Description

Simple

A medication used to prevent or treat migraines and to control a disease called epilepsy, which leads to seizures.

Clinical

An anticonvulsant drug used in the control of epilepsy and in the prophylaxis and treatment of migraines.

Overview

Topiramate is a anti-epileptic drug used to manage seizures and prevent migraines.[4] It was initially approved by the FDA in 1996. In 2004, topiramate was approved for the prevention of migraine in adults.[6,19] Since 2012, the extended-release formulation has been approved in combination with [phentermine] for chronic weight management therapy in adults.[21]

Characteristics that distinguish topiramate from other antiepileptic drugs are a monosaccharide chemical structure containing a sulfamate, and 40% of its mass accounted for by oxygen.[4] Interestingly, topiramate was discovered by chance when... Read more

Pharmacology

Indication

Topiramate is indicated for the following conditions: 1)Monotherapy for partial onset or primary generalized tonic-clonic seizures for patients 2 years of age and above 2)Adjunctive therapy for partial onset seizures or primary generalized tonic-clonic seizures for both adult and pediatric patients... Read more

Pharmacodynamic

Topiramate prevents the occurrence of seizures and prevents migraine symptoms by reducing neural pathway excitability.[ Read more

Mechanism of action

A seizure is an abnormal and unregulated electrical discharge occurring in the brain. This leads to transient interruption in brain function, manifested by reduced alertness, abnormal sensations, and focal involuntary movements or convulsions. Several types of seizures exist, with common types inclu... Read more

Absorption

After a 400mg dose in one clinical trial, topiramate reached maximal concentrations within 1.8-4.3 hours and ranged from 1.73-28.7 ug/mL. Food did not significantly affect the extent of absorption, despite delaying time to peak concentration. In patients with normal creatinine clearance, steady stat... Read more

Protein binding

Topiramate is not highly bound to plasma proteins, with an estimated plasma protein binding of 9-17% according to some studies.[3, Read more

Volume of distribution

The mean apparent volume of distribution of topiramate ranges from 0.6-0.8 L/kg when doses of 100mg to 1200mg are given.[3] Topiramate readily c... Read more

Clearance

The mean oral plasma clearance of topiramate ranges from 22-36 mL/min while the renal clearance is 17-18 mL/min, according to one pharmacokinetic study.[ Read more

Half life

The elimination half-life is reported to be in the range of 19-23 hours.[3] If topiramate is given with enzyme-inducers, the half-life can be re... Read more

Route of elimination

Topiramate is mainly eliminated through the kidneys.[15] About 70-80% of the eliminated dose is found unchanged in the ur... Read more

Toxicity

The LD50 of intraperitoneal topiramate in the rat is above 1500 mg/kg.[20]

Overdose information

In a study of 4 healthy adult women taking topiramate, the severity of clinical effects following an overdose ranged fr... Read more

