Drug info - Topiramate (Topamax)

Discussion in 'Various drugs not covered by other forums' started by ~lostgurl~, Dec 20, 2006.

  1. ~lostgurl~

    ~lostgurl~ Platinum Member & Advisor Donating Member

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    from Australia
    Has anybody tried Topiramate (Topamax) as treatment for any of the following:
    • Addiction (cravings)
    • PTSD
    • Bipolar (mixed episodes or rapid cycling)
    • Restless Leg Syndrome
    • Sleep-Related Eating Disorder (SRED)
    • Nocturnal Eating Syndrome (NES)
    Thanks
    ...............................

    Article 1 - Medsafe Data Sheet fot Topiramate (Topamax)
    http://www.medsafe.govt.nz/profs/datasheet/t/topamaxtabcap.htm

    Topiramate is classified as a sulfamate-substituted monosaccharide.
    The precise mechanism by which topiramate exerts its antiseizure effect is unknown. Electrophysiological and biochemical studies on cultured neurons have identified three properties that may contribute to the antiepileptic efficacy of topiramate.
    Action potentials elicited repetitively by a sustained depolarisation of the neurons were blocked by topiramate in a time-dependent manner, suggestive of a state-dependent sodium channel blocking action. Topiramate increased the frequency at which gama-aminobutyrate (GABA) activated GABAA receptors, and enhanced the ability of GABA to induce a flux of chloride ions into neurons, suggesting that topiramate potentiates the activity of this inhibitory neurotransmitter.
    This effect was not blocked by flumazenil, a benzodiazepine antagonist, nor did topiramate increase the duration of the channel open time, differentiating topiramate from barbiturates that modulate GABAA receptors.
    Because the antiepileptic profile of topiramate differs markedly from that of the benzodiazepines, it may modulate a benzodiazepine-insensitive subtype of GABAA receptor. Topiramate antagonised the ability of kainate to activate the kainate/AMPA (a-amino-3-hydroxy-5-methylisoxazole-4-propionic acid) subtype of excitatory amino acid (glutamate) receptor, but had no apparent effect on the activity of N-methyl-D-aspartate (NMDA) at the NMDA receptor subtype. These effects of topiramate were concentration-dependent over a range of 1 micromol to 200 micromols, with minimum activity observed at 1 micromol to 10 micromols.
    In addition, topiramate inhibits some isoenzymes of carbonic anhydrase. This pharmacologic effect is much weaker than that of acetazolamide, a known carbonic anhydrase inhibitor, and is not thought to be a major component of topiramate's antiepileptic activity.
    In animal studies, topiramate exhibits anticonvulsant activity in rat and mouse maximal electroshock seizure (MES) tests and is effective in rodent models of epilepsy, which include tonic and absence like seizures in the spontaneous epileptic rat (SER) and tonic and clonic seizures induced in rats by kindling of the amygdala or by global ischemia. Topiramate is only weakly effective in blocking clonic seizures induced by the GABAA receptor antagonist, pentylenetetrazole.
    Studies in mice receiving concomitant administration of topiramate and carbamazepine or phenobarbital showed synergistic anticonvulsant activity, while combination with phenytoin showed additive anticonvulsant activity. In well controlled add-on trials, no correlation has been demonstrated between trough plasma concentrations of topiramate and its clinical efficacy. No evidence of tolerance has been demonstrated in humans.
    ......................................

    Article 2 - PubMed: Treatment of nocturnal eating syndrome and sleep-related eating disorder with topiramate.
    http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=14592329&dopt=Abstract

    Winkelman JW.

    Divisions of Psychiatry and Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02459, USA. [email protected]

    BACKGROUND: Sleep-related eating disorder (SRED) and nocturnal eating syndrome (NES) combine features of sleep disorders and eating disorders. Treatment of these nocturnal eating behaviors has been directed towards underlying identifiable sleep or eating disorders using dopaminergic or opioid agonists, as well as anorectic agents, at times with the addition of sedatives. METHODS: Two patients with SRED and two with NES, who had failed multiple previous trials of pharmacotherapy and psychotherapy, were treated in a naturalistic, open-label fashion with topiramate at night. Reduction in nocturnal eating was graded based on self-report. Weight was computed at the outset of, and during, topiramate treatment. RESULTS: One patient with NES had a complete elimination of nocturnal eating with topiramate, two patients (one with NES, one with SRED) had a marked response, and one patient (with SRED) had a moderate response. Mean dose was 218 mg, though three patients noted an improvement at 100 mg. Notable weight loss was observed in all patients (mean of 11.1 kg). Benefits of topiramate treatment have been maintained for a mean period of 8.5 months. CONCLUSIONS: Topiramate may be of benefit for patients with NES or SRED in reducing nocturnal eating, improving nocturnal sleep, and producing weight loss.
    .......................................................

    Article 3 - Psycom: FAQ: Topiramate (Topamax), Mood Disorders and PTSD
    http://www.psycom.net/depression.central.topiramate.html

    NOTE: Topiramate is only approved for the
    treatment of people with seizures. There are
    few systematic studies that establish the safety
    or efficacy of topiramate as a treatment
    for people with mood disorders, PTSD, or eating
    disorders While such studies are underway, what
    is currently known about the use of topiramate
    for the control of mood disorders, PTSD and eating
    disorders comes mostly from uncontrolled case reports.

    1. What is topiramate (Topamax)?
    Topiramate is an anticonvulsant that is chemically unrelated to any other anticonvulsant or mood regulating medication. The mechanism of action is unknown.

