This dosage information may not include all the information needed to use Topiramate safely and effectively. See additional information for Topiramate.
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Usual Adult Dose for:
Usual Pediatric Dose for:
Additional dosage information:
Usual Adult Dose for Migraine Prophylaxis
Initial dose: 25 mg once a day in the evening.
In the second week, the dose may be titrated up to 25 mg twice a day, in the morning and in the evening.
In the third week, the dose may be titrated up to 25 mg in the morning and 50 mg in the evening.
In the fourth week, the dose may be titrated up to 50 mg in the morning and 50 mg in the evening.
The dose and titration should be guided by clinical outcome.
Longer intervals between dose adjustment may be used as needed.
Usual Adult Dose for Seizure Prophylaxis
Greater than or equal to 17 years: For use as adjunctive therapy for patients with partial onset seizures, or primary generalized tonic-clonic seizures:
Recommended dose (as adjunctive therapy): 200 mg/day to 400 mg/day in two divided doses. It is recommended that therapy be initiated at 25 to 50 mg/day followed by titration to an effective dose in increments of 25 to 50 mg/week. Titrating in increments of 25 mg/week may delay the time to reach an effective dose. Daily doses above 1,600 mg have not been studied.
In the study of primary generalized tonic-clonic seizures the initial titration rate was slower than in previous studies; the assigned dose was reached at the end of 8 weeks.
For use as initial monotherapy in patients with partial onset or primary generalized tonic-clonic seizures:
Recommended dose (as monotherapy): 400 mg/day in two divided doses. It is recommended that therapy be initiated at 25 twice a day followed by titration to an effective dose in increments of 50 mg/week (once weekly increases of 25 mg twice a day).
Usual Pediatric Dose for Seizure Prophylaxis
2 to 16 years:
Partial onset seizures or Lennox-Gastaut syndrome:
Initial: 1 to 3 mg/kg/day (maximum: 25 mg) given nightly for 1 week; increase at 1 to 2 week intervals by 1 to 3 mg/kg/day given in 2 divided doses; titrate dose to response.
Usual maintenance: 5 to 9 mg/kg/day given in 2 divided doses
Primary generalized tonic-clonic seizures: Use initial dose as listed above, but use slower initial titration rate; titrate to 6 mg/kg/day by the end of 8 weeks.
Renal Dose Adjustments
In renally impaired subjects (creatinine clearance less than 70 mL/min/1.73 m2 ), one half of the usual adult dose is recommended. Such patients will require a longer time to reach steady-state at each dose.
Liver Dose Adjustments
In hepatically impaired patients topiramate plasma concentrations may be increased. Some clinicians feel the use of one half of the usual adult dose may be appropriate.
Addition or withdrawal of phenytoin and/or carbamazepine during adjunctive therapy with topiramate may require adjustment of the dose of topiramate.
Topiramate is cleared by hemodialysis at a rate that is 4 to 6 times greater than a normal individual. Accordingly, a prolonged period of dialysis may cause topiramate concentration to fall below that required to maintain an antiseizure effect. To avoid rapid drops in topiramate plasma concentration during hemodialysis, a supplemental dose of topiramate may be required. The actual adjustment should take into account 1) the duration of dialysis period, 2) the clearance rate of the dialysis system being used, and 3) the effective renal clearance of topiramate in the patient being dialyzed.
It is not necessary to monitor topiramate plasma concentrations to optimize therapy.
No evidence of tolerance has been demonstrated in humans. Doses above 400 mg/day have not been shown to improve responses in dose range studies in adults with partial onset seizures.
Topiramate may be given without regard to meals. Because of the bitter taste, tablets should not be broken.
Topiramate sprinkle capsules may be swallowed whole or may be administered by carefully opening the capsule and sprinkling the entire contents on a small amount (teaspoon) of soft food. This drug/food mixture should be swallowed immediately and not chewed. It should not be stored for future use.