Topiramate

[jonnylingo]

I have a few pts I inherited who are on Topamax for neuropathic pain. For those of you who use this, do you check routine labs? LFTs?

Per UpToDate:
monitering parameters: electrolytes (recommended monitoring includes serum bicarbonate at baseline and periodically during treatment), serum creatinine

---

Members don't see this ad.

 

[deleted185747]

I have a few pts I inherited who are on Topamax for neuropathic pain. For those of you who use this, do you check routine labs? LFTs?

Per UpToDate:
monitering parameters: electrolytes (recommended monitoring includes serum bicarbonate at baseline and periodically during treatment), serum creatinine

I titrate up to 200mg po qhs. Check chem-7 for renal function and bicarb levels during and after titration.

Chronic topiramate therapy may be associated with hyperchloremic non-anion gap metabolic acidosis and nephrolithiasis. If progressive, untreated metabolic acidosis has also been demonstrated to increase the risk of chronic kidney disease (CKD) development and progression. Therefore, sodium bicarbonate supplementation, beginning 650mg po bid, is recommended when serum bicarbonate level is below 20-21 meq/L. Increased fruit and vegetable consumption may also be a reasonable alternative to alkali therapy in patients with mild metabolic acidosis. Of course, if topiramate is discontinued, alkali therapy is not necessary.

If topiramate is continued, in addition to the above, ibuprofen should also be discontinued because it is a concurrent risk factor for CKD.