    2. When was topiramate approved for marketing in the USA and for what indications may it be promoted?
    topiramate received final approval for marketing in the USDA on 24 December 1996 and is labeled for use as an anticonvulsant.

    3. Is a generic version of topiramate available?
    There is no generic topiramate as the manufacturer has patent protection.

    4. How does topiramate differ from other mood stabilizing drugs?
    Topiramate differs from other mood stabilizing drugs in two major ways:
    1. topiramate's frequent effectiveness for patients who have failed to respond to antidepressants or mood stabilizers;
    2. topiramate's unique side-effect profile.

    5. What, if anything, uniquely distinguishes topiramate from carbamazepine and valproate?
    Topiramate has been successful in controlling rapid cycling and mixed bipolar states in people who have not received adequate relief from carbamazepine and/or valproate.

    6. People with what sorts of disorders are candidates for treatment with topiramate?
    It is too early to be very specific about which mood disorders are most likely to respond to treatment with topiramate. There are just about no published reports on topiramate's use in psychiatry. Patients with hard-to-treat bipolar syndromes have been treated more often than patients with "treatment-resistant" unipolar disorders.
    Topiramate seems especially useful when it comes to treating people who have become manic as the result treatment with lamotrigine.
    There has recently been a report regarding the control of the symptoms of PTSD by topiramate.
    Topiramate has also been successfully used to decrease binge eating and overeating that is caused by other psychiatric medications.

    7. Is topiramate useful for the treatment of acute depressed, manic and mixed states, and can it also be used to prevent future episodes of mania and/or depression?
    The initial use of topiramate was to treat people with depressed, manic rapid-cycling, and mixed states that did not respond to existing medications. Some patients are now being maintained on topiramate on a long term basis in an attempt to prevent future episodes. The effectiveness of topiramate as a long-term prophylactic agent is currently being established.

    8. Are there any laboratory tests that should precede the start of topiramate therapy?
    Before topiramate is prescribed the patient should have a thorough medical evaluation, including blood and urine tests, to rule out any medical condition, such as thyroid disorders, that may cause or exacerbate a mood disorder.

    9. How is treatment with topiramate initiated?
    Topiramate is usually initially prescribed at an initial dose of 12.5 -25 mg once or twice a day and the total daily dose is increased by 12.5 - 25 mg every week. When prescribed in addition to other anticonvulsants being used as mood stabilizers, the final dose is often between 100 and 200 mg per day. Some patient with Bipolar Disorder do well on as little as a total daily dose of 50 mg/day. When used for the control of the symptoms of PTSD the average final dose is about 175 mg/day (with a range of 25 - 500 mg/day).

    10. Are there any special problems prescribing topiramate for people taking lithium, carbamazepine (Tegretol), or valproate (Depakene, Depakote)?
    An interaction between lithium and topiramate has not been reported.
    Carbamazepine and valproate both have the ability to lower plasma levels of topiramate . . . carbamazepine by about 50% and valproate by about 15%. Topiramate has no effect on the plasma level of carbamazepine but can reduce the plasma level of valproate by about 10%. Pharmacokinetic interactions between topiramate and either lamotrigine (Lamictal) or gabapentin (Neurontin) have not been reported.

    11. What is the usual final dose of topiramate?
    When used as a mood-stabilizing agent the final dose of topiramate is most often between 50 and 200 mg/day. Some people require doses as high as 400 mg/day to achieve a good mood stabilizing effect . . . especially when topiramate is being used as a monotherapy . . . while others do fine on 25 mg/day.

    12. How long does it take for topiramate to 'kick-in?'
    While some people notice the antimanic and antidepressant effects early in treatment, others have to take a therapeutic amount of topiramate for up to a month before being aware of a significant amount of improvement.

    13. What are the side-effects of topiramate?
    Here is a listing of topiramate's side effects that affected 10% or more of the 711 people taking the drug during clinical trials and the frequency of those side effects in the 419 people treated with placebo in those trials:
    Common Adverse Reactions (%)
    (Topiramate = 200 mg/day)

    Adverse Reaction Topiramate Placebo


    Somnolence 30 10
    Dizziness 28 14
    Vision problems 28 9
    Unsteadiness 21 7
    Speech problems 17 3
    Psychomotor slowing 17 2
    "Pins and needles" 15 3
    Nervousness 16 8
    Nausea 12 6
    Memory problems 12 3
    Tremor 11 6
    Confusion 10 6
    Side-effects are most noticeable the few days after an increase in dose and then often fade.
    14. Which side-effects are severe enough to force people to discontinue topiramate?
    The side-effects that most frequently caused people to discontinue therapy with topiramate were: psychomotor slowing (4.1%), memory problems ( (3.3%), fatigue (3.3%), confusion (3.2%), and somnolence (3.2%).
    Much less frequently happening but more serious side-effects that force people to stop topiramate therapy include kidney stones, which affect about 1% of people taking the drug, and acute glaucoma, which to date had been reported in about one person in 35,000 taking topiramate. The sudden onset of back pain may indicate the presence of a kidney stone, while eye pain, changes in vision or the develpment of redness in the eye may indicate glaucoma. Most cases of glaucoma have developed within the first two months of therapy with topiramate.
    Information from the FDA on topiramate and glaucoma.

    15. Does topiramate have any psychiatric side effects?
    Among the reported side effects of topiramate are sedation, psychomotor slowing, agitation, anxiety, concentration problems, forgetfulness, confusion, depression, and depersonalization. As with other anticonvulsants, psychosis has rarely been reported as a side-effect.

