INTRODUCTION: Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma due to supraciliary effusion. Although the ocular finding resembles primary angle-closure glaucoma, bilateral infliction should always raise the suspicion that it is drug-induced glaucoma. CASE REPORT: The authors present a case of a 51-year-old patient on Topamax therapy with sudden vertigo, headache and blurred vision. Ophthalmic examination revealed bilateral angle-closure glaucoma, which was initially treated in the classical manner by administration of local antiglaucoma drugs and pilocarpine, followed by administration of osmotically active substances and laser iridotomy. Only the subsequent discontinuation of Topamax and the use of local cycloplegics and corticosteroids led to the release of the anterior segment angle closure and normalization of intraocular pressure. CONCLUSION: The indicating physician and ophthalmologist must be aware of the possible side effects of Topamax therapy to determine the correct diagnosis and to administer treatment appropriately.

• Keywords
• Epilepsy, Migraine, acute myopia, angle-closure glaucoma, epilepsy, migraine, topamax, topiramate,
• MeSH
• Fructose adverse effects   MeSH
• Glaucoma, Angle-Closure * chemically induced   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Intraocular Pressure MeSH
• Tonometry, Ocular MeSH
• Topiramate adverse effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Fructose MeSH
• Topiramate MeSH

INTRODUCTION: The aim of this study is to present a case of 44 years old woman with topiramate induced metabolic acidosis and kidney stones. MATERIALS AND METHODS: The laboratory features of topiramate caused renal tubular acidosis in blood and urine during topiramate treatment, with correction of metabolic acidosis by potassium citrate, and after topiramate withdrawal are presented. Differential diagnosis of all possible causes of metabolic acidosis is discussed. RESULTS: The results revealed negative base excess in extracellular fluid of - 9.2 mmol/L, low serum HCO3- concentration (18.6 mmol/L), trend to alkaline urine (pH 6.39) and low urine citrate concentration (0.3 mmol/24h). After topiramate withdrawal, all parameters of the internal environment normalized. CONCLUSIONS: This study has shown that long-term topiramate administration could induce metabolic acidosis and consequently urholithiasis. Thus, we could recommend testing blood acid base balance, urinary pH and citrates in patients taking topiramate and suffering from kidney stones.

• Keywords
• acidosis, glomerular filtration rate, renal tubular acidosis, topiramate, urolithiasis,
• MeSH
• Acidosis chemically induced   MeSH
• Anticonvulsants adverse effects   MeSH
• Adult MeSH
• Fructose adverse effects   analogs & derivatives   MeSH
• Kidney Calculi chemically induced   MeSH
• Humans MeSH
• Migraine Disorders prevention & control   MeSH
• Withholding Treatment MeSH
• Topiramate MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Anticonvulsants MeSH
• Fructose MeSH
• Topiramate MeSH

Worldwide obesity prevalence has nearly doubled since 1980. Due to numerous co-morbidities, obesity represents a serious health and socioeconomic problem worldwide. Pharmacotherapy should be an integral part of comprehensive obesity management. Drug therapy can assist in weight loss and its maintenance in those individuals who do not achieve appropriate weight loss through lifestyle interventions alone. After the withdrawal of sibutramine from the market in 2010, orlistat, a lipase inhibitor, was the only remaining prescription drug approved for the long-term treatment of obesity. In 2012, phentermine/topiramate extended-release (PHEN/TPM ER) combination and lorcaserin were approved by the US FDA as novel medications for long-term weight management. Three major phase III trials conducted with each drug confirmed their efficacy in terms of weight loss/maintenance and improvement of cardiometabolic risks. No head-to-head studies between the two new anti-obesity drugs have been carried out. However, in the existing studies PHEN/TPM ER had a superior weight loss profile to lorcaserin but the incidence of adverse effects was lower with lorcaserin. Both drugs were well-tolerated, and adverse events were modest in intensity, dose dependent, rather rare, and tended to decrease with the duration of treatment. Major safety concerns regarding PHEN/TPM ER include elevations in resting pulse rate, teratogenicity, mild metabolic acidosis, and psychiatric and cognitive adverse events. Valvulopathy, cognitive impairment, psychiatric disorders, and hypoglycemia represent major safety concerns for lorcaserin. Although existing trials have not demonstrated any significant issues with PHEN/TPM ER-induced heart rate elevation and lorcaserin-induced valvulopathy, all safety concerns should be seriously taken into account in patients treated with either of these novel anti-obesity medications.

