ABSTRACT
Topiramate pharmacotherapy commonly has been associated with the following ADRs: confusion, difficulty concentrating, dizziness, fatigue, incoordination, loss of appetite, nervousness, nystagmus, paresthesia, psychomotor slowing, somnolence, speech and language impairment, and weight loss. Concurrent alcohol use may increase the CNS depressant action of topiramate. Advise patients to avoid, or limit, their use of alcohol while receiving topiramate pharmacotherapy. Avoid discontinuing topiramate pharmacotherapy abruptly. Whenever possible, gradually discontinue topiramate pharmacotherapy by reducing the daily dosage by 100 mg at weekly intervals until it is discontinued completely. The abrupt discontinuation of topiramate pharmacotherapy has been associated with “withdrawal seizures.” In the absence of such data, topiramate overdosage should be treated as a medical emergency requiring symptomatic medical support of body systems with attention to increasing topiramate elimination. Concurrent topiramate pharmacotherapy and pharmacotherapy with opiate analgesics, sedative-hypnotics, or other drugs that produce CNS depression may result in additive CNS depression.