    16. How does topiramate interact with prescription and over-the-counter medications?
    Only a few interactions between topiramate and other drugs have been identified. Topiramate may increase the plasma level of phenytoin (Dilantin). Phenytoin lowers the concentration of topiramate in the blood by about 50%. While topiramate has little effect on the plasma level of carbamazepine, the latter may decrease the plasma level of topiramate by about 50%. Valproate lowers the plasma level of topiramate by about 15%. Topiramate may lead to decreased effectiveness of some oral anticontraceptives.
    Interactions with other prescription and over-the-counter drugs are not known at this time.

    17. Is there an interaction between topiramate and alcohol?
    Alcohol may increase the severity of the side-effects of topiramate.

    18. Is topiramate safe for a woman who is about to become pregnant, pregnant or nursing an infant?
    Topiramate is has been placed in the FDA pregnancy Category C:
    "Animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans; The benefits from the use of the drug in pregnant women may be acceptable despite its potential risks . . . ."

    19. Is topiramate safe for children and adolescents?
    The FDA has recently approved the use of topiramate in children.

    20. Can topiramate be used in elderly people?
    Older people seem to handle topiramate similarly to younger ones. There is little experience using topiramate for the treatment of psychiatric disorders in the elderly.

    21. Do symptoms develop if topiramate is suddenly discontinued?
    There are no specific symptoms that have been described following the abrupt discontinuation of topiramate, other than the seizures that sometimes follow the rapid discontinuation of any anticonvulsant. Only when necessary because of a serious side effect, should topiramate be suddenly discontinued.

    22. Is topiramate toxic if taken in overdose?
    There is only limited data on the effects of overdoses of topiramate. There have been no reports of deaths following an overdose.

    23. Can topiramate be taken along with MAO inhibitors?
    Yes, the combination has been used without any special problems.

    24. What does topiramate cost?
    As of 3 April 2005, an on-line pharmacy (Drugstore.com) was selling topiramate for the following amounts per tablet (when bought in lots of 100 tablets):
    25 mg - $1.45
    100 mg - $3.73
    200 mg - $5.75

    25. Might topiramate be effective in people who have failed to receive benefit from other psychopharmacologic agents?
    The major use of topiramate in psychiatry is with people who have mood disorders that have not been adequately controlled by other medications at times including lamotrigine and gabapentin. A developing use is for people with PTSD.
    Topiramate has also been shown to decrease craving for alcohol in people with alcoholism, and to prevent migraine headaches.

    26. What are the advantages of topiramate?
    Topiramate seems to be effective in some people with bipolar mood disorders that have not responded to lithium and/or other mood-stabilizers. Some people who have not been able to tolerate any antidepressant because of switches to mania or increased speed or intensity of cycling, or because of the development of mixed states, have been able to tolerate therapeutic doses of anti- depressants when taking topiramate.
    For most people, topiramate has tolerable side effects and it can be taken twice a day.
    The weight loss that accompanies topiramate therapy in some instances is useful for those individuals who have gained weight while taking other mood stabilizing drugs. In some studies 20-50% of people taking topiramate lost weight.

    27. What are the disadvantages of topiramate?
    As topiramate has only been available for a relatively short time, it was first marketed in 1996, there is no information about long term side-effects. As its use with people with mood disorders started even more recently, it is not known if people who initially do well on topiramate continue to do so after many years of treatment.
    Topiramate increases the probability of kidney stones. the development of kidney stones may be prevented by increasing one's intake of water.

    28. Why should physicians prescribe, and patients take, topiramate, when there are mood regulating medications that have been available for many years and which have been shown to be effective in double-blind placebo- controlled studies?
    There are two major reasons why physicians prescribe and patients take topiramate rather than conventional, better established drugs. They are that not everyone benefits from treatment with the older, better known drugs, and that some patients find the side effects of the established drugs to be unacceptable.
    As there has not been a good psychopharmacologic treatment for people with PTSD, topiramate offers such people the possibility of medically -induced relief.

    29. Is topiramate available in countries other than the USA?
    Topiramate is available in many countries throughout the world.

    30. Has anything been published on the use of topiramate as a therapeutic agent for people with mood disorders and/or PTSD?
    While reports on the use of topiramate as a treatment for people with mood disorders and PTSD have been presented at various psychiatric meetings, little is in print about the psychiatric uses of this medication. The following publications are relevant to the psychiatric uses of topiramate:


    Alao AO, Dewan MJ.
    Journal of Nervous and Mental Disease, 2001,189, 60-63.
    Evaluating the tolerability of the newer mood stabilizers.
    [No MEDLINE abstract available]

