- Adult (age >10 years old) - Standard Release
- Initial: 25 mg orally twice daily (consider starting 25 mg only at bedtime)
- Increase by 25-50 mg/day increments per week
- Week 2: 50 mg orally twice daily
- Week 3: 75 mg orally twice daily
- Week 4: 100 mg orally twice daily
- Week 5: 150 mg orally twice daily
- Week 6: 200 mg orally twice daily
- Target
- Adults: 400 mg/day divided twice daily
- Elderly: 200 mg/day divided twice daily
- Maximum dose: 1600 mg/day divided twice daily
- However, doses above 400 mg/day have not been shown to be more effective
- Child (age 2 to 10 years, weight based protocol) - Standard Release
- Initial: 1-3 mg/kg up to 25 mg orally at bedtime for 1 week
- Increase by 1-3 mg/kg/day to 25 to 50 mg increments per week
- Target range: 5-9 mg/kg/day divided twice daily
- Weight <11 kg: Target 75 to 125 mg orally twice daily
- Weight 12 to 22 kg: Target 100 to 150 mg orally twice daily
- Weight 23 to 31 kg: Target 100 to 175 mg orally twice daily
- Weight 32 to 38 kg: Target 125 to 175 mg orally twice daily
- Weight >38 kg: Target 125 to 200 mg orally twice daily
- Extended Release (Trokendi XR or Qudexy XR)
- Trokendi XR is approved for age >6 years
- Qudexy XR is approved for age >2 years
- Use same dosing as above, but dose daily instead of twice daily
- Migraine Prophylaxis - Adult (and child age >12 years old)
- Standard Release
- Start 25 mg orally at bedtime
- Titrate weekly, starting at increase of 25 mg/day/week
- Week 2: Take 25 mg orally twice daily
- Week 3: Take 25 mg orally in am and 50 mg orally in pm
- Then 50 mg orally twice daily
- Extended Release (Trokendi XR or Qudexy XR)
- Use same dosing as above, but dose daily instead of twice daily
- Other Indications - Adults (not FDA approved)
-
Essential Tremor
- Start 25 mg orally daily
- Titrate by increasing 25 mg/day/week
- Target: 100 mg/day divided twice daily
- Maximum: 400 mg/day
-
Bipolar Disorder
- Start 25 to 50 mg orally daily
- Titrate to effective target dose
- Maximum: 400 mg/day
-
Alcohol Dependence
- Start 25 mg orally daily
- Titrate by increasing 25 mg/day/week
- Target: 300 mg/day divided twice daily
- Limit duration to 14 weeks
- Obesity Management
- Common (Dose related)
- Serious
- Nephrolithiasis
- Secondary to carbonic anhydrase inhibition
- Narrow Angle Glaucoma
- Hyperammonemia with Encephalopathy
- Increased risk when used with Valproic Acid
- Hypothermia
- Increased risk when used with Valproic Acid
- Hypohidrosis and Heat Stroke risk
- Increased risk in children, and when combined with Anticholinergic Medications
- Nephrolithiasis
- Other
- Hyperchloremic Non-Anion Gap Metabolic Acidosis
- Excreted unchanged in the urine
- Adjust dose if Creatinine Clearance <60 ml/min/sec
- Decrease dose to 50%
- Following Hemodialysis
- Consider replacement dose after Hemodialysis
-
Alcohol
- Avoid Alcohol within 6 hours of Trokendi XR (decreases Topiramate release)
-
CNS Depressants
- Potentiates CNS depression
-
Lithium
- Increases Lithium levels
-
Digoxin
- Increases Digoxin levels
-
Oral Contraceptives
- Decreases contraceptive efficacy
- Topiramate tablets and capsules (DailyMed)
- (2022) Presc Lett, Resource #361206, Antiseizure Medications
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia