Other weight loss, leukopenia, nephrolithiasis, oligogidroz (mainly in children), metabolic acidosis. Symptoms convulsions, disturbance of consciousness up to coma, decreased blood pressure, severe metabolic acidosis, increased severity chlorodehydromethyltestosterone 10 mg opana of side effects.
Treatment: gastric lavage, symptomatic therapy. An effective way to removing topiramate from the body – hemodialysis.
Interaction with other drugs
Effect of topiramate
does not affect the concentration of carbamazepine, phenobarbital, primidone. With the simultaneous use of valproic acid valproic acid is reduced by 11%, topiramate – 14%. In some cases, when using phenytoin, phenytoin may increase the plasma concentration.
Effect of topiramate s
When the joint application of topiramate to phenytoin and carbamazepine may decrease plasma concentrations of topiramate, thus with the addition or withdrawal of phenytoin or carbamazepine is recommended that dose adjustment of topiramate.
Other interactions Digoxin: the area under the concentration-time curve of digoxin is reduced by 12%. Oral contraceptives: Topiramate at a dose of 50-800 mg / day had no significant impact on the efficiency and norethindrone at a dose of 50-200 mg / day – on the effectiveness of ethinyl estradiol. Significant dose-dependent decrease in efficiency was observed when receiving ethinylestradiol topiramate at a dose of 200-800 mg / day. Patients taking oral contraceptives should tell your doctor chlorodehydromethyltestosterone 10 mg opana about any changes in bleeding patterns.
Metformin: In an application with topiramate the mean value of the maximum concentration and area under the curve concentrations of metformin increased by 18% and 25% respectively, while the mean total clearance is reduced by 20%. Topiramate has no effect on the time to reach Cmax of metformin. Plasma clearance of topiramate is reduced under the influence of metformin. The clinical significance of effects of metformin on the pharmacokinetics of topiramate is unclear. The appointment or termination of topiramate on metformin therapy is necessary to monitor the status of carbohydrate metabolism.
Hydrochlorothiazide: while taking topiramate is an increase in the maximum concentration of 27% and the area under the concentration curve of topiramate by 29%.
Means, depressing the central nervous system ): not recommended for concomitant use of topiramate with ethanol and other means, oppressive central nervous system. Pioglitazone: it revealed a decrease in the area under the concentration curve of pioglitazone by 15%, without changing the maximum concentration of the drug. For active gidroksimetabolita pioglitazone showed a 13% reduction in the maximum concentration and the area under the concentration curve and 16%, respectively, and for the reduction of active ketometabolita detected and the maximum concentrations and areas under the concentration curve at 60%. The clinical significance of these data is unknown.
Other facilities: Topiramate, when used in conjunction with other agents predisposing to nephrolithiasis, in particular carbonic anhydrase inhibitors (acetazolamide) may increase the risk of nephrolithiasis.During use of topiramate patients should avoid taking such drugs, as they can establish the physiological conditions that increase the risk of formation of kidney stones.
Before the drug for women is recommended to use adequate contraception. Topiramate, as well , it is recommended to cancel, gradually reducing the dose, in order to reduce the potential risk of increased frequency of seizures.
Renal impairment: Patients with moderate and severe strongly impaired renal function may need 10-15 days to reach the equilibrium state plasma concentrations as opposed to 4-8 days in patients with normal renal function. As with all patients, a gradual increase in dose should be administered in accordance with clinical outcomes (such as the control of seizures, frequency of side effects), given that patients with moderate or severe renal impairment may require a longer time to reach steady-state after each dose.
Nephrolithiasis: in some patients, particularly predisposed to nephrolithiasis, may increase the risk of forming kidney stones, accompanied by symptoms such as renal colic, pain in the side and in the kidney area. It is recommended that adequate hydration to reduce the risk of kidney stones.
Hepatic impairment: in patients with impaired liver function chlorodehydromethyltestosterone 10 mg opana topiramate clearance is reduced.
Myopia and secondary angle-closure glaucoma: the development of myopia, topiramate should be repealed as soon as clinically possible, and to take measures to reduce intraocular pressure.
Metabolic acidosis: When using topiramate may hyperchloraemic not associated with a deficit of anions, metabolic acidosis (ie, decreased bicarbonate concentration in plasma below normal levels in the absence of respiratory alkalosis). This reduction in the concentration of bicarbonate serum is a consequence of the inhibitory effect of topiramate on renal carbonic anhydrase. In this connection, in the treatment of topiramate to periodically determine the concentration of bicarbonate in the blood serum.
By reducing the body weight during therapy topiramate is useful to consider the possibility of appointing additional power. During treatment advised to refrain from driving and work requiring high concentration and speed of psychomotor reactions.