Topiramate interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Topiramate, when coadministered with other CNS depressants including alcoholic beverages, may lead to excessive somnolence and other forms of nervous system depression.

  What to do: The patient should be informed to avoid alcohol or to use caution if these agents are coadministered, especially if performing hazardous tasks such as driving or operating machinery.

  1 source

  1. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):

Conditions

Conditions in which Topiramate needs care, as documented in this source.

• Bone Marrow Failure Disorders

  Major

  The use of carbonic anhydrase inhibitors may rarely cause bone marrow suppression and blood dyscrasias at recommended dosages. Aplastic anemia, thrombocytopenia or thrombocytopenia purpura, leukopenia, agranulocytosis, and hemolytic anemia have been reported. Extreme caution should be exercised if carbonic anhydrase inhibitors are administered to patients with these preexisting conditions. A baseline CBC and platelet count is recommended, as well as monitoring at regular intervals during therapy.

  12 sources

  1. Keisu M, Wiholm BE, Ost A, Mortimer O "Acetazolamide-associated aplastic anaemia." J Intern Med 228 (1990): 627-32
  2. Gangitano JL, Foster SH, Contro RM "Nonfatal methazolamide-induced aplastic anemia." Am J Ophthalmol 86 (1978): 138-9
  3. Wisch N, Fischbein FI, Siegel R, Glass JL, Leopold I "Aplastic anemia resulting from the use of carbonic anhydrase inhibitors." Am J Ophthalmol 75 (1973): 130-2
  4. Lubeck MJ "Aplastic anemia following acetazolamide therapy." Am J Ophthalmol 69 (1970): 684-5
  5. Kristinsson A "Fatal reaction to acetazolamide." Br J Ophthalmol 51 (1967): 348-9
  6. Englund GW "Fatal pancytopenia and acetazolamide therapy." JAMA 210 (1969): 2282
  7. Rentiers PK, Johnston AC, Buskard N "Severe aplastic anemia as a complication of acetazolamide therapy." Can J Ophthalmol 5 (1970): 337-42
  8. McWhae JA, Chang J, Lipton JH "Drug-induced fatal aplastic anemia following cataract surgery." Can J Ophthalmol 27 (1992): 313-5

  Show all 12 sourcesShow fewer sources

  9. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):
  10. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):
  12. "Product Information. Neptazane (methazolamide)." Wyeth-Ayerst Laboratories (2006):

• Hyperthermia

  Major

  Oligohidrosis (decreased sweating) and hyperthermia have been reported in association with the use of some carbonic anhydrase inhibitor anticonvulsants such as topiramate and zonisamide. Most of the reports have been in children. Caution and close monitoring of body temperature is advised when prescribing these drugs, especially in patients with a fever, in hot weather, or if combined with other drugs that predispose to heat related disorders. Zonisamide is not approved for use in pediatric patients in the U.S.

  3 sources

  1. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  2. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):
  3. Shimizu T, Yamashita Y, Satoi M, Togo A, Wada N, Matsuishi T, Ohnishi A, Kato H "Heat stroke-like episode in a child caused by zonisamide." Brain Dev 19 (1997): 366-8

• Liver Failure

  Major

  The use of carbonic anhydrase inhibitors is contraindicated in patients with marked liver disease or cirrhosis. Carbonic anhydrase inhibitors increase the risk of developing hepatic encephalopathy in these patients. Extreme caution should be exercised if carbonic anhydrase inhibitors are administered in patients with mild to moderate liver disease as the clearance of the drug can be decreased. A dose reduction might be needed and monitoring of the liver function is recommended.

  6 sources

  1. Maren TH "Acetazolamide and advanced liver disease ." Am J Ophthalmol 102 (1986): 672-3
  2. Margo CE "Acetazolamide and advanced liver disease." Am J Ophthalmol 101 (1986): 611-2
  3. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):
  4. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  5. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):
  6. "Product Information. Neptazane (methazolamide)." Wyeth-Ayerst Laboratories (2006):

• Acidosis

  Moderate

  Reduced plasma bicarbonate levels and, in some instances, elevated plasma chloride levels may result in metabolic acidosis during long-term therapy with carbonic anhydrase inhibitors. Therapy with carbonic anhydrase inhibitors should be administered cautiously in patients with metabolic or hyperchloremic acidosis or with conditions that predispose to acidosis (renal disease, severe respiratory disorders, diarrhea). The measurement of baseline and periodic serum bicarbonate is recommended. If metabolic acidosis develops (it may be corrected by administration of sodium bicarbonate), and persists, a dose reduction or treatment discontinuation should be considered.

