Most commonly, topamax is started in low doses, 25 or 50 mg per day, and then increased slowly, under a doctors orders, by 25 to 50 mg per week until an effective daily dose is reached. This slow approach to treatment reduces side effects. In children, the starting dose is up to 25 mg (1 to 3 mg/kg/day), taken nightly for the first week. The dose is then increased at 1 or 2 week intervals by 1 to 3 mg/kg/day. Although the usual adult dose is 200 mg twice daily, some adult patients may begin to see a clinical response at 200 mg per day. Some patients need doses higher than 200 mg daily. In children, the usual dose is 2.5 to 4.5 mg/kg twice daily. Patients should maintain an adequate fluid intake in order to minimize the risk of kidney stones.
Drug Class and Mechanism
Topamax is an oral drug that is used to prevent the seizures of epilepsy. (It is an anti-epileptic or anti-seizure drug). It is used primarily among patients who are not controlled by other anti-epileptic drugs. About 1 in 4 Americans diagnosed with epilepsy has seizures that resist treatment with other anti-epileptic drugs. Topamax also prevents migraine headaches. Seizures are due to the abnormal activity ("firing") of nerves in the brain, and the abnormal activity spreads to smaller or larger portions of the brain. Although topamaxs exact mechanism of action is unknown, scientific studies suggest that it may alter neurotransmitters within the brain. Neurotransmitters are chemicals that nerves manufacture and use to communicate with other nearby nerves. By altering the production or action of the neurotransmitters, topamax may suppress the abnormal activity of the nerves in the brain that cause the seizures or may prevent the abnormal activity from spreading to other nerves. Other studies suggest that topamax may suppress the nerves directly (i.e., not by altering neurotransmitters) and make them less likely to fire.
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
Storage
Topamax tablets should be stored at room temperature, 59-86 degrees F (15-30 degrees C). Sprinkle capsules should be stored at or below 77 degrees F (25 degrees C).
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