stearate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • ethinylestradiol

                topiramate will decrease the level or effect of ethinylestradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. The efficacy of hormonal contraceptives may be reduced. Use of a nonhormonal contraceptive is recommended.

              • everolimus

                topiramate will decrease the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • lovastatin

                topiramate will decrease the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • metoclopramide intranasal

                topiramate, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • norethindrone

                topiramate will decrease the level or effect of norethindrone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration unless benefit outweighs risk. When coadministered, hormonal contraceptives are not a reliable method of effective birth control. Concomitant use may increase incidence of menstruation associated adverse effects (amenorrhea, dysmenorrhea, menorrhagia).

              • norethindrone acetate

                topiramate will decrease the level or effect of norethindrone acetate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration unless benefit outweighs risk. When coadministered, hormonal contraceptives are not a reliable method of effective birth control. Concomitant use may increase incidence of menstruation associated adverse effects (amenorrhea, dysmenorrhea, menorrhagia).

              • norethindrone transdermal

                topiramate will decrease the level or effect of norethindrone transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration unless benefit outweighs risk. When coadministered, hormonal contraceptives are not a reliable method of effective birth control. Concomitant use may increase incidence of menstruation associated adverse effects (amenorrhea, dysmenorrhea, menorrhagia).

              • perampanel

                topiramate will decrease the level or effect of perampanel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Increased perampanel dose may be needed when coadministered

              • ranolazine

                topiramate will decrease the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • silodosin

                topiramate will decrease the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • simvastatin

                topiramate will decrease the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • sirolimus

                topiramate will decrease the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • sodium oxybate

                sodium oxybate, topiramate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • tolvaptan

                topiramate will decrease the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              • ulipristal

                topiramate will decrease the level or effect of ulipristal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              Monitor Closely (266)

              • acetazolamide

                topiramate, acetazolamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of kidney stone formation.

              • albuterol

                topiramate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • alfentanil

                alfentanil and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • alitretinoin

                topiramate will decrease the level or effect of alitretinoin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • almotriptan

                topiramate will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • alprazolam

                topiramate will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                alprazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • amiodarone

                topiramate will decrease the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • amitriptyline

                amitriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

                topiramate increases toxicity of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor. Amitriptyline levels may increase; adjust dose based on clinical response and not on basis of plasma levels.

              • amobarbital

                amobarbital and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • amoxapine

                amoxapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • apomorphine

                apomorphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • aprepitant

                topiramate will decrease the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • arformoterol

                topiramate increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • aripiprazole

                topiramate will decrease the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                aripiprazole and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • armodafinil

                topiramate increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • artemether/lumefantrine

                topiramate will decrease the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • atorvastatin

                topiramate will decrease the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • avanafil

                topiramate will decrease the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. For patients with ED, monitor response carefully because of potential for decreased effectiveness.

              • axitinib

                topiramate decreases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • azelastine

                azelastine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • baclofen

                baclofen and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • bazedoxifene/conjugated estrogens

                topiramate will decrease the level or effect of bazedoxifene/conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • belladonna and opium

                belladonna and opium and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • benperidol

                benperidol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • benzphetamine

                topiramate increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • brexanolone

                brexanolone, topiramate. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • brinzolamide

                topiramate, brinzolamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of kidney stone formation.

              • brompheniramine

                brompheniramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • budesonide

                topiramate will decrease the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • buprenorphine

                buprenorphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • buprenorphine buccal

                buprenorphine buccal and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • buspirone

                topiramate will decrease the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • butabarbital

                butabarbital and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • butalbital

                butalbital and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • butorphanol

                butorphanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • caffeine

                topiramate increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • carbamazepine

                topiramate will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                carbamazepine decreases levels of topiramate by increasing metabolism. Use Caution/Monitor.

              • carbinoxamine

                carbinoxamine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • carisoprodol

                carisoprodol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • cenobamate

                cenobamate, topiramate. Either increases effects of the other by sedation. Use Caution/Monitor.