    American Journal of Ophthalmology 2001, 132, 112-114
    Presumed topiramate-induced bilateral acute angle-closure glaucoma.
    [MEDLINE abstract]
    Andrade C.
    Bipolar Disorders, 2001, 3,211-212.
    Confusion and dysphoria with low-dose topiramate in a patient with bipolar disorder.
    [MEDLINE abstract]
    Barbee JG.
    International Journal of Eating Disorders, 2003, 33, 468-472. Topiramate in the treatment of severe bulimia nervosa with comorbid mood disorders: A case series. [MEDLINE abstract]
    Berlant JL.
    Journal of Clinical Psychiatry 2001, 62 (Suppl 17), 60-63.
    Topiramate in posttraumatic stress disorder: preliminary clinical observations.
    [MEDLINE abstract]
    Berlant J.
    Poster, presented at 39th Annual Meeting New Clinical Drug Evaluation Program (NIMH) Boca Raton, Florida, June 1-4, 1999.
    Open-label topiramate treatment of post-traumatic stress disorder.
    [Read a report on this presentation]
    Berlant J.
    Journal of Clinical Psychiatry 2002, 63, 15-20.
    Open-label topiramate as primary or adjunctive therapy in chronic civilian posttraumatic stress disorder: a preliminary report.
    [MEDLINE abstract]
    Besag FM.
    Drug Safety 2001, 24, 513-536.
    Behavioral effects of the new anticonvulsants.
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    Bowden CL.
    Expert Opin Investig Drugs. 2001, 10, 661-671.
    Novel treatments for bipolar disorder.
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    Brandes JL, Saper JR, Diamond M, et al.
    Journal of the American Medical Association, 2004, 291,965-973.
    Topiramate for migraine prevention: A randomized controlled trial.
    [MEDLINE abstract]
    Calabrese JR, Keck PE Jr, McElroy SL, Shelton MD.
    Journal of Clinical Psychopharmacology 2001, 21, 340-342.
    A pilot study of topiramate as monotherapy in the treatment of acute mania.
    [MEDLINE abstract]
    Calabrese JR, van Kammen DP, Shelton MD, et al
    American Psychiatric Association Annual Meeting 1999, New Research Abstracts NR680
    Topiramate in severe treatment-refractory mania.
    [No MEDLINE abstract available]
    [MEDLINE abstract]
    Calabrese JR, Shelton MD, Rapport DJ, Kimmel SE.
    Journal of Clinical Psychiatry 2002, 63 (Suppl 3),5-9.
    Bipolar disorders and the effectiveness of novel anticonvulsants.
    Carpenter LL, Leon Z, Yasmin S, Price LH
    Journal of Affective Disorders 2002 May; 69, 251-255.
    Do obese depressed patients respond to topiramate? a retrospective chart review.
    [MEDLINE abstract]
    Cassano P, Lattanzi L, Pini S, et al.
    Bipolar Disorders 2001, 3, 161.
    Topiramate for self-mutilation in a patient with borderline personality disorder.
    [No MEDLINE abstract available]
    Chengappa K N, Gershon S, Levine J. Bipolar Disorders 2001, 3,215-232
    The evolving role of topiramate among other mood stabilizers in the management of bipolar disorder.
    [MEDLINE abstract
    Chengappa KN, Rathore D, Levine J, et al.
    Bipolar Disorder. 1999 Sep;1(1):42-53.
    Topiramate as add-on treatment for patients with bipolar mania.
    [MEDLINE Abstract]
    Chengappa KN, Levine J, Rathore D, Parepally H, Atzert R.
    European Psychiatry 2001, 16, 186-190.
    Long-term effects of topiramate on bipolar mood instability, weight change and glycemic control: a case-series.
    [MEDLINE abstract]
    Colom F, Vieta E, Benaberra A, et al
    Journal of Clinical Psychiatry 2001, 62, 475-476.
    Topiramate abuse in a bipolar patient with an eating disorder.
    [MEDLINE abstract]
    Davanzo P, Cantwell E, Kleiner J, et al.
    Journal of the American Academy of Child and Adolescent Psychiatry 2001, 40, 262-263.
    Cognitive changes during topiramate therapy.
    [No MEDLINE abstract available]
    De Leon OA. Harvard Review of Psychiatry. 2001, 9, 209-222.
    Antiepileptic drugs for the acute and maintenance treatment of bipolar disorder.
    [MEDLINE abstract]
    DelBello MP, Kowatch RA, Warner J, et al.
    Journal of Child and Adolescent Psychopharmacology, 2002, 12, 323-330.
    Adjunctive topiramate treatment for pediatric bipolar disorder: a retrospective chart review.
    [MEDLINE abstract]
    Deutsch SI, Schwartz BL, Rosse RB, et al.
    Clinical Neuropharmacology, 2003, 26, 199-206.
    Adjuvant topiramate administration: a pharmacologic strategy for addressing NMDA receptor hypofunction in schizophrenia.
    [MEDLINE abstract]
    Doan RJ, Clendenning M.
    Canadian Journal of Psychiatry 2000, 45, 937-938.
    Topiramate and hepatotoxicity.
    [No MEDLINE abstract available]
    Drapalski AL, Rosse RB, Peebles RR, Schwartz BL, Marvel CL, Deutsch SI.
    Clinical Neuropharmacology 2001, 24, 290-294.
    Topiramate improves deficit symptoms in a patient with schizophrenia when added to a stable regimen of antipsychotic medication.
    [MEDLINE abstract
    Dursun SM, Deakin JF.
    Journal of Psychopharmacology, 2001, 15, 297-301.
    Augmenting antipsychotic treatment with lamotrigine or topiramate in patients with treatment-resistant schizophrenia: A naturalistic case-series outcome study.
    [MEDLINE Abstract]
    Dursun SM, Devarajan S.
    Canadian Journal of Psychiatry 2001, 46, 287-288.
    Accelerated weight loss after treating refractory depression with fluoxetine plus topiramate: possible mechanisms of action?
    [No MEDLINE abstract available]
    Erfurth A, Kuhn G.
    Neuropsychobiology 2000, 42 (Suppl 1), 50-51.
    Topiramate monotherapy in the maintenance treatment of bipolar I disorder: Effects on mood, weight and serum lipids.
    [MEDLINE abstract
    Felstrom A, Blackshaw S.
    American Journal of Psychiatry, 2002, 159, 1246-1247 .
    Topiramate for bulimia nervosa with bipolar II disorder. [No MEDLINE abstract available]
    Gareri P, Falconi U, de Fazio P et al.
    Progress in Neurobiology 2000, 61, 353-396.
    Conventional and new antidepressants drugs in the elderly.
    [MEDLINE abstract]
    Ghaemi SN, Manwani SG, Katzow JJ, et al.
    Annals of Clinical Psychiatry 2001, 13, :185-189.
