TOPIRAMATE

 (Topamax)

Standard Prescription

topiramate__mg PO__(frequency) (__mg/kg/24hour)

Dosages

Seizures:

Children 2-16 yrs:
Initial: 0.25-1 mg/kg/dose PO BID (Max 25 mg/dose).
Increment: 0.5 mg/kg/dose PO BID every 7 days (May increase faster if frequent seizures).
Maintenance: 2.5-4.5 mg/kg/dose PO BID.
Maximum: 7.5 mg/kg/dose PO BID or 200 mg/dose PO BID, whichever is less.

Adolescents > 17 yrs:
Initial: 12.5-25 mg/dose PO BID.
Increment: 12.5-25 mg/dose PO BID every 7 days (May increase faster if frequent seizures).
Maintenance: 100-200 mg/dose PO BID.
Maximum: 200 mg/dose PO BID.

Mechanism of Action

Anticonvulsant

Forms Supplied

tablet: 25 mg, 100 mg
(Also available but not stocked at BCCH: 200 mg tablet).
sprinkle capsules: 15 mg, 25 mg
suspension (BCCH): 6 mg/mL

Comments

Hazardous drug. Refer to Hazardous Drug Handling Policy on PHSA SHOP

Doses of 25-100 mg/24 hr shown to be of benefit in migraine prophylaxis.

Evidence of benefit as a mood stabilizer in bipolar disorder is limited. Not recommended as monotherapy.

Rapid titration of 2-3 days can be used for infantile spasms or refractory seizures.

Contents of sprinkle capsules may be added to soft food.

Adverse effects: cognitive impairment, drowsiness, irritability, paresthesia, decreased appetite, kidney stones. Rarely may cause decreased sweating and hyperthermia, especially in children in hot weather.

May decrease efficacy of oral contraceptives.

Consider use of oral contraceptives containing > 35 mcg/dose ethinyl estradiol or an alternative contraceptive method.

References

32, 44, 83, 154

Last Edited

2022-09-12 00:35:34