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To Pi Ram Ate

To Pi Ram Ate

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Published by: api-3797941 on Oct 17, 2008
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03/18/2014

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topiramate
(toepi e' rah mate)
Topamax
Pregnancy Category C
Drug class
Antiepileptic
Therapeutic actions

Mechanism of action not understood; antiepileptic effects may be due to the actions of blocking sodium channels in neurons with sustained depolarization; increasing GABA activity at receptors, thus potentiating the effects of this inhibitory neurotransmitter; and blocking excitatory neurotransmitters at neuron receptor sites.

Indications
\u2022
Adjunctive therapy for partial-onset seizure treatment in adults and children 2\u201316
yr
\u2022
Adjunctive therapy for seizures associated with Lennox-Gastaut syndrome in
adults and children
\u2022
Adjunctive therapy for primary generalized tonic-clonic seizures in adults and
children 2\u201316 yr
\u2022
Unlabeled uses: Cluster headaches, infantile spasms
Contraindications and cautions
\u2022
Contraindicated with hypersensitivity to any component of the drug.
\u2022
Use cautiously with pregnancy (use only if benefits outweigh potential risks to
fetus), lactation, renal or hepatic impairment, renal stones.
Available forms
Tablets\u201425, 100, 200 mg; sprinkle capsules\u201415, 25 mg
Dosages
ADULTS

400 mg PO daily in 2 divided doses; begin adjustment of dose at 25\u201350 mg/day in the evening for wk 1; 50 mg AM and PM for wk 2; 50 mg AM and 100 mg PM for wk 3; 100 mg AM and PM for wk 4; 100 mg AM and 150 mg PM for wk 5; 150 mg AM and PM for wk 6; 150 mg AM and 200 mg PM for wk 7; and 200 mg AM and PM for wk 8 and beyond.

PEDIATRIC PATIENTS 2\u201316 YR

5\u20139 mg/kg/day PO in 2 divided doses, as adjunctive therapy for Lennox-Gastaut
syndrome; begin therapy at < 25 mg and increase in increments of 1\u20133 mg/kg/day every
1\u20132 wk.

PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT

For creatinine clearance < 70 mL/min, use one-half the usual dose; allow increased time
to reach desired level. For patients with hepatic impairment, adjust slowly; monitor
patient carefully.

Pharmacokinetics
Route
Onset
Peak
Oral
Rapid
2 hr

Metabolism: Hepatic; T1/2: 21 hr
Distribution: Crosses placenta; enters breast milk
Excretion:Urin e

Adverse effects
\u2022
CNS: Ataxia, somnolence, dizziness, nystagmus, nervousness, anxiety, tremor,
speech impairment, paresthesias, confusion, depression
\u2022
GI: Nausea, dyspepsia, anorexia, vomiting
\u2022
GU:D ys menorrhea
\u2022
Hematologic:Leukopenia
\u2022
Respiratory: Upper respiratory infection, pharyngitis, sinusitis
\u2022
Other:Fatigu e, rash, acute myopia and secondary angle-closure glaucoma (pain,
visual disturbances, pupil dilation, redness, increased IOP), weight loss
Interactions
Drug-drug
\u2022
Increased CNS depression if taken with alcohol or CNS depressants; use extreme
caution
\u2022
Increased risk of renal stone development with carbonic anhydrase inhibitors
\u2022
Decreased effects of hormonal contraceptives with topiramate; suggest use of
barrier contraceptives instead
Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between Topamax and Toprol-XL
(metoprolol); use caution.
Assessment
\u2022
History: Hypersensitivity to any component of the drug; pregnancy, lactation;
renal or hepatic impairment; renal stones
\u2022
Physical: Skin color, lesions; orientation, affect, reflexes, vision exam; R,
adventitious sounds; liver and renal function tests
Interventions
\u2022
Reduce dosage; discontinue or substitute other antiepileptic gradually; abrupt
discontinuation may precipitate status epilepticus.
\u2022
Stop the drug immediately and arrange for appropriate consultations at first sign
of blurred vision, periorbital edema, or redness.
\u2022
Administer with food if GI upset occurs.

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