              • chloral hydrate

                chloral hydrate and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • chlordiazepoxide

                chlordiazepoxide and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • chlorpheniramine

                chlorpheniramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • chlorpromazine

                chlorpromazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • chlorzoxazone

                chlorzoxazone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • cilostazol

                topiramate will decrease the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • cinacalcet

                topiramate will decrease the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • cinnarizine

                cinnarizine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • clemastine

                clemastine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • clobazam

                topiramate, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • clobetasone

                topiramate will decrease the level or effect of clobetasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • clomipramine

                clomipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • clonazepam

                clonazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • clopidogrel

                topiramate will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel

              • clorazepate

                clorazepate and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • clozapine

                topiramate will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                clozapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • codeine

                codeine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • colchicine

                topiramate will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • conivaptan

                topiramate will decrease the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • conjugated estrogens

                topiramate will decrease the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • conjugated estrogens, vaginal

                topiramate will decrease the level or effect of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • cortisone

                topiramate will decrease the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • cyclizine

                cyclizine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • cyclobenzaprine

                cyclobenzaprine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • cyclosporine

                topiramate will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • dantrolene

                dantrolene and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • darifenacin

                topiramate will decrease the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • darunavir

                topiramate will decrease the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • dasatinib

                topiramate will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • desflurane

                desflurane and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • desipramine

                desipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • deutetrabenazine

                topiramate and deutetrabenazine both increase sedation. Use Caution/Monitor.

              • dexamethasone

                topiramate will decrease the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • dexfenfluramine

                topiramate increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • dexmedetomidine

                dexmedetomidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • dexmethylphenidate

                topiramate increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • dextroamphetamine

                topiramate increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • dextromoramide

                dextromoramide and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • diamorphine

                diamorphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • diazepam

                topiramate will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                diazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • dichlorphenamide

                dichlorphenamide and topiramate both decrease serum potassium. Use Caution/Monitor.

                dichlorphenamide, topiramate. Either increases levels of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

              • dienogest/estradiol valerate

                topiramate will decrease the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Advise women to use alternative method of contraception or back-up method when moderate or weak enzyme inducer is used with combination contraceptives. Back-up contraception should be continued for 28 days after discontinuing medication to ensure contraceptive reliability.

              • diethylpropion

                topiramate increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • difenoxin hcl

                difenoxin hcl and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • diltiazem

                topiramate will decrease the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • dimenhydrinate

                dimenhydrinate and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • diphenhydramine

                diphenhydramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • diphenoxylate hcl

                diphenoxylate hcl and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • dipipanone

                dipipanone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • dobutamine

                topiramate increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • dopamine

                topiramate increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • dopexamine

                topiramate increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • doxepin

                doxepin and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • doxylamine

                doxylamine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • droperidol

                droperidol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • eletriptan

                topiramate will decrease the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ephedrine

                topiramate increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • epinephrine

                topiramate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • epinephrine racemic

                topiramate increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • erlotinib

                topiramate will decrease the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • esketamine intranasal

                esketamine intranasal, topiramate. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • estazolam

                estazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • estradiol

                topiramate will decrease the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • estrogens conjugated synthetic

                topiramate will decrease the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • estrogens esterified

                topiramate will decrease the level or effect of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Topiramate may compromise the efficacy of estrogens used for contraception or hormone replacement therapies

              • estropipate

                topiramate will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ethanol

                ethanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • etonogestrel

                topiramate will decrease the level or effect of etonogestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • etravirine

                topiramate will decrease the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • eucalyptus

                eucalyptus and topiramate both increase sedation. Use Caution/Monitor.

              • felodipine

                topiramate will decrease the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fenfluramine

                topiramate increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • fesoterodine

                topiramate will decrease the level or effect of fesoterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fludrocortisone

                topiramate will decrease the level or effect of fludrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fluphenazine

                fluphenazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • flurazepam

                flurazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • formoterol

                topiramate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • fosamprenavir

                topiramate will decrease the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • fosphenytoin

                fosphenytoin decreases levels of topiramate by increasing metabolism. Use Caution/Monitor.