    Topiramate treatment of bipolar spectrum disorders: A retrospective chart review.
    [MEDLINE abstract]
    Gitlin MJ.
    Bulletin of the Menninger Clinic 2001 65, 26-40.
    Treatment-resistant bipolar disorder.
    [MEDLINE abstract]
    Goldberg JF, Burdick KE.
    Journal of Clinical Psychiatry 2001, 62 Suppl 14, 27-33.
    Cognitive side effects of anticonvulsants.
    [MEDLINE abstract]
    Gordon A, Price LH
    American Journal of Psychiatry 1999, 156, 968-969.
    Mood stabilization and weight loss with topiramate.
    [No MEDLINE abstract available]
    Grunze HC, Normann C, Langosh J et al.
    Journal of Clinical Psychiatry 2001,62, 464-468.
    Antimanic efficacy of topiramate in 11 patients in an open trial with an on-off-on design.
    [MEDLINE abstract]
    Guerdjikova AI, Kotwal R, McElroy SL.
    Obesity Surgery, 2005, 15, 273-277.
    Response of recurrent binge eating and weight gain to topiramate in patients with binge eating disorder after bariatric surgery.
    [MEDLINE abstract]
    Jochum T, Bar KJ, Sauer H. J Neurology Neurosurgery and Psychiatry, 2002, 73, 208-209
    Topiramate induced manic episode.
    [No MEDLINE abstract available]
    Khan A, Faught E, Gelliam F. et al.
    Seizure 1999, 8, 235-237.
    Acute psychotic symptoms induced by topiramate.
    [MEDLINE abstract]
    Ketter TA et al.
    Neurology 1999, 53, (5, Suppl 2), S53-S67.
    Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders.
    [MEDLINE abstract]
    Ketter TA et al.
    Cellular and Molecular Neurobiology, 1999, 19, 511-532.
    Metabolism and excretion of mood stabilizers and new anticonvulsants.
    [MEDLINE abstract]
    Klufas A, Thompson D.
    American Journal of Psychiatry. 2001, 158, 1736.
    Topiramate-induced depression.
    [No MEDLINE abstract available]
    Komanduri R.
    Journal of Clinical Psychiatry, 2003, 64, 612.
    Two cases of alcohol craving curbed by topiramate.
    [No MEDLINE abstract available]
    Kupka RW, Nolen WA, Altshuler LL et al.
    British Journal of Psychiatry, Supplement 2001, 41, s177-s183.
    The Stanley Foundation Bipolar Network. 2. Preliminary summary of demographics, course of illness and response to novel treatments.
    [MEDLINE abstract]
    Kusumakar V, Yatham LN, O'Donovan CA, et al
    American Psychiatric Association Annual Meeting 1999, New Research Abstracts NR477
    Topiramate in rapid-cycling bipolar women.
    [No MEDLINE abstract available]
    Letmaier M, Schreinzer D, Wolf R, Kasper S.
    International Clinical Psychopharmacology. 2001, 16, 295-298.
    Topiramate as a mood stabilizer.
    [MEDLINE abstract]
    Li X, Ketter TA, Frye MA
    Journal of Affective Disorders 2002, May;69, 1-14.
    Synaptic, intracellular, and neuroprotective mechanisms of anticonvulsants: are they relevant for the treatment and course of bipolar disorders?
    [MEDLINE abstract]
    McElroy SL, Suppes T, Keck PE, et al
    Biological Psychiatry, 2000, 47, 1025-1033.
    Open-label adjunctive topiramate in the treatment of bipolar disorders.
    [MEDLINE abstract]
    McIntyre RS, Mancini DA, McCann S, Srinivasan J, Sagman D, Kennedy SH.
    Bipolar Disorders. 2002, 4, 207-213.
    Topiramate versus bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single-blind study.
    [MEDLINE abstract]
    Maidment ID
    Annals of Pharmacotherapy, 2002, 36(7):1277-1281 .
    The use of topiramate in mood stabilization.
    [MEDLINE abstract >
    Marcotte D
    Journal of Affective Disorders 1998, 50, 245-251.
    Use of topiramate, a new anti-epileptic as a mood stabilizer.
    [MEDLINE abstract]
    Martin R, Kuzniecky R, Ho S, et al.
    Neurology, 1999, 15, 321-327.
    Cognitive side effects of topiramate, gabapentin, and lamotrigine in healthy young adults.
    [MEDLINE abstract]
    Millson RC, Owen JA, Lorberg GW, Tackaberry L.
    American Journal of Psychiatry 2002, 159, 675.
    Topiramate for refractory schizophrenia.
    [No MEDLINE abstract available]
    Normann C, Langosch J, Schaerer LO et al.
    American Journal of Psychiatry, 1999, 156, 2014.
    Treatment of acute mania with topiramate.
    [No MEDLINE abstract available]
    Pavuluri MN, Janicak PG, Carbray J.
    Journal of Child and Adolescent Psychopharmacology, 2002, 12, 271-273.
    Topiramate plus risperidone for controlling weight gain and symptoms in preschool mania.
    [No MEDLINE abstract available]
    Pecuch PW, Erfurth A.
    Journal of Clinical Psychopharmacology 2001 21, 243-244.
    Topiramate in the treatment of acute mania.
    [ No MEDLINE abstract available]
    Pinninti NR, Zelinski G.
    Journal of Clinical Psychopharmacology, 2002, 22, 340 .
    Does topiramate elevate serum lithium levels?
    [No MEDLINE abstract available]
    Post RM
    Schizophrenia Research 1999, 39, 153-158.
    Comparative pharmacology or bipolar disorder and schizophrenia.
    [MEDLINE abstract]
    Post RM, Frye MA, Denicoff KD, et al.
    Neuropsychopharmacology 1998 Sep;19(3):206-219
    Beyond lithium in the treatment of bipolar illness.
    [MEDLINE abstract]
    Post RM, Frye MA, Denicoff KD et al.
    Bipolar Disorders 2000, 2, 305-315. Emerging trends in the treatment of rapid cycling bipolar disorder: a selected review.
    [MEDLINE abstract]
    Schlatter FJ, Soutullo CA, Cervera-Enguix S.
    Journal of Clinical Psychopharmacology 2001 21, 464-466.
    First break of mania associated with topiramate treatment.
    [No MEDLINE abstract available]
    Tondo L, Hennen J, Baldessarini RJ.
    Acta Psychiatrica Scandinavica, 2003, 108, 4-14.
    Rapid-cycling bipolar disorder: effects of long-term treatments.
    [MEDLINE abstract]
    Vieta E, Gilabert A, Rodriguez A, et al.
    Actas Esp Psiquiatr 2001, 29, 148-152.
    Effectiveness and safety of topiramate in treatment-resistant bipolar disorder
    [MEDLINE abstract]
    Vieta E, Goikolea JM, OLivares JM, et al.
    Journal of Clinical Psychiatry, 2003, 64, 834-839.
    1-year follow-up of patients treated with risperidone and topiramate for a manic episode.

