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topiramate (toe-peer-i-mate)



Therapeutic: anticonvulsants, mood stabilizers


Seizures including: partial-onset, primary generalized tonic-clonic, seizures due to Lennox-Gastaut syndrome. Prevention of migraine headache in adults. Unlabeled Use: Adjunct in treatment of bipolar disorder.


Action may be due to Blockade of sodium channels in neurons, Enhancement of gamma-aminobutyrate (GABA), an inhibitory neurotransmitter, Prevention of activation of excitatory receptors. Therapeutic Effects: ↓ incidence of seizures. ↓ incidence/severity of migraine headache.

Adverse Reactions/Side Effects

CNS: INCREASED SEIZURES, dizziness, drowsiness, fatigue, impaired concentration/memory, nervousness, psychomotor slowing, speech problems, sedation, aggressive reaction, agitation, anxiety, cognitive disorders, confusion, depression, malaise, mood problems. EENT: abnormal vision, diplopia, nystagmus, acute myopia/secondary angle closure glaucoma. GI: nausea, abdominal pain, anorexia, constipation, dry mouth. GU: kidney stones. Derm: oligohidrosis (↑ in children). F and E: hyperchloremic metabolic acidosis. Hemat: leukopenia. Metab: weight loss, hyperthermia (↑ in children). Neuro: ataxia, paresthesia, tremor. Misc: SUICIDE ATTEMPT, fever.


Examination and Evaluation

  • Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity. Report an increase in seizure activity to the physician immediately.

  • Be alert for suicidal thoughts and ideology; notify physician immediately if patient exhibits signs of depression or other changes in mood and behavior.

  • Assess dizziness or ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor daytime drowsiness, nervousness, agitation, confusion, aggressive behavior, cognitive impairment, memory loss, or difficulty concentrating. Repeated or excessive symptoms may require change in dose or medication.

  • Assess signs of paresthesia (numbness, tingling) or tremor. Perform objective tests including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

  • Monitor signs of metabolic acidosis, including headache, lethargy, stupor, seizures, vision disturbances, increased respiration, cardiac arrhythmias, weakness, and GI symptoms (nausea, vomiting, abdominal pain). Notify physician immediately if these signs occur.

  • Be alert for signs of leukopenia, including fever, sore throat, mucosal lesions, and signs of infection. Report these signs to the physician.

  • Monitor and report signs of kidney stones, including severe pain in the side and back, pain on urination, bloody urine, and a persistent urge to urinate.

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decrease in body fat.

  • If used to prevent migraine headaches, document the frequency and severity of migraines to determine if this drug is successful in helping manage this condition.

  • If treating bipolar disorder, monitor any changes in the patient's mood or behavior. ...

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