TOPIRAMATE 25MG (Topamax)

Topiramate 25MG Tablets

WHAT IS TOPAMAX RELEASE FORM?

The main active ingredient of Topamax is topiramate 15-50 mg.

Auxiliary components are sucrose, starch, povidone, cellulose acetate, gelatin.

You can buy Topamax 25mg, 50 mg, and 100mg pills on the market.

WHAT DOES TOPAMAX DO?

The drug is used to treat epilepsy at the initial stage, migraine and relieve seizures. Topamax has spasmolytic, analgesic and anti-inflammatory effects.

Topamax is highly rated as an efficient drug to remove convulsive activity as well as nervous irritability.

The drug is absorbed quickly and effectively. You can take Topamax-Topiramate 25MG Tablets with your meals because it does not have a clinically significant effect on the bioavailability of topiramate.

About 20% of the taken dosage is metabolized. However, Topiramate metabolism is increased by up to 50% in people having concomitant therapy with antiepileptic drugs, which induce the enzymes responsible for metabolism. Unchanged topiramate (around 70%) and its metabolites are released by kidneys.

After taking multiple dosages of Topamax 50mg and 100 mg twice a day the elimination half-life of topiramate from blood is, on average, 21 hours.

People with renal failure need more time to achieve Topamax equilibrium concentration in blood. Take half of the recommended initial and maintenance dosage, if you have kidney failure.

WHAT IS TOPAMAX USED FOR?

Topamax is used to treat epilepsy:

•  as monotherapy for adults and children over 2 years old with epilepsy (including people with first time diagnosed epilepsy);
•  as a part of complex therapy for adults and children over 2 years with partial or general tonic-clonic seizures as well as for treatment of seizures in the case of Lennox-Gastaut syndrome.

TOPAMAX FOR MIGRAINE:

- prevention of migraine seizures for adults (use of Topamax to treat acute migraine seizures is not studied).

WHAT IS TOPAMAX DOSAGE?

Take Topamax pill with or without food, watching it down with a glass of water.

Topiramate 25MG Tablets are specially designed for people experiencing difficulties with pills swallowing (for example, for children and people of advanced age).

THE DOSAGE OF TOPAMAX IN CASE OF PARTIAL OR GENERAL TONIC-CLONIC SEIZURES AS WELL AS IN CASE OF LENNOX-GASTAUT SYNDROME

In the case of combined anticonvulsant therapy for adults, the minimal effective dosage is Topamax 200 mg a day. Usually, the total daily dosage is from 200 mg to 400 mg used in two intakes. The increase of Topamax daily dosage up to 1600 mg may be needed for some people.

It is recommended to start treatment with a low dosage with the subsequent gradual adjustment of an effective dosage. The right dosage selection usually starts from 25-50 mg of Topamax, used before going to bed at night for 1 week. Topamax dosage is then increased with 1-2 week intervals by 25-50 mg taken 2 times a day.

The main guidance to adjust the right dosage is a clinical effect. The positive effect for some people can be reached by taking the drug one time a day. You should not control Topamax concentration in the blood to achieve a positive treatment effect.

These dosage recommendations apply to all adults, including people of advanced age, if they do not have kidney disorders.

TOPAMAX DOSAGE FOR COMBINED ANTICONVULSANT THERAPY FOR CHILDREN OVER 2 YEARS OLD.

The recommended total daily dosage of Topamax as an additional therapy drug is from 5 to 9 mg on each kg of body weight, which is taken 2 times a day. Start adjusting Topamax dosage from 25 mg (or less, based on an initial dosage from 1 to 3 mg/kg a day) at night before going to bed for 1 week.

Dosage can be then increased with an interval of 1-2 weeks by 1-3 mg/kg taken 2 times a day. The clinical effect is going to show whether you chose the right dosage. Topamax daily dosage up to 30 mg/kg is usually well tolerated.

TOPAMAX DOSAGE TO TREAT EPILEPSY (INCLUDING EPILEPSY DIAGNOSED FOR THE FIRST TIME)

The frequency of seizures may be changed if you stop taking an anticonvulsant drug to take Topiramate 25MG Tablets. If there is no need to rapidly cancel the accompanying anticonvulsant drugs intake for safety reasons, it is recommended to reduce their dosages gradually, reducing the dosage of the accompanying antiepileptic drugs for 1/3 every 2 weeks.