Adverse Effects

Effect Regions Age Groups Incidences Evidence Type
Paresthesia US
  • adult
  • Kind: experimental
    • Percent: 21-40%
  • Clinical Trial
    Dizziness US
    • adult
  • Kind: experimental
    • Percent: 25-32%
  • Kind: placebo
    • Percent: 15%
  • Clinical Trial
    Fatigue US
    • adult
  • Kind: experimental
    • Percent: 15-30%
  • Kind: placebo
    • Percent: 13%
  • Clinical Trial
    Somnolence US
    • adult
  • Kind: experimental
    • Percent: 28-29%
  • Kind: placebo
    • Percent: 12%
  • Clinical Trial
    Somnolence US
    • pediatric
  • Kind: experimental
    • Percent: 26%
  • Kind: placebo
    • Percent: 16%
  • Clinical Trial
    Anorexia US
    • pediatric
  • Kind: experimental
    • Percent: 24%
  • Kind: placebo
    • Percent: 15%
  • Clinical Trial
    Psychomotor Slowing US
    • adult
  • Kind: experimental
    • Percent: 13-21%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Nervousness US
    • adult
  • Kind: experimental
    • Percent: 16-19%
  • Kind: placebo
    • Percent: 6%
  • Clinical Trial
    Paresthesia US
    • adult
  • Kind: experimental
    • Percent: 11-19%
  • Kind: placebo
    • Percent: 4%
  • Clinical Trial
    Upper Respiratory Tract Infection US
    • pediatric
  • Kind: experimental
    • Percent: 16-18%
  • Clinical Trial
    Weight decrease US
    • adult
  • Kind: experimental
    • Percent: 6-17%
  • Clinical Trial
    Weight decrease US
    • pediatric
  • Kind: experimental
    • Percent: 7-17%
  • Clinical Trial
    Fatigue US
    • pediatric
  • Kind: experimental
    • Percent: 16%
  • Kind: placebo
    • Percent: 5%
  • Clinical Trial
    Ataxia US
    • adult
  • Kind: experimental
    • Percent: 14-16%
  • Kind: placebo
    • Percent: 7%
  • Clinical Trial
    Somnolence US
    • adult
  • Kind: experimental
    • Percent: 10-15%
  • Clinical Trial
    Nervousness US
    • pediatric
  • Kind: experimental
    • Percent: 14%
  • Kind: placebo
    • Percent: 7%
  • Clinical Trial
    Injury US
    • pediatric
  • Kind: experimental
    • Percent: 14%
  • Kind: placebo
    • Percent: 13%
  • Clinical Trial
    Difficulty with concentration US
    • adult
  • Kind: experimental
    • Percent: 6-14%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Difficulty with attention US
    • adult
  • Kind: experimental
    • Percent: 6-14%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Difficulty with memory US
    • adult
  • Kind: experimental
    • Percent: 12-14%
  • Kind: placebo
    • Percent: 3%
  • Clinical Trial
    Confusion US
    • adult
  • Kind: experimental
    • Percent: 11-14%
  • Kind: placebo
    • Percent: 5%
  • Clinical Trial
    Anorexia US
    • adult
  • Kind: experimental
    • Percent: 4-14%
  • Clinical Trial
    Dizziness US
    • adult
  • Kind: experimental
    • Percent: 13-14%
  • Clinical Trial
    Vision abnormal US
    • adult
  • Kind: experimental
    • Percent: 10-13%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Depression US
    • adult
  • Kind: experimental
    • Percent: 5-13%
  • Kind: placebo
    • Percent: 5%
  • Clinical Trial
    Weight decrease US
    • adult
  • Kind: experimental
    • Percent: 9-13%
  • Kind: placebo
    • Percent: 3%
  • Clinical Trial
    Speech Disorders US
    • adult
  • Kind: experimental
    • Percent: 11-13%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Hyperammonaemia US
    • adolescent
  • Kind: experimental
    • Percent: 12
  • Kind: experimental
    • Percent: 6
  • Kind: placebo
    • Percent: 6
  • Clinical Trial
    Anorexia US
    • adult
  • Kind: experimental
    • Percent: 10-12%
  • Kind: placebo
    • Percent: 4%
  • Clinical Trial
    Nausea US
    • adult
  • Kind: experimental
    • Percent: 10-12%
  • Kind: placebo
    • Percent: 8%
  • Clinical Trial
    Fever US
    • pediatric
  • Kind: experimental
    • Percent: 1-12%
  • Clinical Trial
    Paresthesia US
    • pediatric
  • Kind: experimental
    • Percent: 3-12%
  • Clinical Trial
    Personality Disorder US
    • pediatric
  • Kind: experimental
    • Percent: 11%
  • Kind: placebo
    • Percent: 9%
  • Clinical Trial
    Nystagmus US
    • adult
  • Kind: experimental
    • Percent: 10-11%
  • Kind: placebo
    • Percent: 7%
  • Clinical Trial
    Difficulty with memory US
    • adult
  • Kind: experimental
    • Percent: 6-11%
  • Clinical Trial
    Difficulty with concentration US
    • pediatric
  • Kind: experimental
    • Percent: 10%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Difficulty with attention US
    • pediatric
  • Kind: experimental
    • Percent: 10%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Diplopia US
    • adult
  • Kind: experimental
    • Percent: 10%
  • Kind: placebo
    • Percent: 5%
  • Clinical Trial
    Language problems US
    • adult
  • Kind: experimental
    • Percent: 6-10%
  • Kind: placebo
    • Percent: 1%
  • Clinical Trial
    Difficulty with concentration or attention US
    • pediatric
  • Kind: experimental
    • Percent: 7-10%
  • Clinical Trial
    Aggressive reaction US
    • pediatric
  • Kind: experimental
    • Percent: 9%
  • Kind: placebo
    • Percent: 4%
  • Clinical Trial
    Weight decrease US
    • pediatric
  • Kind: experimental
    • Percent: 9%
  • Kind: placebo
    • Percent: 1%
  • Clinical Trial
    Mood problems US
    • adult
  • Kind: experimental
    • Percent: 4-9%
  • Kind: placebo
    • Percent: 2%
  • Clinical Trial
    Tremor US
    • adult
  • Kind: experimental
    • Percent: 9%
  • Kind: placebo
    • Percent: 6%
  • Clinical Trial
    Insomnia US
    • adult
  • Kind: experimental
    • Percent: 8-9%
  • Clinical Trial
    Depression US
    • adult
  • Kind: experimental
    • Percent: 7-9%
  • Clinical Trial
    Diarrhea US
    • pediatric
  • Kind: experimental
    • Percent: 8-9%
  • Clinical Trial
    Insomnia US
    • pediatric
  • Kind: experimental
    • Percent: 8%
  • Kind: placebo
    • Percent: 7%
  • Clinical Trial
    Purpura US
    • pediatric
  • Kind: experimental
    • Percent: 8%
  • Kind: placebo
    • Percent: 4%
  • Clinical Trial
    Gait abnormal US
    • pediatric
  • Kind: experimental
    • Percent: 8%
  • Kind: placebo
    • Percent: 5%
  • Clinical Trial

    Contraindications

    • Route:
      • Oral
    • Dose Form:
      • Capsule
      • Capsule, extended release
      • Tablet
    • Regions: US
    • Patient Conditions:
        • Name: Metabolic Acidosis
        • Drugbank Id: DBCOND0043658
    • With Drugs:
        • Name: Metformin
        • Drugbank Id: DB00331

    Food Interactions

    Avoid a ketogenic diet. This type of diet increases the risk of kidney stones.

    Take with or without food. Food slightly alters absorption but not to any clinically significant extent.