Topamax and Metabolic Acidosis

[NoPain]

A quick question about Topamax and hyperchloremic metabolic acidosis -

It is a known effect with the use of Topamax - but how do you manage it's presence? Do you watch for other side effects - or watch to see if it progresses before discontinuing the medication?
Would you leave a patient with a modest drop in bicarbonate but remains stable on Topamax?

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[drusso]

A quick question about Topamax and hyperchloremic metabolic acidosis -

It is a known effect with the use of Topamax - but how do you manage it's presence? Do you watch for other side effects - or watch to see if it progresses before discontinuing the medication?
Would you leave a patient with a modest drop in bicarbonate but remains stable on Topamax?

I have not seen this, but I guess I'd consider giving them some po alkylinizing agent like sodium bicarb citrate (Shol's Solution) or similar. Curb side a nephrologist and see what they think. I'd be interested in knowing too.

 

[Mister Mxyzptlk]

You should expect to see this to some extent with anyone on Topamax because it is a carbonic anhydrase inhibitor. In most people it's not a problem but in others it's severe. Patients might be doing fine, but then if other risk factors evolve (diarrhea, Atkins diet, renal disease, other CA inhibitory drugs, etc) they can get into trouble. You can try bicarb replacement but unless it's a "must-have" drug I'd look for a substitute. Do you really want to get into acid-base management?