• MeSH
• Benzazepines adverse effects   MeSH
• Benzoxazines adverse effects   MeSH
• Bupropion adverse effects   MeSH
• Chemistry, Pharmaceutical MeSH
• Phentermine administration & dosage   adverse effects   MeSH
• Fructose administration & dosage   adverse effects   analogs & derivatives   MeSH
• Glucagon-Like Peptide 1 adverse effects   analogs & derivatives   MeSH
• Anti-Obesity Agents administration & dosage   adverse effects   MeSH
• Humans MeSH
• Liraglutide MeSH
• Naltrexone adverse effects   MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Obesity drug therapy   MeSH
• Topiramate MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Names of Substances
• Benzazepines MeSH
• Benzoxazines MeSH
• Bupropion MeSH
• cetilistat MeSH Browser
• Phentermine MeSH
• Fructose MeSH
• Glucagon-Like Peptide 1 MeSH
• Anti-Obesity Agents MeSH
• Liraglutide MeSH
• lorcaserin MeSH Browser
• Naltrexone MeSH
• Topiramate MeSH

The present article describes two unrelated cases of progressive myoclonic epilepsy (PME) of the Lafora's disease and Unverricht-Lundborg types who were treated with topiramate (TPM) as add-on therapy for their myoclonus. After the initiation of topiramate therapy both cases responded with marked decrease in myoclonic seizure frequency and improvement of quality of life. Topiramate appears to be a useful alternative agent in cases of PME and could be consider for adjunctive therapy.

• MeSH
• Anticonvulsants therapeutic use   MeSH
• Fructose analogs & derivatives   therapeutic use   MeSH
• Drug Therapy, Combination MeSH
• Humans MeSH
• Young Adult MeSH
• Myoclonic Epilepsies, Progressive drug therapy   MeSH
• Topiramate MeSH
• Check Tag
• Humans MeSH
• Young Adult MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Anticonvulsants MeSH
• Fructose MeSH
• Topiramate MeSH

The first step in a study of possible cognitive side effects of topiramate in immature rats is to determine if and how topiramate (TPM) influences motor ability and spontaneous behavior. We therefore studied the effects of TPM on motor performance of 12- and 25-day-old rats using age-appropriate tests. Spontaneous behavior in the open field was studied in 25-day-old animals only. TPM was administered intraperitoneally at 80 and/or 160 mg/kg; control rats were injected with solvent (dimethylsulfoxide). A battery of motor tests was conducted before and 1, 3, and 24 hours after administration; behavior in the open field was recorded 2 and 24 hours after TPM administration. The effects of TPM on motor performance were similar to those of solvent. A few differences were found only at the 3-hour interval in 12-day-old rats. Behavior in the open field was not impaired by TPM; on the contrary, an apparent anxiolytic effect was observed. Habituation (a decrease in locomotor activity during the 5-minute observation period), a form of simple nonassociative learning, was also not compromised by TPM. A single high dose of TPM resulted only in transient changes in motor performance. A possible anxiolytic effect observed in 25-day-old rats should be studied.

• MeSH
• Anticonvulsants pharmacology   MeSH
• Behavior, Animal drug effects   MeSH
• Fructose analogs & derivatives   pharmacology   MeSH
• Rats MeSH
• Rotarod Performance Test MeSH
• Animals, Newborn physiology   MeSH
• Exploratory Behavior drug effects   MeSH
• Motor Activity drug effects   MeSH
• Rats, Wistar MeSH
• Psychomotor Performance drug effects   physiology   MeSH
• Body Weight drug effects   MeSH
• Topiramate MeSH
• Age Factors MeSH
• Dose-Response Relationship, Drug MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Names of Substances
• Anticonvulsants MeSH
• Fructose MeSH
• Topiramate MeSH

A short overview of new drugs approved for the treatment of obesity (lorcaserin, phentermine/topiramate combination) as well as those with a perspective for approval as antiobesity drugs (cetilistat, naltrexone/bupropion combination, liraglutide) is presented. All these drugs produce significant weight loss accompanied by reductions in cardiometabolic health risks. Although the adverse events were rather rare and tended to decrease with the duration of treatment with most of these medications, the drug-specific safety concerns should be seriously considered. In order to ensure an appropriate, efficient and safe implementation of novel antiobesity drugs into the comprehensive treatment of obesity, it will be necessary to establish a network of physicians and other health-care providers well educated in obesity management.