              • haloperidol

                haloperidol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • hydrocortisone

                topiramate will decrease the level or effect of hydrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • hydromorphone

                hydromorphone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • hydroxyprogesterone caproate

                topiramate will decrease the level or effect of hydroxyprogesterone caproate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • iloperidone

                topiramate will decrease the level or effect of iloperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                iloperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • imipramine

                imipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • indinavir

                topiramate will decrease the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • isoproterenol

                topiramate increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • ketamine

                ketamine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • ketotifen, ophthalmic

                ketotifen, ophthalmic and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • lapatinib

                topiramate will decrease the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lasmiditan

                lasmiditan, topiramate. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                lemborexant will increase the level or effect of topiramate by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • levalbuterol

                topiramate increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • levonorgestrel intrauterine

                topiramate decreases levels of levonorgestrel intrauterine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • levonorgestrel oral

                topiramate decreases levels of levonorgestrel oral by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                topiramate will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The efficacy of hormonal contraceptives may be reduced. Use an alternative method of contraception or a backup method when enzyme inducers are used with combined hormonal contraceptives (CHCs), and continue backup contraception for 28 days after discontinuing enzyme inducer to ensure contraceptive reliability.

              • levorphanol

                levorphanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • linagliptin

                topiramate will increase the level or effect of linagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use of alternative treatments is strongly recommended when linagliptin is to be administered with a CYP3A4 inducer

              • lisdexamfetamine

                topiramate increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • lithium

                topiramate increases levels of lithium by unspecified interaction mechanism. Use Caution/Monitor. Increase in lithium exposure may occur with doses of up to 600 mg/day; monitor lithium levels when coadministered with high-dose topiramate .

              • lofepramine

                lofepramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • lofexidine

                lofexidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • lopinavir

                topiramate will decrease the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • loprazolam

                loprazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • loratadine

                topiramate will decrease the level or effect of loratadine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lorazepam

                lorazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • lormetazepam

                lormetazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • loxapine

                loxapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • loxapine inhaled

                loxapine inhaled and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • lumefantrine

                topiramate will decrease the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lurasidone

                lurasidone, topiramate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maprotiline

                maprotiline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • maraviroc

                topiramate will decrease the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • marijuana

                marijuana and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • melatonin

                melatonin and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • meperidine

                meperidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • meprobamate

                meprobamate and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • mestranol

                topiramate will decrease the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • metaproterenol

                topiramate increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • metaxalone

                metaxalone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • metformin

                topiramate increases toxicity of metformin by Other (see comment). Use Caution/Monitor. Comment: Decreases serum bicarbonate and induce non-anion gap, hyperchloremic metabolic acidosis.

              • methadone

                topiramate will decrease the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                methadone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • methamphetamine

                topiramate increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • methazolamide

                topiramate, methazolamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of kidney stone formation.

              • methocarbamol

                methocarbamol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • methylenedioxymethamphetamine

                topiramate increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • methylprednisolone

                topiramate will decrease the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • midazolam

                topiramate will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                midazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • midazolam intranasal

                midazolam intranasal, topiramate. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • midodrine

                topiramate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • mirtazapine

                mirtazapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • modafinil

                topiramate increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • morphine

                morphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • motherwort

                motherwort and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • moxonidine

                moxonidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • nabilone

                nabilone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • nalbuphine

                nalbuphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • nelfinavir

                topiramate will decrease the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nicardipine

                topiramate will decrease the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nilotinib

                topiramate will decrease the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nisoldipine

                topiramate will decrease the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • norepinephrine

                topiramate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • nortriptyline

                nortriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • olanzapine

                olanzapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • opium tincture

                opium tincture and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • orlistat

                orlistat decreases levels of topiramate by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.

              • orphenadrine

                orphenadrine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • oxazepam

                oxazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • oxycodone

                oxycodone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • oxymorphone

                oxymorphone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • paliperidone

                paliperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • papaveretum

                papaveretum and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • papaverine

                papaverine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • pazopanib

                topiramate will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • pentazocine

                pentazocine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • pentobarbital

                pentobarbital and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • perphenazine

                perphenazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • phendimetrazine

                topiramate increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • phenobarbital

                phenobarbital and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • phentermine

                topiramate increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • phenylephrine

                topiramate increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • phenylephrine PO

                topiramate increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely. .

              • phenytoin

                phenytoin decreases levels of topiramate by increasing metabolism. Use Caution/Monitor.

