Dosing & Uses
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)
oral solution
- 25mg/mL (Eprontia)
Partial-Onset or Primary Generalized Tonic-Clonic Seizures
Monotherapy
- Topamax, Topamax Sprinkles, Eprontia: 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, Eprontia: 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, Eprontia: 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, Eprontia
- 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)
oral solution
- 25mg/mL (Eprontia)
Partial-Onset or Primary Generalized Tonic-Clonic Seizures
Monotherapy (Topamax, Topamax Sprinkles, Eprontia)
- <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
-
2 to <10 years weight-based maintenance dosing
- ≤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 initial dosing
- 25 mg/day nightly for the first week; based upon tolerability
- May increase to 50 mg/day in the second week, and then increased by 25-50 mg/day each subsequent week as tolerated
-
6-10 years weight-based maintenance dosing
- 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 intial dosing
- 25 mg PO qHS initially during the first week; based upon tolerability,
- May increase 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
-
2 to <10 years weight-based maintenance dosing
- ≤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
- Target dose is 400 mg PO qDay
Adjunctive therapy (Topamax, Topamax Sprinkles, Eprontia)
- <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, Eprontia)
- <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, Eprontia
- 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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (26)
- 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).
- olopatadine intranasal
topiramate and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- pacritinib
topiramate will decrease the level or effect of pacritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- 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 (281)
- acetazolamide
topiramate, acetazolamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of kidney stone formation.
- acrivastine
acrivastine and topiramate both increase sedation. Use Caution/Monitor.
- 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.
- 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.
- asenapine
asenapine and topiramate both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and topiramate both increase sedation. Use Caution/Monitor.
- atogepant
topiramate will decrease the level or effect of atogepant 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.
- avapritinib
avapritinib and topiramate both increase sedation. Use Caution/Monitor.
- 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.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and topiramate both increase sedation. Use Caution/Monitor.
- 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.
- brexpiprazole
brexpiprazole and topiramate both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and topiramate both increase 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.
- brivaracetam
brivaracetam and topiramate both increase sedation. Use Caution/Monitor.
- 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.
- buprenorphine subdermal implant
buprenorphine subdermal implant and topiramate both increase sedation. Use Caution/Monitor.
- 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).
- 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.
- daridorexant
topiramate and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- 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.
- difelikefalin
difelikefalin and topiramate both increase sedation. Use Caution/Monitor.
- 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.
- fosaprepitant
topiramate will decrease the level or effect of fosaprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fosphenytoin
fosphenytoin decreases levels of topiramate by increasing metabolism. Use Caution/Monitor.
- ganaxolone
topiramate and ganaxolone both increase sedation. 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 (DSC)
topiramate will decrease the level or effect of hydroxyprogesterone caproate (DSC) 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.
- isavuconazonium sulfate
topiramate will decrease the level or effect of isavuconazonium sulfate 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.
- lacosamide
topiramate increases toxicity of lacosamide by Other (see comment). Use Caution/Monitor. Comment: Coadministration of lacosamide with sodium channel-blocking antiseizure drugs may increase the risk for AV block, bradycardia, or ventricular tachyarrhythmias. Monitor ECG before beginning lacosamide and after lacosamide is titrated to steady-state.
- 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.
- mavacamten
topiramate will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
- 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.
- methylphenidate transdermal
methylphenidate transdermal will increase the level or effect of topiramate by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.
- 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.
- 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 (77)
- 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.
- 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.
- levoketoconazole
topiramate will decrease the level or effect of levoketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate increases effects of topiramate by decreasing 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.
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
Warnings
Contraindications
Hypersensitivity
Extended release: Within 6 hr of alcohol intake; patients with metabolic acidosis that are taking metformin concomitantly
Cautions
Kidneys stones reported with therapy; increased fluid intake increases urinary output, lowering the concentration of substances involved in stone formation; hydration is recommended to reduce new stone formation; increased ratio of urinary calcium/citrate increases risk of kidney stones and/or nephrocalcinosis; an increase in urinary calcium and marked decrease in urinary citrate was observed in immediate-release topiramate-treated pediatric patients in one-year active-controlled study; this increased ratio of urinary calcium/citrate increases risk of kidney stones and/or nephrocalcinosis
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)
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
Significant reductions in mean annual change from baseline in body weight compared to the control group reported; attenuation in height velocity and height change from baseline also reported with treatment along with negative effects on weight and height; growth (height and weight) of children receiving prolonged therapy should be carefully monitored
Metabolic acidosis