• Keywords
• antiobesity drugs, cetilistat, liraglutide, lorcaserin, naltrexone/bupropion, phentermine/topiramate,
• MeSH
• Benzazepines therapeutic use   MeSH
• Benzoxazines therapeutic use   MeSH
• Bupropion therapeutic use   MeSH
• Phentermine therapeutic use   MeSH
• Drug Combinations MeSH
• Fructose analogs & derivatives   therapeutic use   MeSH
• Glucagon-Like Peptide 1 analogs & derivatives   therapeutic use   MeSH
• Weight Loss drug effects   MeSH
• Anti-Obesity Agents therapeutic use   MeSH
• Humans MeSH
• Liraglutide MeSH
• Naltrexone therapeutic use   MeSH
• Obesity drug therapy   MeSH
• Topiramate MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Editorial MeSH
• Names of Substances
• Benzazepines MeSH
• Benzoxazines MeSH
• Bupropion MeSH
• cetilistat MeSH Browser
• Phentermine MeSH
• Drug Combinations MeSH
• Fructose MeSH
• Glucagon-Like Peptide 1 MeSH
• Anti-Obesity Agents MeSH
• Liraglutide MeSH
• lorcaserin MeSH Browser
• Naltrexone MeSH
• Topiramate MeSH

OBJECTIVE: To determine transplacental passage of topiramate and its transport to colostrum, mature maternal milk and breastfed infants, we examined data from 27 women treated with topiramate from 2004 to 2020. METHODS: In this cohort study, maternal serum, umbilical cord serum, milk and infant serum levels were measured by gas chromatography in the delivery subgroup, the colostrum subgroup (3-4 days postpartum) and the mature milk subgroup (7-30 days postpartum). Paired umbilical cord serum, maternal serum, breastfed infant serum, and milk levels were used to assess the ratios of umbilical cord/maternal serum, milk/maternal serum and infant/maternal serum levels. RESULTS: Topiramate levels varied from 1.0 to 7.1 mg/L in maternal serum and from 0.8 to 6.2 mg/L in umbilical cord serum, and the mean umbilical cord/maternal serum ratio was 0.93 ± 0.11. At 3-4 days after delivery, topiramate concentrations were 1.4-8.4 mg/L in maternal serum, 1.5-8.6 mg/L in milk and 0.3-4.4 mg/L in infant serum. The mean milk/maternal serum ratio was 0.99 ± 0.45, and the mean infant/maternal serum ratio was 0.25 ± 0.15. At 7-30 days after delivery, maternal serum levels varied from 1.9 to 9.7 mg/L, milk levels ranged from 2.3 to 10.6 mg/L and infant serum levels ranged from 0.3 to 6.5 mg/L. The mean milk/maternal serum ratio was 1.07 ± 0.31, and the mean infant/maternal serum ratio was 0.51 ± 0.27. CONCLUSIONS: We extended information about free transplacental passage of topiramate and its extensive transport to maternal milk with lower serum concentrations in breastfed infants in the largest group of patients ever reported to our knowledge. DATA AVAILABILITY STATEMENT: Authors declare that take full responsibility for the data, the analyses and interpretation, and the conduct of the research; that they have full access to all of the data; and that they have the right to publish all data. Authors were not participations in industry-sponsored research and corporate activities for evaluation of a manuscript.

• Keywords
• Breastfeeding, Delivery, Therapeutic drug monitoring, Topiramate,
• MeSH
• Anticonvulsants administration & dosage   analysis   metabolism   MeSH
• Adult MeSH
• Cohort Studies MeSH
• Breast Feeding MeSH
• Lactation drug effects   metabolism   MeSH
• Humans MeSH
• Milk, Human drug effects   metabolism   MeSH
• Young Adult MeSH
• Drug Monitoring methods   MeSH
• Infant, Newborn MeSH
• Topiramate administration & dosage   analysis   metabolism   MeSH
• Delivery, Obstetric methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Anticonvulsants MeSH
• Topiramate MeSH

We present a case of late acute myopia syndrome following discontinuation of treatment with a combination of sulphonamide drugs. To the best of our knowledge, this is the first reported case with such a presentation, and suggests that the pathophysiological basis for the acute myopia syndrome is a rapid decrease in serum carbonic anhydrase inhibitors levels which may lead to a rebound increase in the production of aqueous humor and accumulation of suprachoroidal fluid. It is further postulated that there may be a cumulative effect of sulphonamide drug use on carbonic anhydrase activity in the ciliary body epithelium of susceptible individuals.

