January 26, 2023

In this episode, I discuss a medication known as topiramate (Topamax, Topiragen, Trokendi XR, Qudexy XR).

Everybody welcome back to another episode of drug talk is always am your host garyx amble they’re gonna be discussing the medication known as topiramate its brand name is tapa max but before we talk about the medication itself just keep in mind that this channel is for information purposes only and not to be used as a source for recommendations for your personal

Health care so the exact mechanism of action of topiramate is unknown but there are four properties that are thought to contribute to its anti epileptic as well as anti migraine activity one is a blockade of voltage dependent sodium channels another is the augmentation of gaba at some subtype gaba-a receptors antagonism at a subtype of glutamate receptors and the

Inhibition of carbonic anhydrase enzymes in terms of indications for use it can be used as an adjunct therapy and primary generalized tonic-clonic seizures and in this same situation it can also be used as initial mono therapy it can be used as an adjunct or again as initial mono therapy in partial seizures can be used for a prophylaxis of migraines and finally

It can be used as an adjunct therapy when treating the lennox-gastaut syndrome now before somebody was to use to appear mate or tapa max there are some contraindications they must clear as well as some precautions and warnings that they should be made aware of this medication will be contraindicated in patients who have used alcohol within six hours before

Using topiramate on the other end you would also not be able to use alcohol for six hours after a dose of topiramate and it would also be contraindicated in patients who have metabolic acidosis who are using metformin now in terms of precautions till pier mate or tapa max is on the beers criteria which is a list of medications at the elderly population should

Either avoid or use cautiously because of the syncope ataxia an impaired motor function that this medication may cause in this population it may put them at an increased risk of experiencing falls and in this population falls can sometime lead to fractures we would want to avoid using medications with topiramate that induced metabolic acidosis such as carbonic

Anhydrase inhibitors patients should be made aware that metabolic acidosis has occurred with the use of topiramate and it would happen more commonly in patients who have conditions or using therapies that would predispose them to acidosis hyper ammonia with or without encephalopathy has been reported with the use of this medication both in patients who are using

It with or without valproic acid oligo hydrosis and hyperthermia has been reported especially in younger patients hypothermia has also occurred in some situations with a core body temperature less than 95 degrees fahrenheit and again this has happened in patients both using topiramate with or without valproic acid there would be reduced to a pyramid clearance

In patients using it who have hepatic impairment and abrupt withdrawal of this medication may increase the risk of seizures both in patients who have epilepsy and in patients who do not have epilepsy dose-related cns depression has been reported this would be more of a risk for patients who are using other cns depressants cognitive related dysfunctions have

Occurred especially in patients who increase their dose rapidly and in patients who are using high doses acute myopia associated with angle closure glaucoma has been reported in some situations the medication may have to be discontinued if this occurs some patients have experienced visual fields defects not necessarily associated with an increase in intraocular

Pressure suicidal thoughts or suicidal behaviors may occur with the use of topiramate so patients should be monitored closely for any signs of suicidal ideation psychiatric and behavioral changes have been reported including depression and mood changes and finally a dose adjustment may be required in patients who have moderate to severe renal impairment now when

Somebody is cleared of the contraindications and made aware of the precautions and warnings and they start to use tapa max or topiramate they can expect to receive their dose in either tablet or capsule form when somebody is using topi are made for initial mono therapy with a partial seizure they would start off by using 25 milligrams twice-daily in the first

Week during the second week they would increase their dose to 50 milligrams twice daily it would then increase each week to 75 milligrams twice daily 100 milligrams twice daily 150 milligrams twice daily until they reach 200 milligrams twice daily 200 milligrams twice daily would be the maximum dose in this situation and of course a physician may decide to stop

The titration along the way up to 200 milligrams and stop somewhere at for example 150 or 175 twice daily my patient is using till pier mate for migraine prophylaxis the typical maintenance dose would be 100 milligrams daily given and divided doses now the patient wouldn’t start off using 100 milligrams a day they would titrate up slowly similar to what we just

Discussed with the partial seizure dosing now as with all medications there are some side effects or adverse reactions that patients may experience while using topiramate or tapa max they’ll go over some of those here now about five percent of pediatric patients experience flushing anywhere from 25 percent to 67 percent of patients may notice an abnormal sodium

Bicarbonate level and to 24 percent of patients may notice a loss of appetite or to 21 percent of patients may experience a decrease in weight anywhere from 2 to 8 percent of patients may develop an infectious disease while using 2 a pyramid infusion can happen up to 11 percent of the time and dizziness up to 25 percent of the time 2 to 7 percent of patients may

Experience impaired cognition 3 to 12 percent of patients may experience memory impairment somnolence can occur between 6 and 29 percent of the time or to 16 percent of patients may develop a feeling of nervousness and 4 to 11 may develop a mood disorder tigue can happen up to 16 percent of the time and fever make him in at 12 percent more rare but serious side

Effects would be steven johnson syndrome drug-induced encephalopathy and metabolic acidosis that’s all going to talk about today with topiramate or tapa max as always i’m very thankful you took the time to come by and watch one of my videos if you did find the information valuable and you’d like to help me grow this channel you can like the videos share the

Videos or most importantly subscribe to the youtube channel there’s also some links in the description you can check out as well that’s it for today take care

Transcribed from video