              • pholcodine

                pholcodine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • pimozide

                pimozide and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • pirbuterol

                topiramate increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • prednisone

                topiramate will decrease the level or effect of prednisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • primidone

                primidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • prochlorperazine

                prochlorperazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • promethazine

                promethazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • propofol

                propofol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • propylhexedrine

                topiramate increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • protriptyline

                protriptyline and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • quazepam

                quazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • quetiapine

                topiramate will decrease the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                quetiapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • quinidine

                topiramate will decrease the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ramelteon

                ramelteon and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • repaglinide

                topiramate will decrease the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • risperidone

                risperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • ritonavir

                topiramate will decrease the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • romidepsin

                topiramate will decrease the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • sage

                sage and topiramate both increase sedation. Use Caution/Monitor.

              • salmeterol

                topiramate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • saquinavir

                topiramate will decrease the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • scullcap

                scullcap and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • secobarbital

                secobarbital and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • sevelamer

                sevelamer decreases levels of topiramate by increasing elimination. Use Caution/Monitor.

              • sevoflurane

                sevoflurane and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • shepherd's purse

                shepherd's purse and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • solifenacin

                topiramate will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • stiripentol

                stiripentol, topiramate. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                sufentanil and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • sunitinib

                topiramate will decrease the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tacrolimus

                topiramate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tadalafil

                topiramate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tapentadol

                tapentadol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tazemetostat

                topiramate will decrease the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • temazepam

                temazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • temsirolimus

                topiramate will decrease the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • terbutaline

                topiramate increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • theophylline

                topiramate will decrease the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • thioridazine

                thioridazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • thiothixene

                thiothixene and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tipranavir

                topiramate will decrease the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tobramycin inhaled

                tobramycin inhaled and topiramate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

              • tolterodine

                topiramate will decrease the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tramadol

                tramadol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • trazodone

                topiramate will decrease the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                trazodone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • triamcinolone acetonide injectable suspension

                topiramate will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • triazolam

                topiramate will decrease the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                triazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • triclofos

                triclofos and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • trifluoperazine

                trifluoperazine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • trimipramine

                trimipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • triprolidine

                triprolidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • ubrogepant

                topiramate will decrease the level or effect of ubrogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Dose adjustment is recommended with concomitant use of ubrogepant and moderate and weak CYP3A4 inducers. (see Dosage Modifications)

              • valproic acid

                valproic acid, topiramate. Either increases toxicity of the other by unknown mechanism. Use Caution/Monitor. Risk of hyperammonemia with or without encephalopathy; pts. with inborn errors of metabolism may be at greater risk. S/S: altered LOC, lethargy, vomiting.

              • vardenafil

                topiramate will decrease the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • verapamil

                topiramate will decrease the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • warfarin

                topiramate will decrease the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • xylometazoline

                topiramate increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • yohimbine

                topiramate increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • ziconotide

                topiramate and ziconotide both increase sedation. Modify Therapy/Monitor Closely.

              • ziprasidone

                ziprasidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              Minor (76)

              • acetaminophen

                topiramate decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • acetaminophen IV

                topiramate decreases levels of acetaminophen IV by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • acetaminophen rectal

                topiramate decreases levels of acetaminophen rectal by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

              • alfentanil

                topiramate will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • alfuzosin

                topiramate will decrease the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • alosetron

                topiramate will decrease the level or effect of alosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • amobarbital

                amobarbital decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • armodafinil

                topiramate will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • atazanavir

                topiramate will decrease the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • atracurium

                topiramate decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • biotin

                topiramate decreases levels of biotin by unspecified interaction mechanism. Minor/Significance Unknown. Biotin supplementation may be necessary.

              • bortezomib

                topiramate will decrease the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Caution is advised with concurrent use.

              • bosentan

                topiramate will decrease the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • butabarbital

                butabarbital decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • butalbital

                butalbital decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • cevimeline

                topiramate will decrease the level or effect of cevimeline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cisatracurium

                topiramate decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • clarithromycin

                topiramate will decrease the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • clomipramine

                topiramate will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cyanocobalamin

                topiramate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • dapsone

                topiramate will decrease the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • desipramine

                topiramate will decrease the level or effect of desipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dexmethylphenidate

                dexmethylphenidate increases effects of topiramate by decreasing metabolism. Minor/Significance Unknown.