• MeSH
• Acute Disease MeSH
• Anti-Infective Agents adverse effects   MeSH
• Anticonvulsants adverse effects   MeSH
• Adult MeSH
• Pharyngitis drug therapy   MeSH
• Fructose adverse effects   analogs & derivatives   MeSH
• Trimethoprim, Sulfamethoxazole Drug Combination adverse effects   MeSH
• Drug Therapy, Combination MeSH
• Humans MeSH
• Migraine Disorders prevention & control   MeSH
• Myopia chemically induced   diagnosis   MeSH
• Intraocular Pressure drug effects   MeSH
• Topiramate MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Anti-Infective Agents MeSH
• Anticonvulsants MeSH
• Fructose MeSH
• Trimethoprim, Sulfamethoxazole Drug Combination MeSH
• Topiramate MeSH

BACKGROUND: Topiramate (TPM) decreases cytokine release and generation of reactive oxygen species (ROS). Cytokine and endothelin-1 (ET-1) secretion and ROS formation play an important role in ischemia-reperfusion (I/R) injury. We aimed to evaluate whether TPM prevents damage occurring in lung tissue during I/R. MATERIALS AND METHODS: A total of 27 Wistar albino rats were divided into three groups of nine. To the I/R group, two hours of ischemia via infrarenal abdominal aorta cross-ligation and then two hours of reperfusion process were applied. TPM (100 mg/kg/day) orally for seven days was administered in the TPM treatment group. After the last dose of TPM treatment, respectively, two hours of ischemia and two hours of reperfusion were applied in this group. RESULTS: Tumor necrosis factor-alpha (TNF-α) (p < 0.05), malondialdehyde (MDA) (p < 0.05), myeloperoxidase (MPO) (p < 0.05) and ET-1 (p < 0.05) levels of TPM treatment group's lung tissue were significantly lower than for the I/R group. Caspase-3 and histopathological damage were rather lower than that of the I/R group. CONCLUSIONS: During I/R, lung damage occurs due to excessive TNF-α and ET-1 release and ROS generation. TPM could well reduce development of lung damage by decreasing cytokine and ET-1 release and levels of ROS produced.

• Keywords
• endothelin-1, ischemia-reperfusion, lung injury, topiramate, tumor necrosis factor-alpha,
• MeSH
• Aorta, Abdominal MeSH
• Biomarkers blood   MeSH
• Caspase 3 blood   MeSH
• Rats MeSH
• Ligation MeSH
• Malondialdehyde blood   MeSH
• Peroxidase blood   MeSH
• Lung Injury drug therapy   MeSH
• Rats, Wistar MeSH
• Reperfusion Injury drug therapy   MeSH
• Tumor Necrosis Factor-alpha blood   MeSH
• Topiramate pharmacology   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Biomarkers MeSH
• Caspase 3 MeSH
• Malondialdehyde MeSH
• Peroxidase MeSH
• Tumor Necrosis Factor-alpha MeSH
• Topiramate MeSH

AIMS: The Norwegian Association for Clinical Pharmacology in their National Guidelines decreased the therapeutic range (TR) of topiramate (TPM) from 5-20 mg/L to 2-10 mg/L. The objective of this study is to ascertain which TR produces better clinical outcomes. METHODS: The data sources were request forms for routine therapeutic drug monitoring (TDM) of TPM. Concentration dependent adverse drug reactions (ADRs) were evaluated in 1721 samples taken pre-dose. Seizure frequency analysis was performed in 294 samples of monotherapy. Statistical analysis was performed using Prism 5.0, GraphPad Instatt: One-way ANOVA with Bonferroni correction for median plasma level (PL) and χ2 -test with Bonferroni correction for seizure frequency and for distribution of PL according to TR 5-20 mg/L and intervals <2, 2-5, 5-10, 10-20, >20 mg/L. RESULTS: Better seizure control was found in children both in the whole cohort (without seizure 49% vs 37% adults), as well as in monotherapy (56% vs 44%), in children with PL 5-20 mg/L vs <5 mg/L (65% vs 44%) and in children with PL 5-10 mg/L vs <2 mg/L (63 vs 14%). PL in seizure-free patients did not differ from those with seizure. Seizure control was poorer in the period 2003-2005 compared to 2006-2011. ADRs reported in 38 samples (2.8%) were not related to PL. CONCLUSIONS: Change of TR is not recommended.

• Keywords
• adverse drug reaction, seizure frequency, therapeutic drug monitoring, topiramate,
• MeSH
• Anticonvulsants adverse effects   MeSH
• Child MeSH
• Adult MeSH
• Epilepsy * drug therapy   MeSH
• Fructose adverse effects   MeSH
• Humans MeSH
• Drug-Related Side Effects and Adverse Reactions * MeSH
• Topiramate adverse effects   MeSH
• Seizures chemically induced   drug therapy   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Anticonvulsants MeSH
• Fructose MeSH
• Topiramate MeSH