In the case of adult monotherapy, take 25 mg of Topamax as an initial dosage before going to bed at night for 1 week. Then the dosage is gradually increased on 25mg or 50 mg with an interval of 1-2 weeks. Use the daily dosage in two intakes.

If you have problems with this mode of dosage increasing, you can raise intervals between dosage increasing, or to increase dosage more smoothly. Take into account the clinical effect of the drug when increasing Topamax dosage. The initial Topamax dosage for adults is 100 mg a day.

The maximum daily dosage should not exceed 500 mg. Some people with refractory forms of epilepsy can tolerate 1000 mg of Tomapax a day. These dosages recommendations are for all adults, including elderly people without kidney disorders.

In the case of children older than 2 years monotherapy, take 0.5-1 mg/kg of body weight for 1 week before going to bed at night. Then Topiramate 25MG Tablets dosage is increased with an interval of 1-2 weeks on 0.5-1 mg/kg a day taken 2 times a day.

If a child does not tolerate well such a way of dosage increasing, you can raise dosage more smoothly or extend intervals between dosage increasing. The size of the dosage and speed of its increasing depending on a clinical effect.

The recommended range of dosages during Topamax treatment for children more than 2 years is 100-400 mg a day. Children with recently diagnosed partial seizures can take up to 500 mg a day.

TOPAMAX FOR MIGRAINE TREATMENT

Topamax is also used to prevent migraine seizures. The recommended daily dosage of Topamax for migraines treatment is 100 mg taken 2 times a day. Use 25mg of Topamax before going to bed at night at the beginning of treatment. Then the dosage is increased by 25 mg a day with an interval of 1 week.

In case of such treatment mode intolerance, the dosage is increased in smaller quantities or with larger intervals. The dosage is adjusted depending on the clinical effect. In certain cases, the positive effect is reached with a daily dosage of Topamax 50 mg. Patients used different Topamax dosages during clinical trials, but no more than 200 mg of Topamax a day.

TOPAMAX USE FOR SPECIAL GROUPS OF PATIENTS

Take decreased dosages of Topamax, if you suffer from kidney failure. It is recommended to use half of the recommended initial and maintenance dosages.

Use Topamax with caution if you have liver disorders.

HEMODIALYSIS

Topiramate 25MG Tablets are removed from the blood during hemodialysis. That is why use an additional dosage of the drug, equal to about a half of daily dosage in days when you have hemodialysis. The additional dosage should be divided into two dosages taken at the beginning and after completion of hemodialysis. The additional dosage can vary depending on the characteristics of equipment for hemodialysis.

TOPAMAX SIDE EFFECTS

Most common side effects during treatment with Topamax include:

Nervous system:

• drowsiness;
• dizziness, paresthesias;
• apathy;
• impaired concentration;
• nystagmus;
• slackness;
• memory disorders;
• tremor;
• amnesia;
• hypesthesia;
• thinking disorders;
• speech disorders;
• cognitive disturbances;
• mental lameness;
• psychomotor disorders;
• sedative action;
• loss of flavoring sensitivity;
• aphasia;
• apraxia;
• aura, burning to feel (mainly of a face, arms, and legs);
• cerebellar syndrome;
• circadian rhythm of dream disorders;
• movements coordination disorders;
• acute partial seizures;
• spasms;
• increased salivation;
• dysesthesia;
• dysgraphia;
• dystonia;
• goosebumps feeling;
• tonic-clonic seizures of grand mal type;
• hyperesthesia;
• hypogeusia;
• hypokinesia;
• hyposmia;
• peripheral neuropathy;
• stupor;
• faints;
• lack of reactions to a stimulus;
• psychomotor hyperactivity.

Mental disorders:

• decreased thinking;
• confusion of consciousness;
• depression;
• sleeplessness;
• aggressive reactions;
• excitement;
• disorientation;
• emotional lability;
• erectile dysfunction;
• anorgasmia;
• sexual dysfunction;
• crying;
• sexual excitement disorders;
• disfemiya;
• early awakenings in the mornings;
• euphoric mood;
• audio and visual hallucinations;
• hypomaniacal states;
• a decrease in libido;
• mania;
• panic state;
• paranoid states;
• reading skills disturbances;
• sleep disorders;
• suicide ideas or attempts;
• tearfulness;
• a feeling of hopelessness.