              • digoxin

                topiramate decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

              • disopyramide

                topiramate will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • donepezil

                topiramate will decrease the level or effect of donepezil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dutasteride

                topiramate will decrease the level or effect of dutasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • efavirenz

                topiramate will decrease the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • eplerenone

                topiramate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ethotoin

                topiramate increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

                ethotoin decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • eucalyptus

                topiramate will decrease the level or effect of eucalyptus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • finasteride

                topiramate will decrease the level or effect of finasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fosphenytoin

                topiramate increases levels of fosphenytoin by decreasing metabolism. Minor/Significance Unknown.

              • galantamine

                topiramate will decrease the level or effect of galantamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • glyburide

                topiramate will decrease the level or effect of glyburide by unknown mechanism. Minor/Significance Unknown. Effect in glycemic control is likely small.

              • imatinib

                topiramate will decrease the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • imipramine

                topiramate will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • incobotulinumtoxinA

                topiramate decreases effects of incobotulinumtoxinA by pharmacodynamic antagonism. Minor/Significance Unknown.

              • isradipine

                topiramate will decrease the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • itraconazole

                topiramate will decrease the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ketoconazole

                topiramate will decrease the level or effect of ketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • levocarnitine

                topiramate decreases levels of levocarnitine by unspecified interaction mechanism. Minor/Significance Unknown.

              • montelukast

                topiramate will decrease the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nifedipine

                topiramate will decrease the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nimodipine

                topiramate will decrease the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nitrendipine

                topiramate will decrease the level or effect of nitrendipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • onabotulinumtoxinA

                topiramate decreases effects of onabotulinumtoxinA by pharmacodynamic antagonism. Minor/Significance Unknown.

              • ondansetron

                topiramate will decrease the level or effect of ondansetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • oxybutynin

                topiramate will decrease the level or effect of oxybutynin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • paclitaxel

                topiramate will decrease the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • paclitaxel protein bound

                topiramate will decrease the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pancuronium

                topiramate decreases effects of pancuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • parecoxib

                topiramate will decrease the level or effect of parecoxib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pentobarbital

                pentobarbital decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • phenobarbital

                phenobarbital decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • phenytoin

                topiramate increases levels of phenytoin by decreasing metabolism. Minor/Significance Unknown.

              • pimozide

                topiramate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pioglitazone

                topiramate will decrease the level or effect of pioglitazone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • primidone

                primidone decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • propafenone

                topiramate will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • quinine

                topiramate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ramelteon

                topiramate will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • rapacuronium

                topiramate decreases effects of rapacuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • rocuronium

                topiramate decreases effects of rocuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • sage

                sage decreases effects of topiramate by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction; some species of sage may cause convulsions.

              • saxagliptin

                topiramate will decrease the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • secobarbital

                secobarbital decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

              • succinylcholine

                topiramate decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • sufentanil

                topiramate will decrease the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • valproic acid

                topiramate decreases levels of valproic acid by increasing metabolism. Minor/Significance Unknown.

              • vecuronium

                topiramate decreases effects of vecuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • vincristine liposomal

                topiramate will decrease the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • zaleplon

                topiramate will decrease the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ziprasidone

                topiramate will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • zolpidem

                topiramate will decrease the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • zonisamide

                topiramate will decrease the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Decrease in serum bicarbonate (7-67%)

              Dizziness (4-29%)

              Fatigue (9-16%)

              Ataxia (6-16%)

              Nervousness (9-18%)

              Paresthesia (1-11%)

              Psychomotor slowing (3-13%)

              Abnormal vision (2-13%)

              Anorexia (4-24%)

              Confusion (4-11%)

              Decreased memory (2-12%)

              Nausea (6-10%)

              Speech disorder (2-13%)

              Injury (14%)

              1-10%

              Abdominal pain (6-10%)

              Weight loss (4-9%)

              Diplopia (1-10%)

              Mood problems (<6%)

              Pharyngitis (6%)

              Tremor (3-9%)

              Abnormal gait (3-8%)

              Apathy (1%)

              Asthenia (1-5%)

              Dry mouth (2%)

              Menorrhagia (1-2%)

              Skin disorder (2-3%)

              Taste change (2%)

              Edema (2%)

              Hypertension (1-2%)

              Syncope (1%)

              Bradycardia (1%)

              Pallor (1%)

              <1%

              Angina

              Erythema

              Hepatic failure

              Hyperthermia

              Hypokalemia

              Neuropathy

              Toxic epidermal necrolysis

              Postmarketing Reports

              Increased risk for bleeding; in patients with serious bleeding events, conditions that increased the risk for bleeding were present