- Manifestations of acute or chronic metabolic acidosis may include hyperventilation, nonspecific symptoms such as fatigue and anorexia, or more severe sequelae including cardiac arrhythmias or stupor; chronic, untreated metabolic acidosis may increase risk for nephrolithiasis or nephrocalcinosis, and may also result in osteomalacia (referred to as rickets in pediatric patients) and/or osteoporosis with an increased risk for fractures
- 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
- Chronic metabolic acidosis in pediatric patients may reduce growth rates, which may decrease maximal height achieved, although these patients with epilepsy are likely to have different growth rates than normal 1 to 24-month-old pediatrics
Decrease in bone mineral density
- Results of a one-year active-controlled study in pediatric patients demonstrated negative effects of drug monotherapy on bone mineral acquisition via statistically significant decreases in bone mineral density (BMD) measured in lumbar spine and in total body less head; although decreases in BMD occurred across all pediatric age subgroups, patients 6 to 9 years of age were most commonly affected
- Decreased BMD in the lumbar spine was correlated with decreased serum bicarbonate, which commonly occurs with treatment and reflects metabolic acidosis, a known cause of increased bone resorption; although small decreases in some markers of bone metabolism (eg, serum alkaline phosphatase, calcium, phosphorus, and 1,25-dihydroxyvitamin D) occurred in treated patients, more significant decreases in serum parathyroid hormone and 25-hydroxyvitamin D, hormones involved in bone metabolism, were observed, along with an increased excretion of urinary calcium
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
Drug interaction overview
- Possibility of decreased contraceptive efficacy and increased breakthrough bleeding may occur in patients taking contraceptive products; patients taking estrogen-containing or progestin-only contraceptives should be asked to report any change in their bleeding patterns; contraceptive efficacy can be decreased even in absence of breakthrough bleeding
- Dosage adjustment may be needed when administered concomitantly with phenytoin or carbamazepine; concomitant administration of valproic acid has been associated with hypothermia and hyperammonemia with and without encephalopathy; examine blood ammonia levels in patients in whom onset of hypothermia reported
- Concomitant use of this drug, a carbonic anhydrase inhibitor, with any other carbonic anhydrase inhibitor (eg, zonisamide or acetazolamide) may increase severity of metabolic acidosis and may also increase risk of kidney stone formation; monitor closely for appearance or worsening of metabolic acidosis when administered concomitantly with another carbonic anhydrase inhibitor
- Because of potential of this drug to cause CNS depression, as well as other cognitive and/or neuropsychiatric adverse reactions, administer with extreme caution if used in combination with alcohol and other CNS depressants
- When added to pioglitazone therapy or pioglitazone give careful attention to routine monitoring of patients for adequate control of their diabetic disease state
- Lithium levels should be monitored when co-administered with high-dose of this drug
- Amitriptyline dose should be made according to patient's clinical response and not on basis of plasma levels
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 of major congenital malformations, including but not limited to 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
Women of childbearing potential who are not planning a pregnancy should use effective contraception because of risk of major congenital malformations, including oral clefts, and risk of infants being SGA
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.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%)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 50 mg tablet |  | |
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 50 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| 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 - | 200 mg capsule |  | |
| topiramate oral - | 50 mg capsule |  | |
| topiramate oral - | 25 mg capsule |  | |
| topiramate oral - | 150 mg capsule |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 50 mg tablet |  | |
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 50 mg tablet |  | |
| topiramate oral - | 200 mg capsule |  | |
| topiramate oral - | 100 mg capsule |  | |
| topiramate oral - | 50 mg capsule |  | |
| topiramate oral - | 100 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 150 mg capsule |  | |
| topiramate oral - | 100 mg capsule |  | |
| topiramate oral - | 200 mg capsule |  | |
| topiramate oral - | 50 mg capsule |  | |
| topiramate oral - | 25 mg capsule |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 25 mg capsule |  | |
| topiramate oral - | 15 mg capsule |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 200 mg tablet |  | |
| topiramate oral - | 150 mg capsule |  | |
| topiramate oral - | 50 mg tablet |  | |
| topiramate oral - | 50 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 25 mg tablet |  | |
| topiramate oral - | 100 mg tablet |  | |
| Topamax oral - | 15 mg capsule |  | |
| Topamax oral - | 25 mg tablet |  | |
| Topamax oral - | 25 mg capsule |  | |
| Topamax oral - | 200 mg tablet |  | |
| Topamax oral - | 100 mg tablet |  | |
| Topamax oral - | 50 mg tablet |  | |
| Topamax oral - | 50 mg tablet |  | |
| Topamax oral - | 25 mg tablet |  | |
| Trokendi XR oral - | 25 mg capsule |  | |
| Trokendi XR oral - | 100 mg capsule |  | |
| Trokendi XR oral - | 200 mg capsule |  | |
| Trokendi XR oral - | 50 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 | |
Copyright © 2010 First DataBank, Inc.
Patient Handout
topiramate oral
TOPIRAMATE EXTENDED RELEASE - ORAL
(toe-PYRE-a-mate)
COMMON BRAND NAME(S): Trokendi XR
USES: Topiramate is used alone or 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 a day. Swallow the capsules whole. Do not sprinkle on food, crush, dissolve, or chew. Doing so can release all of the drug at once, increasing the risk of side effects. Do not drink alcoholic beverages for 6 hours before or 6 hours after taking topiramate extended release capsules, since alcohol may affect how well this medication works.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. Carefully follow your doctor's instructions.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 last or get worse, 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).This medication 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. Consult your doctor or pharmacist for more details.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, 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.Lab and/or medical tests (such as eye exams, bicarbonate blood level) should be done while you are taking this medication. Keep all medical and lab appointments.
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 October 2022. Copyright(c) 2023 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.
Formulary
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.
