Topiramate: Difference between revisions

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{{topiramate}}
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'''''For patient information about topiramate, click [[Topiramate (patient information)|here]].'''''
{{SB}} TOPIRAMATE<sup>®</sup>
==Overview==
'''Topiramate''' (brand name '''Topamax''') is an [[anticonvulsant]] drug produced by Ortho-McNeil Neurologics, a division of [[Johnson & Johnson]].  It is used to treat [[epilepsy]] in both children and adults. In children it is also indicated for treatment of [[Lennox-Gastaut syndrome]] (a disorder that causes seizures and developmental delays). It is also [[Food and Drug Administration]] (FDA) approved for, and now most frequently prescribed for, the prevention of [[migraine]]s.  It has been used by psychiatrists to treat [[bipolar disorder]],<ref>Kusumakar, V.;Lakshmi, N.;Yatham, MB.;O'Donovan, CA.; Kutcher, SP. 152nd Annual Meeting of the American Psychiatric Association. Washington, DC; 1999. Topiramate in rapid cycling bipolar women.</ref><ref>Marcotte D. Longer term treatment with topiramate for bipolar disorders. Bipolar Disord. 2001;3:46.</ref><ref>Sachs, G.;Koslow, GC.;Orsini, C.;Cosgrove, V.;Sambur, M.;Demopulos, C.; Ghaemi, S. Topiramate shows efficacy in the treatment of refractory bipolar mood disorder. 22nd Congress of the Collegium of Internationale Psychopharmacologieum. Brussels, Belgium. 2000.</ref> although it is not FDA approved for this purpose. This drug has been investigated for use in treatment of obesity,<ref>Van Ameringen M, Mancini C, Pipe B, Campbell M, Oakman J. Topiramate treatment for SSRI-induced weight gain in anxiety disorders. J Clin Psychiatry. 2002;63:981-984.</ref><ref>Wilding J, Van Gaal L, Rissanen A, Vercruysse F, Fitchet M; OBES-002 Study Group. A randomized double-blind placebo-controlled study of the long-term efficacy and safety of topiramate in the treatment  of obese subjects. Int J Obes Relat Metab Disord. 2004 Nov;28(11):1399-410.</ref> especially to aid in the reduction of binge eating,<ref>Shapira NA, Goldsmith TD, McElroy S. Treatment of binge disorder with topiramate: a clinical case series. J Clin Psychiatry. 2000;61:368-372.</ref><ref>McElroy SL, Arnold LM, Shapira NA, Keck PE, Rosenthal NR, Rezaul Karim M, Kamin M, Hudson JI. Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. Am J Psychiatry. 2003;160:255-261.</ref> and also as a possible treatment for alcoholism.<ref>Johnson BA, Ait-Daoud , Bowden CL, DiClemente C, Roache JD, Lawson K, Javors MA, MA JZ. Oral Topiramate in the treatment of alcohol dependence: a randomised controlled trial. Lancet. 2003;361:1677-85.</ref>  However, these uses are not actively promoted by the manufacturer, and like its use for bipolar disorder, are [[Off-label use|off-label]] uses. The drug is also used in clinical trials to treat [[Post Traumatic Stress Disorder]].<ref>Berlant JL, Van Kammen DP. Open label topiramate as primary or adjunctive therapy in chronic civilian posttraumatic stress disorder: a preliminary report. J Clin Psychiatry. 2002;63:15-20.</ref> A pilot study suggests that Topiramate is possibly effective against infantile spasm.<ref>Glauser TA, Clark PO, Strawsburg R. A pilot study of topiramate in the treatment of infantile spasms. Epilepsia. 1998 Dec;39(12):1324-8.</ref>  In May 2006 the U.S. National Institutes of Health web site clinicaltrials.gov listed several studies sponsored by Ortho-McNeil which propose to examine the use of topiramate on [[migraine]], [[cluster headache|cluster]],<ref>La'inez MJ, Pascual J, Pascual AM, Santonja JM, Ponz A, Salvador  A. Topiramate in the prophylactic treatment of cluster headache. Headache. 2003 Jul-Aug;43(7):784-9.</ref> and severe headaches within various demographics. Other off-label and investigational uses of topiramate include: treatment of [[bulimia nervosa]],<ref>Hoopes SP, Reimherr FW, Hedges DW, Rosenthal NR, Kamin M, Karim R, Capece JA, Karvois D. Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, part 1: improvement in binge and purge measures. J Clin Psychiatry. 2003;64:1335-41.</ref> [[obsessive-compulsive disorder]], treatment of alcoholism <ref>http://www.cnn.com/2007/HEALTH/conditions/10/09/alcoholism.pill.ap/index.html</ref>, smoking cessation,<ref>Khazaal Y, Cornuz J, Bilancioni R, Zullino DF. Topiramate for smoking cessation. Psychiatry Clin Neurosci. 2006 Jun;60(3):384-8.</ref> and treatment of [[neuropathic pain]].<ref>Chong MS, Libretto SE. The rationale and use of topiramate for treating neuropathic pain. Clin J Pain. 2003 Jan-Feb;19(1):59-68.</ref>
==Category==
Anticonvulsants, Mood Stabilizers, Antimigraine Medications
==FDA Package Insert==
====TOPIRAMATE (topiramate) tablet, film coated====
'''  [[Topiramate indications and usage|Indications and Usage]]'''
'''| [[Topiramate dosage and administration|Dosage and Administration]]'''
'''| [[Topiramate dosage forms and strengths|Dosage Forms and Strengths]]'''
'''| [[Topiramate contraindications|Contraindications]]'''
'''| [[Topiramate warnings and precautions|Warnings and Precautions]]'''
'''| [[Topiramate adverse reactions|Adverse Reactions]]'''
'''| [[Topiramate drug interactions|Drug Interactions]]'''
'''| [[Topiramate use in specific populations|Use in Specific Populations]]'''
'''| [[Topiramate overdosage|Overdosage]]'''
'''| [[Topiramate description|Description]]'''
'''| [[Topiramate clinical pharmacology|Clinical Pharmacology]]'''
'''| [[Topiramate nonclinical toxicology|Nonclinical Toxicology]]'''
'''| [[Topiramate clinical studies|Clinical Studies]]'''
'''| [[Topiramate how supplied storage and handling|How Supplied/Storage and Handling]]'''
'''| [[Topiramate patient counseling information|Patient Counseling Information]]'''
'''| [[Topiramate labels and packages|Labels and Packages]]'''
==Mechanism of Action==
The precise mechanisms by which topiramate exerts its [[anticonvulsant]] and other effects are unknown; however, preclinical studies have revealed four properties that may contribute to topiramate’s efficacy for epilepsy and other indications. Electrophysiological and biochemical evidence suggests that topiramate, at pharmacologically relevant concentrations, blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the [[GABA]] receptor, antagonizes the [[AMPA]]/kainate subtype of the glutamate receptor, and inhibits the [[carbonic anhydrase]] enzyme, particularly isozymes II and IV.
==References==
{{Reflist|2}}
{{Anticonvulsants}}
[[Category:Drugs]]
[[Category:Antimigraine drugs]]
[[Category:Anticonvulsants]]
[[Category:Carbonic anhydrase inhibitors]]
[[Category:Monosaccharides]]
[[Category:Mood stabilizers]]

Revision as of 16:30, 26 May 2014