Digestive system:

• a decrease in appetite;
• anorexia;
• nausea;
• diarrhea;
• abdominal pain;
• dry mouth;
• oral cavity sensitivity disorders;
• pancreatitis;
• appetite increase;
• gastritis;
• gastroesophageal reflux;
• gums bleeding;
• unpleasant smell from the mouth;
• meteorism;
• oral cavity pain;
• thirst;
• discomfort in a stomach, epigastric area;

Musculoskeletal system:

• myalgia;
• muscular spasms;
• chest pain;
• arthralgia;
• body pain;
• muscles constraints;
• joint swelling.

Cardiovascular system:

• bradycardia;
• tachycardia;
• blood flush;
• orthostatic hypotension;

Eyes:

• diplopia;
• vision disorder;
• dry eyes;
• accommodation disorder;
• amblyopia;
• transient blindness;
• unilateral blindness;
• increased lacrimation;
• mydriasis;
• night blindness;
• photopsia;
• scotoma (including ciliary);
• visual acuity reduction;
• closed-angle glaucoma;
• involuntary movements of eyeglobes;
• conjunctival hypostasia;

Hearing:

• ear pain;
• tinnitus,
• vertigo;
• deafness (including neurosensory and unilateral);
• discomfort in ears;
• hearing disorder.

Respiratory system:

• labored breathing;
• nasal bleeding;
• hoarseness;
• short breath during physical activity;
• nose congestion;
• rhinorrhea;
• nasopharyngitis.

Skin and hypodermic tissues:

• rash;
• alopecia;
• itch;
• a decrease in face sensitivity;
• decreased sweating;
• allergic dermatitis;
• erythema;
• the unpleasant smell of skin;
• hives;
• edema;
• toxic epidermal necrolysis.

Urinary system:

• nephrolithiasis;
• dysuria;
• pollakiuria;
• urolithiasis aggravation;
• hamaturia;
• urine incontinence;
• frequent urination;
• renal colic;
• kidney pain in kidney;.

Hemopoiesis:

• anemia;
• leukopenia;
• lymphadenopathy;
• thrombocytopenia;
• neutropenia.
• General disorders:
• a decrease of bicarbonates in the blood;
• crystalluria;
• fatigue;
• irritability;
• weight loss;
• adynamy;
• fever;
• face edema;
• allergic reactions;
• appetite increase;
• metabolic acidosis;
• polydipsia;
• the cold snap of extremities;
• weight gain

General disorders:

• a decrease of bicarbonates in the blood;
• crystalluria;
• fatigue;
• irritability;
• weight loss;
• adynamy;
• fever;
• face edema;
• allergic reactions;
• appetite increase;
• metabolic acidosis;
• polydipsia;
• the cold snap of extremities;
• weight gain

CONTRAINDICATIONS TO USE OF TOPAMAX

Avoid using Topiramate 25MG Tablets for children under 2 years old.

You should also avoid taking the drug if you have hypersensitivity to its components.

Take Topamax with caution if you suffer from renal or liver failure, history or family history of nephrolithiasis (including in the past or the family history) or hypercalciuria.

TOPAMAX AND PREGNANCY - CAN I TAKE TOPAMAX DURING PREGNANCY AND BREASTFEEDING?

There were no special controlled studies conducted for treating pregnant women with Topiramate 25MG Tablets. Topiramate may hurt a fetus if used by pregnant women.

According to available data, babies, affected by Topamax during pregnancy, have an increased risk of inborn malformations development (for example, craniofacial defects, such as cheiloschisis, hypospadias, and anomalies of various body systems development). The specified malformations have been recorded both in the case of Topamax monotherapy and at its use with other drugs.

In comparison with a group of women, not taking antiepileptic drugs, there is an increased probability of babies with low body weight to be born at women, taking Topamax during pregnancy.

Using Topamax during pregnancy is justified only in that case when the potential advantage of treatment for a mother exceeds possible risk for a fetus. The attending physician has to weigh all the advantages and risks of treatment and to consider alternative possibilities of treatment.

If Topamax is used during pregnancy or if the woman has become pregnant during the drug intake, the attending physician has to warn about the potential risk for a fetus.

The limited number of supervisions allows assuming, that topiramate is released in breast milk during breastfeeding. If you need to take Topamax during breastfeeding, you should consider whether to postpone breastfeeding during treatment or to cancel the drug intake.

WHAT SHOULD I KNOW BEFORE TAKING TOPAMAX?