    Vieta E, Sanchez-Moreno J, Goikolea JM, et al.
    World Journal of Biological Psychiatry, 2003, 4, :172-176.>/I>
    Adjunctive Topiramate in Bipolar II Disorder.
    [MEDLINE abstract]
    Vieta E, Torrent C, Garcia-Ribas G, Gilabert A, et al.
    Journal of Clinical Psychopharmacology, 2002, 22, 431-435
    Use of topiramate in treatment-resistant bipolar spectrum disorders.
    [MEDLINE abstract]
    Winkelman JW.
    Sleep Medicine, 2003, 4, 243-266.
    Treatment of nocturnal eating syndrome and sleep-related eating disorder with topiramate.
    [MEDLINE abstract]
    31. Additions and corrections?
    Please address additions and corrections to:
    Ivan K. Goldberg, M.D.
    1556 Third Avenue
    New York, NY 10128-3100
    Voice: +1-212 876 7800
    Fax: +1-212-876-7821
     
    Last edited by a moderator: Sep 10, 2017
    1. 3/5,
      very useful collection of info and links!
      Jan 8, 2007
  2. Riconoen {UGC}

    Riconoen {UGC} Newbie

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    topamax is known as "dopamax" in the med community because of its simularity to benzos. no bullshit.
     
  3. ~lostgurl~

    ~lostgurl~ Platinum Member & Advisor Donating Member

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    Is it prescribed much? I'd never heard of it until I had me doing some research for her today.
     
  4. Riconoen {UGC}

    Riconoen {UGC} Newbie

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    a freind of swims was prescribed it for bipolar disorder and it made her zombified.
     
  5. ~lostgurl~

    ~lostgurl~ Platinum Member & Advisor Donating Member

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    Ah well that is no good.... interesting that she was prescribed this for bipolar though. Thanks for the input!
     
  6. monkeygone2heaven

    monkeygone2heaven Titanium Member

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    I have been taking topiramate for neuropathic pain for 3-4 years but not for those reasons. it's called dopamax or more commonly stupimax among neurologists not because it's sedating (the sedating effect habituates after a few weeks) but because of severe cognitive side effects (which do not get better unless you stop the drug).

    swim cannot recommend this drug to anyone unless it really helps with pain/epilepsy etc significantly as the side effect profile is very severe (both for swim and statistically). the drug is known for being the only anti-epileptic which does not lead to weight gain and in many cases weight loss. in fact there was a clinical trial for using the drug for obesity and as successful as trial was going, it had to be discontinued due to the high adverse effect profile. see: http://www.defeatdiabetes.org/Articles/drug030611.htm

    this website discusses topamax in relation to many of the uses you asked about: http://www.crazymeds.org/topamax.html

    hope this helps. PM me if you want more info on swim's experience.
     
    Last edited: Jan 8, 2007
    1. 4/5,
      3 cheers for the links- please update the crazymeds url to crazymeds.us domain, Jerod will surely appreciate it!
      Oct 2, 2008
    2. 5/5,
      good info
      Jan 8, 2007
  7. cyndi

    cyndi R.I.P. Silver Member

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    Interesting I was given this for migraines. It didn't help.
     
  8. toe

    toe Gold Member

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    Zonisamide is another anti-convulsant with a very similar side-effect profile.

    I don't know that it's prescribed for migraines, though.
     