              Somnolence

              Fever

              Cognitive problems

              Infection

              Flushing

              Body as a whole-general disorders: Oligohydrosis and hyperthermia, hyperammonemia, hyperammonemic encephalopathy, hypothermia with concomitant valproic acid

              Gastrointestinal system disorders: Hepatic failure (including fatalities), hepatitis, pancreatitis

              Urinary system disorders: Kidney stones, nephrocalcinosis

              Vision disorders: Acute myopia, secondary angle closure glaucoma, maculopathy, acute myopia, secondary angle closure glaucoma

              Skin and appendage disorders: Bullous skin reactions (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), pemphigus

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              Warnings

              Contraindications

              Hypersensitivity

              Extended release: Within 6 hr of alcohol intake; patients with metabolic acidosis that are taking metformin concomitantly

              Cautions

              Maintain adequate fluid intake due to kidney stone risk

              Use caution with alcohol use

              Monitor closely for decreased sweating and increased body temperature; oligohydrosis reported with use; monitor during strenuous exercise

              Concomitant use of drugs that predispose patients to heat-related disorders (such as carbonic anhydrase inhibitors and anticholinergics)

              Coadministration with valproic acid increases risk of hyperammonemia (with or without encephalopathy)

              Risk of hyperchloremic, non-anion gap, metabolic acidosis; especially if concomitant renal disease, severe respiratory disorder, status epilepticus, diarrhea, surgery, ketogenic diet, or drugs predisposing to acidosis; if metabolic acidosis develops and persists, consideration should be given to reducing dose or discontinuing therapy (using dose tapering); if decision is made to continue patients on therapy in face of persistent acidosis, alkali treatment should be considered

              Visual field defects reported independent of elevated IOP; reversible upon discontinuation

              Rapid titration rate, dose, and higher initial dose associated with higher incidence of neuropsychiatric disorder in both epilepsy and migraine patients; also associated with higher incidences of cognitive-related dysfunction

              Monitor serum bicarbonate at baseline and then periodically; may also monitor serum chloride, ammonia, and phosphorus

              When discontinuing drug, gradually withdraw to decrease risk of seizure or increased seizure frequency

              Increased risk in suicidal thoughts/behavior reported; monitor patients for notable changes in behavior and notify healthcare provider if symptoms occur

              Use caution when operating heavy machinery

              Hypothermia reported with and without hyperammonemia during topiramate treatment with concomitant valproic acid use; consideration should be given to stopping topiramate or valproate in patients who develop hypothermia

              Hyperammonemia with or without encephalopathy with monotherapy or in combination with valproic acid reported in patients that have tolerated each drug alone; risk may increase in patients with inborn errors of metabolism or decreased hepatic mitochondrial activity; monitor for vomiting, lethargy, or unusual changes in mental status; in some patients, hyperammonemia can be asymptomatic

              Infants exposed to topiramate in utero may have an increased risk for cleft lip and/or cleft palate (oral clefts) and for being small for gestational age

              Women of childbearing potential who are not planning a pregnancy should use effective contraception because of risks to fetus of oral clefts and of being small for gestational age

              Skin reactions

              • Serious skin reactions (Stevens-Johnson Syndrome [SJS] and Toxic Epidermal Necrolysis [TEN]) reported in patients receiving therapy
              • Therapy should be discontinued at first sign of a rash, unless rash is clearly not drug-related; if signs or symptoms suggest SJS/TEN, use of this drug should not be resumed and alternative therapy should be considered
              • Inform patients about signs of serious skin reactions

              Glaucoma syndrome

              • A syndrome consisting of acute myopia associated with secondary angle closure glaucoma reported in patients receiving drug
              • Symptoms include acute onset of decreased visual acuity and/or ocular pain
              • Ophthalmologic findings can include some or all of the following: myopia, mydriasis, anterior chamber shallowing, ocular hyperemia (redness), choroidal detachments, retinal pigment epithelial detachments, macular striae, and increased intraocular pressure
              • This syndrome may be associated with supraciliary effusion resulting in anterior displacement of the lens and iris, with secondary angle closure glaucoma
              • Symptoms typically occur within 1 month of initiating therapy; in contrast to primary narrow angle glaucoma, which is rare under 40 years of age, secondary angle closure glaucoma associated with topiramate has been reported in pediatric patients as well as adults
              • The primary treatment to reverse symptoms is discontinuation of therapy as rapidly as possible, according to judgment of treating physician; other measures, in conjunction with discontinuation of therapy, may be helpful
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              Pregnancy & Lactation

