TOPAMAX has been associated with serious adverse events, including:
Hyperchloremic, non-anion gap metabolic acidosis - lowering of bicarbonate levels in the blood. Measurement of baseline and periodic serum bicarbonate is recommended.
Acute myopia and secondary angle-closure glaucoma - patients should be cautioned to seek medical attention if they experience blurred vision or ocular pain.
Oligohidrosis and hyperthermia - decreased sweating and increased body temperature, especially in hot weather. The majority of reports have been in children.
Cognitive/psychiatric side effects including cognitive dysfunction, psychiatric/behavioral disturbances including suicidal thoughts or behavior, and somnolence and fatigue.
Most common adverse events associated with TOPAMAX 100 mg vs placebo were: paresthesia, 51% vs 6%; anorexia,* 15% vs 6%; fatigue, 15% vs 11%; nausea, 13% vs 8%; diarrhea, 11% vs 4%; weight decrease, 9% vs 1%; taste alteration, 8% vs 1%.
The possibility of decreased contraceptive efficacy and increased breakthrough bleeding should be considered in patients taking combination oral contraceptive products with TOPAMAX.
Patients should be instructed to maintain an adequate fluid intake in order to minimize the risk of renal stone formation.
Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343-349.
Silberstein SD, for the US Headache Consortium. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review). Am Acad Neurol. 2000:1-11.
Snow V, Weiss K, Wall EM, Mottur-Pilson C, for the American Academy of Family Physicians and the American College of Physicians American Society of Internal Medicine. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002;137:840-849.
Hahn SR, Nelson M, Lipton RB. The language of migraine (LOM) study: frequency, impairment, and prevention in migraine communication. Poster presented at: Diamond Headache Clinic's 19th Annual Practicing Physician's Approach to the Difficult Headache Patient, February 14-18, 2006; Rancho Mirage, Calif.
Silberstein SD, Neto W, Schmitt J, Jacobs D, for the MIGR-001 Study Group. Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol. 2004;61:490-495.
Brandes JL, Saper JR, Diamond M, et al, for the MIGR-002 Study Group. Topiramate for migraine prevention: a randomized controlled trial. JAMA. 2004;291:965-973.
IMS Health, IMS LRx Longitudinal data, Topamax Monthly Tracking Report, December 2007. Custom Study conducted by IMS Management Consulting.
Adelman J, Freitag F, Lainez M, et al. Analysis of Safety and Tolerability Data Obtained from Over 1,500 Patients Receiving Topiramate for Migraine Prevention in Controlled Trials. Pain Medicine. 2007. 1526-4637
Lipton RB, Diamond M, Freitag FG, Bigal M, Stewart WF, Reed ML. Migraine prevention patterns in a community sample: results from the American Migraine Prevalence and Prevention (AMPP) Study. Poster presented at the American Headache Society meeting, 2005; Philadelphia, PA.
Health Plan Audit-Multimedia, Yardley, PA: June 8, 2007