  9. cyndi

    cyndi R.I.P. Silver Member

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    Swim's doctor is a quack.
     
  10. ~lostgurl~

    ~lostgurl~ Platinum Member & Advisor Donating Member

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    Pill Helps Alcoholics Taper Off Drinking

    Pill Helps Alcoholics Taper Off Drinking


    By CARLA K. JOHNSON
    Associated Press Writer

    October 9, 2007

    CHICAGO - A migraine pill seems to help alcoholics taper off their drinking without detox treatment, researchers report, offering a potential option for a hard-to-treat problem.

    The drug, Topamax, works in a different way than three other medications already approved for treating alcoholism.

    Experts said the drug is likely to appeal to heavy drinkers who would rather seek help from their own doctors, rather than enter a rehab clinic to dry out.
    The drug costs at least $350 a month, plus the price of doctor's visits.

    But side effects are a problem, and it's unclear whether the findings will make a dent in an addiction that affects millions of Americans.

    Addiction specialists not involved in the study said the findings are promising, although side effects such as trouble concentrating, tingling and itching caused about one in five people to drop out of the study.
    Drowsiness and dizziness are also problems.

    "The size of the treatment effect is larger than in most of the other medications we've seen," said Dr.
    Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism. "And all the drinking variables changed in the right direction."

    The study, published in Wednesday's Journal of the American Medical Association, was funded by the maker of the drug, Johnson & Johnson Inc.'s Ortho-McNeil Neurologics. The researchers also reported financial ties to the company. Ortho-McNeil reviewed the manuscript, but did not change the results or interpretation, the researchers reported.

    The study followed 371 heavy drinkers for 14 weeks.
    About half were randomly assigned to take Topamax, also called topiramate, in gradually increasing doses.
    The others took dummy pills.

    All volunteers were encouraged - but not required - to stop drinking.

    At the start of the study, they drank, on average, 11 standard drinks daily. That's about two six-packs of beer each day, or two bottles of wine, or a pint of hard liquor.

    By the end of the study, 27 of the 183 people, or 15 percent, who took Topamax had quit drinking entirely for seven weeks or more. That compared to six out of 188, or 3 percent, in the placebo group.

    Others cut back. The Topamax group cut back to six drinks a day, on average, assuming everyone who dropped out of the study relapsed into heavy drinking.
    That compared to seven drinks a day for the placebo group.

    "You can come in drinking a bottle of scotch a day and get treatment without detox," said Dr. Bankole Johnson of the University of Virginia, who led the study, which was conducted at 17 U.S. sites from 2004-2006.

    The study didn't follow the drinkers long-term, so it's unclear how many relapsed after they stopped taking the pill.

    But there were lasting effects for Tom Wolfe, 44, a carpenter from Earlysville, Va., who said he has been sober for two years thanks to Topamax. After years of heavy drinking, he took part in an earlier Topamax study. He felt "a little lightheaded" at first until he got used to the drug. Alcohol lost its enjoyment, strengthening his resolve to quit.

    "It's been a miracle to me," Wolfe said. "It got the monkey off my back."

    The drug works by inhibiting dopamine, the brain's "feel-good" neurotransmitters that are involved in all addictions, said Stephen Dewey, a neuroscientist the Brookhaven National Laboratory, who was not involved in the study but does similar research.

    It's a new approach, he said, that "clearly did work on a very small subset in the population."

    Willenbring, who wrote an accompanying editorial, predicts that a future pill, although probably not Topamax, will do for alcohol dependence what Prozac did for depression: Remove the stigma.

    Prozac changed the nature of depression treatment 20 years ago by allowing patients to see their family doctors for help, Willenbring said. An effective drug with few side effects could do the same for alcoholism treatment, he said.

    "This is a huge market," Willenbring said. "We're approaching a Prozac moment."

    But Topamax has big obstacles. With the drug maker's patent expiring next year, there won't be any big push to advertise it for alcoholism, Willenbring said.

    Doctors are free to prescribe drugs for uses that have not been approved, but drug companies are prohibited by law from marketing drugs for these so-called "off-label" uses.

    On Tuesday, Dr. Sidney Wolfe, director of Public Citizen's health research group, sent a protest letter to the U.S. Food and Drug Administration questioning the promotion of Topamax for alcoholics by researchers funded by Ortho-McNeil.

    "This is a very bad message to send out," Wolfe said.

    Ortho-McNeil has no plans to seek federal approval for the drug as an alcoholism treatment and promotes it only for its approved uses of migraine prevention and epilepsy, said company spokeswoman Tricia Geoghegan.
    The company dropped development of new uses for the drug in 2004, but has continued to support some research.

    http://hosted.ap.org/dynamic/stories/A/ALCOHOLISM_PILL?SITE=WBBMAM&SECTION=HOME&TEMPLATE=DEFAULT
     
  11. toe

    toe Gold Member

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    It took me about five minutes to figure out that the second sentence referred to subject of the first, and not to the OP.Somebody has recently had her dose doubled (from 100mg to 200mg).

    Somebody was reluctant to take anything that smacked of mood-stabilizer, due to oodles of negative experiences with "mood-stabilizing" anti-convulsants and "mood-stabilizing" anti-psychotics and just plain "mood-trammelling" lithium. IIRC her shrink (of late 2003) talked her into trying topiramate on the basis that it definitely wouldn't make her gain weight or convulse and no labwork was required. SWIM's primary diagnoses at the time included: I. A. Not crying over, but actually mourning spilt milk and B. Waiting until everyone had left the scene to clean up the table by devouring the now-soured milk and anything in the way. and II. Insisting upon the others' return that there NEVER was any milk, what were they accusing her of and fuck them if they are ALWAYS going to be like that.