              Pregnancy

              There is pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drug during pregnancy; to enroll, patients can call the toll-free number 1-888-233-2334. Information about North American Drug Pregnancy Registry can be found at http://www.aedpregnancyregistry.org/

              Topiramate can cause fetal harm when administered to a pregnant woman; data from pregnancy registries indicate that infants exposed to topiramate in utero have increased risk for cleft lip and/or cleft palate (oral clefts) and for being small for gestational age

              In multiple animal species, topiramate demonstrated developmental toxicity, including teratogenicity, in the absence of maternal toxicity at clinically relevant doses

              Consider benefits and risks of topiramate when prescribing to women of childbearing potential, particularly when topiramate is considered for a condition not usually associated with permanent injury or death; because of risk of oral clefts to fetus, which occur in first trimester of pregnancy before many women know they are pregnant, all women of childbearing potential should be informed of potential risk to fetus from exposure to topiramate; women who are planning a pregnancy should be counseled regarding relative risks and benefits of topiramate use during pregnancy; alternative therapeutic options should be considered for these patients

              Although effect of topiramate on labor and delivery in humans has not been established, development of topiramate-induced metabolic acidosis in mother and/or in fetus might affect fetus’ ability to tolerate labor; metabolic acidosis in pregnancy (due to other causes) can cause decreased fetal growth, decreased fetal oxygenation, and fetal death, and may affect the fetus’ ability to tolerate labor; pregnant patients should be monitored for metabolic acidosis and treated as in nonpregnant state; newborns of mothers treated with topiramate should be monitored for metabolic acidosis because of transfer of topiramate to fetus and possible occurrence of transient metabolic acidosis following birth

              Lactation

              Topiramate is excreted in human milk; effects of topiramate exposure in breastfed infants or on milk production are unknownare unknown; developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for extended release formulation and any potential adverse effects on the breastfed infant from extended release formulation or from the underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Mechanism unknown; may inhibit neuronal voltage-dependent sodium channels and may enhance the neurotransmitter inhibitory activity of gamma-aminobutyric acid (GABA)

              Weak carbonic anhydrase inhibitor

              Absorption

              Bioavailability: 80%

              Peak serum time: 1-4 hr (IR); 24 hr (ER))

              Distribution

              Protein bound: 13-17% (IR); 15-41% (ER)

              Metabolism

              Hepatic (30%); 70% unchanged

              Enzyme induced: CYP3A4 (weak)

              Enzyme inhibited: CYP2C19 (weak)

              Elimination

              Half-life: 21 hr (IR); 31 hr (ER)

              Dialyzable: Yes

              Total body clearance: 20-30 mL/min; 50% higher in pediatric patients

              Excretion: Urine (70-80%)

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              Administration

              Oral Administration

              Can be taken without regard to meals

              Trokendi XR

              • Swallow capsule whole and intact
              • Do not sprinkle on food, chew, or crush

              Qudexy XR, Topamax Sprinkle Capsules

              • Capsules may be swallowed whole or may be administered by carefully opening the capsule and sprinkling the entire contents on a small amount (teaspoon) of soft food
              • This drug/food mixture should be swallowed immediately and not chewed or crushed
              • Do not store drug/food mixture for further use
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Trokendi XR oral
              -
              200 mg capsule
              Trokendi XR oral
              -
              100 mg capsule
              Trokendi XR oral
              -
              50 mg capsule
              Trokendi XR oral
              -
              25 mg capsule
              Qudexy XR oral
              -
              150 mg capsule
              Qudexy XR oral
              -
              25 mg capsule
              Qudexy XR oral
              -
              50 mg capsule
              Qudexy XR oral
              -
              100 mg capsule
              Qudexy XR oral
              -
              200 mg capsule
              Topamax oral
              -
              200 mg tablet
              Topamax oral
              -
              100 mg tablet
              Topamax oral
              -
              50 mg tablet
              Topamax oral
              -
              25 mg tablet
              Topamax oral
              -
              25 mg tablet
              Topamax oral
              -
              50 mg tablet
              Topamax oral
              -
              100 mg tablet
              Topamax oral
              -
              15 mg capsule
              Topamax oral
              -
              25 mg capsule
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              15 mg capsule
              topiramate oral
              -
              15 mg capsule
              topiramate oral
              -
              25 mg capsule
              topiramate oral
              -
              25 mg capsule
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              25 mg capsule
              topiramate oral
              -
              15 mg capsule
              topiramate oral
              -
              25 mg capsule
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              25 mg tablet
              topiramate oral
              -
              100 mg tablet
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              50 mg tablet
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              150 mg capsule
              topiramate oral
              -
              100 mg capsule
              topiramate oral
              -
              50 mg capsule
              topiramate oral
              -
              25 mg capsule
              topiramate oral
              -
              200 mg capsule
              topiramate oral
              -
              200 mg tablet
              topiramate oral
              -
              100 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              topiramate oral

