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What Does Topiramate Do

What Does Topiramate Do

What Does Topiramate Do

Topiramate is often sold under the brand name Topamax. It is an anti-convulsive drug that stands apart from all other drugs used to treat convulsions or mood disorders because it does not share the same chemical composition. Medical researchers currently do not know how Topiramate works.

When did the FDA approve this drug for marketing in the US, and what uses of the drug are approved?

The FDA gave final approval for the drug on December 24, 1996. As stated above, the only approved use to date is the treatment of convulsions.

Does Topiramate have a generic version?

The manufacturer of Topiramate still holds patent protection over the drug, so there is no generic version available yet.

How is Topiramate different from other mood stabilizers?

There are two things that set Topiramate apart from other drugs in this class. First of all, physicians and psychiatrists sometimes prescribe it when other mood-stabilizing drugs fail to be effective for a patient. Secondly, the set of side effects that patients may experience is quite different on Topiramate compared to other mood stabilizers.

How is Topiramate different from carbamazepine and valproate?

For rapid cycling or mixed bipolar states, there are some cases where Topiramate is effective when these other two drugs are not.

Which disorders has Topiramate been most successful in controlling so far?

The lack of research about Topiramate makes it hard to tell which disorders will respond best to the drug: to date, there is not enough psychiatric research to make specific recommendations. In the field, practitioners have had success when prescribing Topiramate to individuals with bipolar disorders that have resisted other forms of treatment. The most effective use of Topiramate appears to be the case of patients whose use of lamotrigine has induced mania. Some psychiatrists have reported using Topiramate to help relieve the symptoms of PTSD and the side effects related to eating that other psychiatric drugs can create.

Can Topiramate treat episodes of depression, mania, and mixed states? Can it prevent these episodes?

While Topiramate’s first use was for the treatment of mania, depression, or mixed states that were resistant to other drugs, its effectiveness for preventing those states has not yet been tested. There have been no research studies that placed patients on Topiramate for an extended time and evaluated whether it decreased their likelihood of these episodes.

What lab tests are necessary before a patient can be prescribed Topiramate?

It is important to test for any of several conditions that can interact with mood disorders. The necessary tests include blood and urine tests, because these conditions could be the cause of a mood disorder.

What dosage is appropriate for starting a course of Topiramate?

The initial dose for Topiramate should be either 12.5 or 25 milligrams taken either once or twice a day. This dose increases by 12.5 or 12 milligrams each week until it reaches the final level, which depends on the use of the drug and how the patient is responding. A typical final dosage is between 100 and 200 mg per day, although some patients benefit from no more than 50 mg. The case of PTSD entails a final dose of approximately 175 mg per day and generally not exceeding 500 mg per day.

There are no known interactions between Topiramate and lithium. However, carbamazepine can lower the blood-plasma level of Topiramate by 50 percent and valproate can lower it by 15 percent. Topiramate itself can lower the blood-plasma level of valproate by 10 percent. Thus far, there are no known interactions for patients taking Topiramate and either lamotrigine or gabapentin.

What final doses of Topiramate are typical and what doses are appropriate for different disorders?

The final doses of Topiramate vary widely based on the targeted disorder, the patient, and whether or not the patient is taking any other drugs at the same time. The most common doses fall between 50 and 200 mg a day for most therapies, but this can be lower for PTSD. Higher final doses may be required if Topiramate is being taken alone, up to 500 mg a day. Some patients experience relief with only 25 mg a day.

How long until the patient feels the effects of Topiramate?

This also varies significantly depending on the individual. Some feel the effects within days, while others need up to a month before they feel any difference.

How does Topiramate interact with prescription and over-the-counter medications?

The interactions between Topiramate, valproate, and carbamazepine have already been noted above. In addition to that, Topiramate appears to raise the blood-plasma level of phenytoin, while phenytoin decreases the level of Topiramate by 50 percent. There have been some reports that Topiramate reduces the effectiveness of oral contraceptive pills.

Is it safe to take Topiramate if you are pregnant?

The FDA places Topiramate in the “C” category for pregnancy safety. That means the drug is known to affect the human fetus in an adverse way, but there is not much research about the specifics, and that the drugs benefits may outweigh the risks.

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