    Suffice it to say that topirimate works a lot better to control compulsive behaviors when there's an actual mental illness behind them. Shit, I forgot what I was going to write next. Maybe some stimulants would help BUZZ! wrong! Topiramate completely blocks the effects of cocaine and- turns a fire hose on varying strengths on the most common members of the amphetamine family. More precisely- it reduces the subjective (mental) effects of amphetamine, dextroamphetamine, propylhexadrine, (and presumably propyl-amphetamine) by >50%. It is either sufficient to block 95% of the subjective effects of methamphetamine or meth is just not a particularly notable high. There was an urge to do more, but without reason why- no high to chase, or just a very, very low pitch buzz veritably imperceptable. Between bupropion and topiramate, MDMA simply does not work. It also dampens the subjective effects of methylphenidate and phendimatrazine, but to a lesser degree than those mentioned above, perhaps 30-50%. Changes in tolerance to modafinil and caffeine were not detected, but somebody's use of these substances was erratic, so reliable data is missing. Somebody's only data on the interaction between ephedrine and topiramate is equally unreliable, as the ephedrine used for the experiment was ~10 years old and had been stored in unknown conditions. Somebody did report diminished effects probably consistent with degradation of the chemical.

    Somebody reports that she has yet to experience a topiramate-induced ceiling with the cathinones and family: bupropion, MDPV, (tentatively) a-PPP. Somebody rubs her hands together deviously.

    Hopefully my brain will allow me to indulge you a bit more later, I know this isn't much. But- long story short- it's done nothing good for her affect (probably due to her dx eternally being in flux) and has done astonishing things for her various compulsions. If you're the congratulatin' type, you may wish to give her a high five (or whatever) on 4 October, her one year anniversary tobacco-free after 18 years of covering every living space she inhabited with tar.
     
    Last edited: Oct 4, 2008
    1. 5/5,
      Thanks for sharing, look forward to more on this topic if you have it :)
      Oct 2, 2008
  12. XthisloveX

    XthisloveX Silver Member

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    I was put on topamax after I had shingles on my head and now I suffer from Postherpetic neuralgia. I currently only have to take 100mg's a day. When I first started taking it I noticed alot of side effects. I got realllly bad tingling in my fingers, back and toes, to the point I couldn't do anything with my hands till it was done, I also lost weight...but both have gone away and I dont feel any different. My dad has migraines and used to take 800mg's a day!
     
    1. 4/5,
      Thanks for sharing about this medication
      Dec 20, 2008
  13. toe

    toe Gold Member

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    Thanks for contributing to our small (but growing) collection of topiramate experiences. Before you go any further, though, it's important that you reread the rules, especially those concerning self-incrimination. Because not the laws are not the same everywhere and the mods cannot be expected to keep up both with all the laws and the locations of all DF members, it's best you learn to SWIM at all times when discussing use of psychoactive chemicals and plants.

    And welcome!
     
  14. ~lostgurl~

    ~lostgurl~ Platinum Member & Advisor Donating Member

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    But if you state that you are prescribed this medication that is ok too.
     
  15. Jatelka

    Jatelka Psychedelic Shepherdess Platinum Member & Advisor

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    ^^^ As long as the medication is being taken as prescribed!
     
  16. toe

    toe Gold Member

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    Speaking of which, the efficacy of this medication against compulsive behaviors has been determined to be significantly diminished by not doing so.

    Yeah, it doesn't seem to work if you don't take it.
     
  17. sweetchild

    sweetchild Silver Member

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    i take 200mg. of topamax at night. i used to be on 350mg but i stopped taking them for a while. i recently went back on it so its low. i have bipolar disorder axis 1, rapid cycling. its pretty severe and was a huge pain in the ass to finally find a medicine that works to help control the extremes. a lot of the time its fun though- the mania. on the way up (hypomania) is the best part-its almost like cocaine. but as my mind continues to climb up the stairway to full-blown mania, it becomes unmanagable to the point where i almost kill myself doing things that arent good. the intensity heightens remarkably and everything is too fucking slow. but anyways, i've heard it called "dopamax" since it really chills people out. it really helps me calm down with my mania and anger problems and impulsivity. whats funny though is that so many psychiatrists are against using it for bipolar. my therapist argues with them because she knows it works for so many people.
     
    1. 5/5,
      Thanks for sharing your personal expeience with this uncommon drug.
      Jan 13, 2009
  18. RX420

    RX420 Newbie

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    my dog was prescribed it for migraines. He didn't know it had any other uses..weird.
     
  19. koqlb

    koqlb Silver Member

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    I got it for migraines. She had been having bad migraines for the past 2 days and naturally with three screaming children, she was unable to get the rest necessary. Granted, the little piece of paper says little of the information, so we should be grateful that there was something done by the forum administrators to get more information. I do agree that this drug should not be taken recreationally as it could have certain inhibitors. If you're prescribed it, right on. At the same time, I myself have posted SWIM's experiences on diphenhydramine, which is also a known over the counter sedative. But aside from that, the reports I've found while researching for SWIM helped out a lot more, and proves that Topamax will be more useful as long as it's taken as prescribed.
     
  20. Boca Bitch

    Boca Bitch Silver Member

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    My mother takes Topamax daily for her recurrent migraines. I wasn't aware there was CNS depression from the medication... very interesting post!