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Topiramate Mechanism Of Action

Topiramate Mechanism Of Action


Topiramate blocks voltage-dependent sodium and calcium channels. It also inhibits the excitatory glutamate pathway while enhancing the inhibitory effect of GABA. Moreover, it inhibits carbonic anhydrase activity. The relevant mechanism of action responsible for efficient migraine prophylaxis remains to be determined.

Mechanism of Action of Topiramate

Topiramate is a medication that is used to treat seizures and prevent migraines. It is usually taken in a pill form two times a day. Its mechanism of action is relatively unknown but has been researched to show that it interacts with the neurotransmitter gamma-aminobutyrate (GABA). A neurotransmitter is a chemical in the brain that transmits communication from one brain cell to another. GABA decreases the action of nerve cells in order to help control anxiety and fear. GABA also plays a role in behavior, cognition, and the body's stress response. Topiramate has been shown to enhance the GABA, thereby helping the mind and body remain calm and less excited.

Topiramate also reduces the action of excitatory neurotransmitters through kainate and AMPA receptors, as well as decreasing the action of carbonic anhydrase. Kainate and AMPA are ionotropic glutamate receptors that produce excitatory responses by allowing the passage of sodium and potassium. The decrease in response from kainate and AMPA reduce the risk of seizures from occurring. Carbonic anhydrase is not directly associated with seizure activity but is involved in transporting carbon dioxide in the blood.


Topamax has both its approved and off-label uses. In the United States, the drug is officially approved by the U.S. Food and Drug Administration (FDA) to:

  • Treat partial onset seizures in adults and children two and older
  • Treat primary generalized tonic-clonic seizures in adults and children two and older
  • Prevent migraines in adults and adolescents 12 and older
  • Topamax can also be in combination with other drugs to treat partial onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome (a severe form of childhood epilepsy).


Topamax is available in capsule and tablet formulations. The tablet is offered in a 25-, 50-, 100-, and 200-milligram (mg) dose. The capsule is available in 15-mg or 25-mg dose.The dosage can vary by the condition and the age of the user.When starting treatment, the dosage is typically tapered up to reduce the risk of a symptom flare. It should also be tapered down if the decision is made to stop treatment. Stopping abruptly can cause a rebound of disease symptoms (such as seizures in people with epilepsy or abnormal moods in people with bipolar disorder).

Side Effect

  • Stomach upset
  • Taste changes
  • Tingling or prickly skin sensations
  • Tremors
  • Uncontrollable eye movements
  • Urinary tract infection
  • Weakness
  • Weight loss


  • Kidney stones might develop. Drink six to eight glasses of water a day and tell your doctor beforehand if you've ever had kidney stones.
  • Cognitive problems involving thinking, concentration, attention, memory or speech might occur. Topiramate has also been found to cause confusion, dizziness, and sleepiness. Don't drive a car or operate machinery until you know how the drug affects you, and avoid alcohol and sedating drugs.
  • Other side effects include headaches, tingling in the hands or feet, dry mouth, nausea, taste disturbance, diarrhea, upset stomach, and menstrual problems. Additionally, the FDA recently announced that Topamax can cause birth defects in humans.
  • Drug interactions include reduced effectiveness of birth-control pills. Tell your doctor what prescription and over-the-counter medications and supplements you are taking or plan to take.

How should I keep topiramate stored?

  • Topiramate tablets should be stored at room temperature, 15 C to 30 C (59F to 86 F).
  • Sprinkle capsules should be stored at or below 25 C (77 F).

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