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Is Topiramate A Narcotic

is topiramate a narcotic

What is the topiramate a narcotic?

There have been studies focused on topiramate for binge-eating disorder, and a few have examined its use in treating bulimia nervosa. Most were lasted a short period of time (12 to 24 weeks), included primarily women, and excluded people with psychiatric problems, which are common among people with eating disorders. That makes it difficult to draw conclusions about topiramate's long-term effectiveness or its benefits for a broader population. Most studies also noted a high placebo response. In addition, pharmaceutical companies that market topiramate sponsored nearly all of the significant published trials, raising the possibility of a conflict of interest.

According to guidelines from the American Psychiatric Association (APA), small controlled trials demonstrate topiramate's effectiveness as a treatment for bulimia nervosa. But the drug is recommended only when other medications have been ineffective, and is problematic for bulimic people of normal or low body weight. "It could be used by women with normal-weight bulimia nervosa who don't have menstrual irregularities and for whom the risk of losing a few pounds won't cause health concerns," says Yager, chairman of the group that wrote the guidelines. For those with binge-eating disorder, the APA finds topiramate effective for binge reduction and weight loss, but the side effects might limit its usefulness for many people.

Drug Interactions

Topiramate is a mild inducer of CYP3A4 and a mild inhibitor of CYP2C19. Serum potassium concentrations were lower in patients who took both topiramate and hydrochlorothiazide than in those who took either drug alone. Topiramate taken with valproic acid has been associated with hyperammonemia, with and without encephalopathy. Serum concentrations of topiramate decreased about 40% when the drug was taken with phenytoin or carbamazapine. Phentermine is contraindicated while taking, and for 14 days after stopping, a monoamine oxidase (MAO) inhibitor because of the risk of hypertensive crisis.


 Topiramate has been associated with a 2- to 5-fold increased risk of oral clefts when taken in the first trimester of pregnancy. Qsymia is contraindicated for use during pregnancy and is available only through a restricted access program (Qsymia REMS) designed to prevent fetal exposure to the drug.

Dosage and Administration

 Phentermine/topiramate ER is taken once daily, preferably in the morning to prevent insomnia. The recommended dosage is 3.75/23 mg for 14 days followed by 7.5/46 mg. If a 3% weight loss is not achieved after 12 weeks on the 7.5/46 mg dose, the dosage may be increased to 11.25/69 mg for 14 days, and then to 15/92 mg. If the patient does not achieve at least a 5% decrease in weight after 12 weeks on the highest dose, the drug should be discontinued gradually; abrupt withdrawal of topiramate can cause seizures even in patients with no history of epilepsy.


Both lorcaserin (Belviq) and the phentermine/topiramate ER combination (Qsymia) taken as adjuncts to diet and exercise may be effective in increasing weight loss in the first year of use, but much less so in the second year. Qsymia appears to be more effective than lorcaserin, but may cause more troublesome adverse effects.

What are the risks and warnings?

Eye problems can lead to permanent loss of vision if not treated. Tell your doctor beforehand if you've had glaucoma and report eye pain, redness, or vision changes during treatment.

Decreased sweating makes it more difficult for your body to cool down when it gets very hot and might make you more vulnerable to heat-stroke. Avoid exposure to heat, drink plenty of fluids, and notify your doctor if you have a fever.

Suicidal thoughts or actions should be reported immediately to your doctor, including panic attacks, agitation, irritability, anxiety, depression, sleep problems, talking or thinking about suicide, and any other changes in behavior or mood.

Excess acid in the blood (acidosis) can cause tiredness, loss of appetite, irregular heartbeat, and impaired consciousness, and is more likely if you consume a high-fat, low-carbohydrate diet or have kidney disease, respiratory problems, or diarrhea. Tell your doctor if you have any of those conditions before or during treatment, and don't follow a high-fat, low-carb diet while taking the medication.

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