Monitor eating behaviors and weight closely in patients receiving topiramate who have eating disorder symptoms or risk factors (Lebow 2015; Rosenow 2002).• Hepatic impairment: Use caution with hepatic impairment; clearance may be reduced. Available for Android and iOS devices. Discontinue treatment at the first appearance of skin rash and consider alternative therapy.• Hyperammonemia/encephalopathy: Hyperammonemia with or without encephalopathy may occur with monotherapy or in combination with valproic acid and has been documented in patients who have tolerated each drug alone; incidence may be dose-related. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.Adverse events are reported for adult and pediatric patients for various indications and regimens. Dosage adjustment may be required.• Renal impairment: Use caution with renal impairment; clearance may be reduced. If treatment is continued, alkali supplementation should be considered.• Oligohidrosis/hyperthermia: May be associated with oligohidrosis and hyperthermia, most frequently in children; use caution and monitor closely during strenuous exercise, during exposure to high environmental temperature, or in patients receiving other carbonic anhydrase inhibitors and drugs with anticholinergic activity.• Ophthalmic effects: Has been associated with acute myopia and secondary angle-closure glaucoma in adults and children, typically within 1 month of initiation; discontinue in patients with acute onset of decreased visual acuity and/or ocular pain.• Renal calculus: Topiramate exhibits weak carbonic anhydrase inhibitory properties and may increase the risk of kidney stones about 2 to 4 times that of the untreated population. Topiramate dose reductions may be necessary.Trimeprazine: May enhance the CNS depressant effect of CNS Depressants.Ulipristal: Topiramate may decrease the serum concentration of Ulipristal. Her only other medication is Ortho-Tri-Cyclen Lo.She was prescribed topiramate for migraine prophylaxis. Protect from light.Sprinkle capsules: Store at or below 25°C (77°F). If another combination is used, monitor patients closely for adverse effects. In general, maternal polytherapy with antiepileptic drugs may increase the risk of congenital malformations; monotherapy with the lowest effective dose is recommended. 5. The migraines are relieved by the use of Sumatriptan, but she is desiring better control.Her past medical history includes depression for which she is being treated with sertraline. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Valproic acid, amitriptyline, propranolol all certainly have their downsides as well, but would be potential alternatives to avoid the interaction.OVER 3.000 healthcare professionals have signed up for FREE to my Mental slowing is a very real and fairly common SE of topiramate, earning it the nickname “Dope-a-max” by my pharmacy school classmates that had to discontinue topiramate to keep up with the rigors of pharm school.Enjoy the blog? Doses were also gradually withdrawn in migraine prophylaxis studies (decreased in weekly intervals by 25-50 mg/day).Seizure frequency, hydration status; electrolytes (recommended monitoring includes serum bicarbonate at baseline and periodically during treatment), serum creatinine; monitor for symptoms of acute acidosis and complications of long-term acidosis (nephrolithiasis, nephrocalcinosis, osteomalacia/osteoporosis, and reduced growth rates and/or weight in children); ammonia level in patients with unexplained lethargy, vomiting, or mental status changes; intraocular pressure, symptoms of secondary angle closure glaucoma; suicidality (eg, suicidal thoughts, depression, behavioral changes); weight and eating behaviors in patients with eating disorder symptoms or risk factors; sedationEffective contraception should be used in females of reproductive potential who are not planning a pregnancy; consider use of alternative medications in women who wish to become pregnant.Based on limited data (n=5), topiramate was found to cross the placenta and could be detected in neonatal serum (Ohman 2002).Topiramate may cause fetal harm if administered to a pregnant woman. 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