              TOPIRAMATE EXTENDED RELEASE SPRINKLE - ORAL

              (toe-PYRE-a-mate)

              COMMON BRAND NAME(S): Qudexy XR

              USES: Topiramate is used alone and with other medications to prevent and control seizures (epilepsy). It is also used to prevent migraine headaches. Topiramate belongs to a class of drugs known as anticonvulsants.

              HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking topiramate and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually once daily. You may swallow this medication whole, or you may open the capsule and sprinkle the contents on a teaspoonful of soft food (such as applesauce, yogurt). Swallow the drug/food mixture right away. Do not crush or chew the mixture. Do not prepare the mixture ahead of time for later use. Drink some liquid after swallowing the mixture to make sure all of the drug is swallowed.To prevent kidney stones from forming, drink plenty of fluids while taking this medication unless otherwise directed by your doctor.The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.Tell your doctor if your condition does not improve or if it worsens.

              SIDE EFFECTS: Tiredness, drowsiness, dizziness, loss of coordination, tingling of the hands/feet, loss of appetite, changes in how foods taste, diarrhea, and weight loss may occur. Mental problems such as confusion, slowed thinking, trouble concentrating or paying attention, nervousness, memory problems, or speech/language problems may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: bone pain, signs of kidney stones (such as severe back/side/abdominal/groin pain, fever, chills, painful/frequent urination, bloody/pink urine), unusual bleeding/bruising.Get medical help right away if you have any very serious side effects, including: rapid breathing, fast/slow/irregular heartbeat.A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.Rarely, topiramate may cause a very serious eye problem, usually within 1 month of starting treatment. This eye problem can lead to permanent blindness. Get medical help right away if any of these side effects occur: sudden vision changes (such as decreased vision, blurred vision), eye pain/redness.This medication can rarely cause a serious metabolic problem (high amount of ammonia in the blood), especially if you are also taking valproic acid. Tell your doctor right away if you experience sudden/unexplained tiredness, vomiting, or mental changes (such as decreased alertness).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking topiramate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: glaucoma, kidney problems (such as kidney stones), liver problems, lung/breathing problems, mental/mood problems (such as depression, thoughts of suicide), a certain metabolic imbalance (metabolic acidosis), a diet high in fat and low in carbohydrates (ketogenic diet), weak/brittle bones (osteoporosis).This drug may make you dizzy or drowsy or affect your thinking/coordination. Alcohol or marijuana (cannabis) can worsen these effects. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Topiramate may make you sweat less, making you more likely to get heat stroke. Avoid doing things that may cause you to overheat, such as hard work or exercise in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest. Get medical help right away if you have a fever that does not go away, mental/mood changes, headache, or dizziness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the side effects of this drug, especially weakened bones, slowed growth rate, and decreased sweating.Older adults may be more sensitive to the side effects of this drug, especially dizziness. Dizziness can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. However, if you are taking this drug to treat seizures, note that untreated seizures are a serious condition that can harm both a pregnant woman and her unborn baby, so do not stop taking this medication unless directed by your doctor. Discuss the use of reliable forms of birth control with your doctor (see also Drug Interactions section). If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor about the benefits and risks of using this medication during pregnancy.This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: See also Side Effects section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: orlistat.This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, loss of consciousness.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as eye exams, bicarbonate blood level) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up. If you have missed more than one dose, ask your doctor or pharmacist for advice.

              STORAGE: Store in a tightly closed container at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.