You should cancel Topamax (as well as other antiepileptic drugs) intake gradually to minimize the possibility of an increase in the frequency of seizures. During clinical trials Topamax dosage was reduced to 50-100 mg once a week for adults in case of epilepsy treatment and on 25-50 mg for adults using 100 mg of Topamax a day to prevent a migraine.

Topamax was gradually canceled within 2-8 weeks for children during clinical studies. If you need a rapid termination of Topamax intake, it is recommended to have thorough supervision of health conditions.

As well as during any disease, you should adjust Topamax dosage according to a clinical effect (i.e. seizures frequency, lack of side effects). Take into account that people with kidney failure need more time for the stable concentration of the drug to be established in blood for each dosage.

Reduced sweating and anhidrosis are possible during Topamax treatment. A decrease of sweating and increased body temperature may be observed in children, subjected to the influence of the high temperature of the environment.

Drink more water during Topamax treatment. It will decrease the risk of nephrolithiasis (kidney stones formation).

You should consider possible side effects, which can occur as a result of physical activity or increased temperatures, during Topamax treatment.

There is an increased frequency of mood swings and depression observed during treatment.

The risk of suicidal thoughts and suicide behavior increases during treatment with Topiramate 25MG Tablets and other antiepileptic drugs.

Thus, your doctor has to control your mental condition during treatment to identify signs of suicidal thoughts and to prescribe the corresponding treatment.

Contact your doctor immediately if you have suicidal thoughts or suicidal behavior.

There is an increased risk of kidney stones formation with accompanying symptoms, such as renal colic, for some people, especially with a predisposition to nephrolithiasis.

Drink more water during treatment to reduce this risk. Risk factors for nephrolithiasis development are a history of nephrolithiasis (including in family history), hypercalciuria, concomitant therapy with other drugs promoting nephrolithiasis development.

Children's chronic metabolic acidosis, which can be a result of treatment with Topamax, may lead to growth retardation. Topamax's influence on growth and possible complications connected with a bone system was not studied systematically in children and adults.

In connection with the information above, it is recommended to conduct necessary researches, including bicarbonates concentration check-in blood serum during treatment with Topiramate 25MG Tablets. Decrease a dosage or stop taking the drug, in case of metabolic acidosis emergence.

You should consume more calories if you lose weight during Topamax treatment.

CAN I DRIVE A CARE DURING TOPAMAX TREATMENT?

Topamax affects the nervous system and can cause drowsiness, dizziness, vision disorder and other symptoms. These adverse effects can dangerous for your safety when driving a car or working with other potentially dangerous mechanisms. It is especially important during a period when you are adjusting your Topiramate 25MG Tablets dosage and the clinical effect of the drug is not established yet.

TOPAMAX OVERDOSE

Most common symptoms of Topamax overdose are:

•  spasms;
•  drowsiness;
•  speech and vision disorders;
•  diplopia;
•  thinking disorder;
•  lack of coordination;
•  lethargy;
•  stupor;
•  arterial hypotension;
•  abdominal pain;
•  dizziness;
•  excitement or depression.

Clinical effects were not serious in most cases. However, fatal cases of overdose with a mix of several medicines, including topiramate, have been noted. The development of heavy metabolic acidosis is possible.

OVERDOSE TREATMENT

If you had your meals shortly before you took the large dosage of Topamax, wash out your stomach or cause vomiting. In vitro studies have shown, that absorbent carbon adsorbs topiramate. Hemodialysis is an efficient way to withdraw topiramate out of the body. It is recommended to drink more liquid in case of overdose.

However, it is better to contact your doctor or seek professional medical help, if you experience symptoms of Topamax overdose.

TOPAMAX INTERACTION

Topamax influence on the concentration of other antiepileptic drugs (AEDs)

Topiramate does not interact with other AEDs like Phenytoin, Carbamazepine, Valproic acid, Phenobarbital, Primidone

AEDs influence on Topamax concentration in blood plasma

Phenytoin and Carbamazepine reduce a concentration of topiramate in blood in case of simultaneous intake. You may need to adjust the Topamax dosage if you add or cancel Phenytoin or Carbamazepine together with Topamax.

The right dosage is determined depending on the necessary clinical effect. Adding or canceling valproic acid to the treatment with Topamax does not cause clinically significant changes in topiramate concentration in blood plasma. Therefore, you do not have to change the Topamax dosage in this case.

