Group
Antiepileptic drug (sulfamate-substituted monosaccharide)
Mechanism of Action
Multiple mechanisms: blocks voltage-dependent sodium channels, enhances GABA-A receptor activity, antagonizes AMPA/kainate glutamate receptors, and inhibits carbonic anhydrase, reducing neuronal excitability.
Indications
- Partial-onset seizures (adjunctive therapy)
- Primary generalized tonic-clonic seizures (adjunctive therapy)
- Lennox-Gastaut syndrome (adjunctive therapy)
- Prophylaxis of migraine headaches
Dose
- Adults: Start 25–50 mg/day orally, titrate weekly by 25–50 mg/day; usual maintenance 100–400 mg/day in 2 divided doses.
- Children: Weight-based titration; usually 1–3 mg/kg/day initially, increase weekly to maintenance 5–9 mg/kg/day.
Major Side Effects
- Dizziness, somnolence
- Cognitive impairment (difficulty concentrating, memory issues)
- Weight loss, anorexia
- Paraesthesia (tingling)
- Metabolic acidosis, kidney stones (rare)
Contraindications
- Hypersensitivity to topiramate
- History of kidney stones (relative contraindication)
- Metabolic acidosis
Compatible Fluid
Oral administration only – tablets or sprinkle capsules; swallow with liquid or sprinkle on soft food.
Route of Administration
- Oral (tablet, sprinkle capsule)
Type of Administration
Chronic therapy – daily maintenance for seizure control and migraine prophylaxis.