  10 sources

  1. Reid W, Harrower AD "Acetazolamide and symptomatic metabolic acidosis in mild renal failure ." Br Med J (Clin Res Ed) 284 (1982): 1114
  2. Goodfield M, Davis J, Jeffcoate W "Acetazolamide and symptomatic metabolic acidosis in mild renal failure ." Br Med J (Clin Res Ed) 284 (1982): 422
  3. Maisey DN, Brown RD "Acetazolamide and symptomatic metabolic acidosis in mild renal failure." Br Med J (Clin Res Ed) 283 (1981): 1527-8
  4. Watson WA, Garrelts JC, Zinn PD, Garriott JC, McLemore TL, Clementi WA "Chronic acetazolamide intoxication." J Toxicol Clin Toxicol 22 549-63
  5. Heller I, Halevy J, Cohen S, Theodor E "Significant metabolic acidosis induced by acetazolamide: not a rare complication." Arch Intern Med 145 (1985): 1815-7
  6. Gabay EL "Metabolic acidosis from acetazolamide therapy ." Arch Ophthalmol 101 (1983): 303-4
  7. Berthelsen P "Cardiovascular performance and oxyhemoglobin dissociation after acetazolamide in metabolic alkalosis." Intensive Care Med 8 (1982): 269-74
  8. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  10. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

• Depressive Disorder

  Moderate

  Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

  16 sources

  1. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals (2002):
  2. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  3. "Product Information. Dilantin (phenytoin)." Parke-Davis (2001):
  4. "Product Information. Cerebyx (fosphenytoin)." Parke-Davis (2001):
  5. "Product Information. Mysoline (primidone)." Elan Pharmaceuticals (2001):
  6. "Product Information. Lyrica (pregabalin)." Pfizer U.S. Pharmaceuticals Group (2005):
  7. "Product Information. Sabril (vigabatrin)." Lundbeck Inc (2009):
  8. "Product Information. Potiga (ezogabine)." GlaxoSmithKline (2011):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Qsymia (phentermine-topiramate)." Vivus Inc (2012):
  10. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  11. "Product Information. Briviact (brivaracetam)." UCB Pharma Inc (2016):
  12. "Product Information. Diacomit (stiripentol)." Biocodex USA (2018):
  13. "Product Information. Epidiolex (cannabidiol)." Greenwich Biosciences LLC (2018):
  14. "Product Information. Xcopri (cenobamate)." SK Life Science, Inc. (2020):
  15. "Product Information. Fintepla (fenfluramine)." Zogenix, Inc (2020):
  16. "Product Information. Ztalmy (ganaxolone)." Marinus Pharmaceuticals, Inc (2022):

• Diseases requiring hemodialysis

  Moderate

  Topiramate is cleared by hemodialysis at a rate that is 4 to 6 times greater than that in a normal individual. A prolonged period of dialysis may cause plasma topiramate level to fall below that required to maintain an anti-seizure effect, thus a supplemental dose may be required in patients undergoing hemodialysis. The actual adjustment should take into account the duration of dialysis, the clearance rate of the dialysis system being used, and the effective renal clearance of topiramate in the patient being dialyzed.

  1 source

  1. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):

• Glaucoma, Angle-Closure

  Moderate

  A syndrome consisting of acute myopia associated with secondary angle closure glaucoma has been reported in patients receiving topiramate. Symptoms include acute onset of visual acuity and/or ocular pain. It typically occurs within 1 month of treatment initiation and it has been reported in both pediatric and adult patients. Caution is recommended when prescribing topiramate in patients with elevated intraocular pressure regardless of the etiology.

  1 source

  1. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):

• Kidney Diseases

  Moderate

  The major route of elimination of carbonic anhydrase inhibitors is through the kidney. These drugs should be administered cautiously in patients with reduced renal function and a dose adjustment might be required depending on the level of impairment.

  3 sources

  1. "Product Information. Diamox (acetazolamide)." Lederle Laboratories (2001):
  2. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):
  3. "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals (2001):

• Nephrolithiasis

  Moderate

  The use of topiramate may infrequently be associated with the development of kidney stones. The reported incidence was 1.5% (32 of 2,086 patients) during premarketing use, which is about 2 to 4 times that expected in a similar, untreated population. Topiramate is a weak carbonic anhydrase inhibitor and may promote stone formation by reducing urinary citrate excretion and increasing urinary pH. Therapy with topiramate should be administered cautiously with adequate hydration in patients with a history of nephrolithiasis. The concomitant use of topiramate with other carbonic anhydrase inhibitors should be avoided. Patients who are dehydrated may be at increased risk for the development of nephrolithiasis and should be encouraged to consume additional amounts of liquid during topiramate therapy.

  2 sources

  1. Shorvon SD "Safety of topiramate: adverse events and relationships to dosing." Epilepsia 37(suppl 2 (1996): s18-22
  2. "Product Information. Topamax (topiramate)." Ortho McNeil Pharmaceutical (2001):