During conducted researches, a concentration of Digoxin has decreased by 12% after taking a single dosage of Topamax. The clinical importance of this effect is not established. You have to monitor Digoxin concentration in blood if adding or canceling Topamax in case the concomitant use of two drugs.

The effect of combined use of Topiramate 25MG Tablets with other drugs oppressing CNS functions as well as with ethanol was not studied during clinical studies. Avoid using Topamax together with other medications affecting CNS as well as with ethanol.

Topiramate concentration in blood may be decreased in the case of simultaneous intake of Topamax and St. John's wort. This may decrease the efficiency of Topamax treatment. There were no clinical trials of Topamax interaction with medications, containing St. John's Wort.

There may be an interaction of Topamax with oral contraceptives. If you take oral contraceptives containing estrogen together with Topamax, report your doctor about any changes of menstrual terms. The efficiency of contraceptives can be decreased even in the absence of bleedings.

Topamax may interact with drugs, containing lithium.

Clinical trials have revealed an interaction between Topamax and hydrochlorothiazide. The clinical importance of these studies is not revealed. You should adjust your Topamax dosage if you take it together with hydrochlorothiazide.

Topiramate 25MG Tablets may interact with Metformin in case of simultaneous intake. Topiramate did not increase the concentration of Metformin in blood. Whereas, topiramate concentration decreased if it is taken together with Metformin.

The clinical importance of Metformin's impact on Topamax action is not clear. In case you add or cancel Topamax intake to treatment with Metformin, it is recommended to control your health condition, especially if you have diabetes mellitus.

There is an increased risk of kidney stones formation, in case of simultaneous intake of Topamax with other drugs, which have a predisposition to nephrolithiasis development.

Avoid using such drugs during treatment with Topamax, as they may cause physiological changes promoting the development of nephrolithiasis.

The concomitant use of Topiramate 25MG Tablets and valproic acid may cause ammonia with encephalopathy or without it. In most cases, symptoms disappear after you stop taking one of two drugs. This adverse reaction does not influence the action of both medications.

Using Topamax together with valproic acid may also cause hypothermia (unintentional decrease of body temperature below 35 °C).

STORAGE

The drug should be stored in a dry place at room temperature, away from the reach of children.

TOPAMAX AND WEIGHT LOSS - DOES TOPAMAX CAUSE WEIGHT LOSS?

Weight loss is one of the main side effects of Topiramate 25MG Tablets. That is why the drug is widely used not only to treat epileptic seizures but also to lose weight. Numerous clinical tests of the drug in patients with obesity (without epilepsy) have proved the drug helps to lose weight and to decrease arterial pressure levels.

The drug was especially effective for people with bad habits of eating behavior, such as compulsive eating behavior, emotional eating behavior, night eating syndrome, and panic seizures.

Topamax is still officially prescribed to treat epilepsy. The combination of epilepsy and obesity can be a special indication to use Topamax, considering that most of the other anti-epileptic drugs can increase your weight by up to 50%.

However, you can buy Topamax online without prescription, if you don't have epilepsy and want to use the drug for weight loss. Just order generic Topamax online, which would be cheaper than the brand medication.

TOPAMAX WEIGHT LOSS DOSAGE

If you want to use Topamax for weight loss, start taking 25 mg of the drug a day. Then increase the dosage by 25 mg of Topamax every two weeks to reach clinically effective dosage.

The average daily dosage is usually 200 mg of Topamax a day, which is used in two intakes. The duration of the weight loss course is 14 weeks. You need to increase Topiramate 25MG Tablets dosage gradually to avoid unpleasant side effects, such as paresthesias, dry mouth, headache, etc.

MAY I TAKE TOPAMAX WITH ALCOHOL?

Avoid using Topamax with alcohol as well as with other drugs and substances oppressing the nervous system.

WHERE TO BUY TOPAMAX WITHOUT A PRESCRIPTION?

Usually, you need to have a prescription to buy Topiramate 25MG Tablets. However, if you don't have epilepsy and want to take Topamax to lose weight you simply can't get a Topamax prescription. Nevertheless, you can buy Topamax online without prescription. Order Topamax generic from an online pharmacy – a cheap analog of the brand medication.

HOW MUCH DOES TOPAMAX COST?

Topiramate 25MG Tablets price may be different depending, where are you going to buy the drug – from an online pharmacy or in your local drugstore. You can save some money buying Topamax generic online with no RX. You can't just purchase Topamax over the counter at a physical pharmacy, you need to have a valid prescription.