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Indications

Migraine Epilepsy Headache

Epilepsy: Topirva XR is indicated as monotherapy in adults and children aged 6 years and above with newly diagnosed epilepsy who have generalised tonic clonic seizures or partial seizures, with or without secondarily generalised seizures. It is also indicated as adjunctive therapy for adults and children over 2 years of age whose partial seizures, with or without secondarily generalised seizures, are not adequately controlled on conventional first line antiepileptic drugs. This adjunctive use also covers seizures associated with Lennox Gastaut Syndrome and primary generalised tonic clonic seizures. Migraine: Topirva XR is indicated in adults for the prevention of migraine headache. Preventive treatment may be considered for adults who experience three or more migraine attacks per month, or whose frequent migraine attacks significantly interfere with their daily routine. Continuing therapy should be reviewed every six months.

⚠️ Always consult a registered physician before taking any medicine.

Pharmacology

A seizure is an abnormal, unregulated electrical discharge in the brain. This causes a brief interruption in brain function, showing up as reduced alertness, unusual sensations, and focal involuntary movements or convulsions. Several types of seizures exist, with tonic-clonic seizures and partial onset seizures being among the most common.

The exact mechanisms by which topiramate acts against seizures and migraines are not yet fully understood. However, several properties of the drug are thought to contribute to its therapeutic effects. Topiramate has been observed to act on voltage-dependent sodium channels, GABA receptors, and glutamate receptors.

It stimulates GABA-A receptor activity at non-benzodiazepine sites in the brain and reduces glutamate activity at both AMPA and kainate receptors. GABA-A receptors are normally inhibitory, while glutamatergic receptors are normally stimulatory for neuronal activity. By increasing GABA activity and reducing glutamate activity, topiramate curbs neuronal excitability, helping to prevent seizures and migraines. It also blocks voltage-dependent sodium channels, further reducing seizure activity. Topiramate has also been shown to inhibit various carbonic anhydrase isozymes, though the clinical significance of this effect is not yet known.

Pregnancy & Breastfeeding

Topiramate is generally avoided in pregnancy, and it should only be used if your physician judges that the benefit to you clearly outweighs the possible risk to your unborn baby. Breastfeeding is not recommended while taking topiramate.

⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.

Dosage Reference

⚠️ Reference ranges from official sources only. Consult your doctor for personalized dosing.

Adults: Epilepsy, monotherapy, adults and children over 16 years: Titration should begin at 25 mg nightly for 1 week. The dosage should then be increased at 1 or 2 week intervals by increments of 25 or 59 mg/day, given in two divided doses. The recommended initial target dose for topiramate monotherapy in adults with newly diagnosed epilepsy is 100 mg/day, and the maximum recommended daily dose is 400 mg. Children aged 6 to 16 years: Treatment of children aged 6 years and above should begin at 0.5 to 1 mg/kg nightly for the first week. The dosage should then be increased at 1 or 2 week intervals by increments of 0.5 to 1 mg/kg/day, given in two divided doses. The recommended initial target dose range for topiramate monotherapy in children with newly diagnosed epilepsy aged 6 years and above is 3 to 6 mg/kg/day. Higher doses have been tolerated, and rarely doses up to 16 mg/kg/day have been given. Epilepsy, adjunctive therapy, adults and children over 16 years: The minimal effective dose as adjunctive therapy is 200 mg per day. The usual total daily dose is 200 mg to 400 mg in two divided doses. Some patients may require doses up to 800 mg per day, which is the maximum recommended dose. Children aged 2 to 16 years: The recommended total daily dose of topiramate as adjunctive therapy is approximately 5 to 9 mg/kg/day in two divided doses. Titration should begin at 25 mg nightly for the first week. The dosage should then be increased at 1 or 2 week intervals by increments of 1 to 3 mg/kg/day, given in two divided doses, to achieve optimal clinical response. Dose titration should be guided by clinical outcome. Daily doses up to 30 mg/kg/day have been studied and were generally well tolerated. Migraine, adults and children over 16 years: Titration should begin at 25 mg nightly for 1 week. The dosage should then be increased in increments of 25 mg/day, administered at 1 week intervals. The recommended total daily dose of topiramate for the prophylaxis of migraine headache is 100 mg/day, given in two divided doses. Some patients may experience benefit at a total daily dose of 50 mg/day. Children: Topiramate for migraine prophylaxis has not been studied in children under 16 years.

Side Effects & Interactions

Side Effects

No side-effect data recorded yet.