TOPIRAMATE

Parent or patient Information Leaflet

Dr. C. P. Ravi Kumar

Consultant Paediatric Neurologist MRCPCH, CCT in Paediatrics (U.K.) Fellow in Paediatric Epilepsy & Neurology (London)

Brand names : Tablet : Topirol, Topaz

Topiramate is a medicine used in epilepsy to control generalized tonic-clonic seizures and focal seizures.

Why is Topiramate important for my child?

It is important that your child takes Topiramate regularly so that they have no Seizures or fewer seizures. Stopping Topiramate abruptly has potential to worsen seizures, hence please consult your doctor before stopping.

What is Topiramate available as?

Tablets “Generic Vs Branded Drugs”

When should Topiramate be given?

Twice a day; morning and evening. Ideally, 10-12 hours apart.

For example, anytime between 7 to 8 am and right after 12 hours between 7 to 8 pm. You can adjust the time slot according to your schedule.

However, there are some exceptions when your doctor may advise to give it thrice a day. Please follow your doctor’s instructions in such case.

It should ideally be given at the same time every day to establish a routine as it minimizes the chances of missing a dose.

What if I miss a dose?

Tablets: The child can be given the missed dose, if you remember to give it within a lapse of 6 hours. If you fail to give the missed dose within 6 hours, then might as well leave it. It is advisable to wait until the time of next routine dose.

Never give a double dose of Topiramate.

If your child vomits out the content within 30 minutes of taking the medicine dosage then you can give the dose again; but if your child vomits after 30 minutes of taking the dose, then just leave it be and do not give it again.

How much of the drug should be given?

Your doctor will work out the accurate amount of Topiramate (the dose) for your child in the prescription.

When you first start giving Topiramate to your child, you are supposed to give them a small amount and then increase the dose little by little over a course of few days or weeks. This helps your child’s body to get use to the medicine. Your doctor will clarify what steps to take.

It is mandatory to follow the instructions given by your doctor about the dosage of medication.

Ultimately, when your child is free of seizures or convulsions (fits) and has no obvious side effects, you will know that the dosage is just correct.

How should I give the medicine? “Giving Medicines”

Tablets: A whole tablet must be swallowed with a glass of water, juice or milk. You may give it by crushing and mixing it in water/ juice or small serving of yogurt / Curd.

Could this medication have any side effects on my child? Side effects

Although medicines are given to make children feel better, sometimes, they may cause some unwanted side effects.

Side-effects that you must do something about – Common

Loss of appetite leading to weight loss

Metabolic acidosis: blood is more acidic than usual, due to effect of the drug. This may lead to fast breathing, confusion, sensation of vomiting (nausea) or vomiting.

Dehydration: Make sure your child drinks adequate water.

Kidney stones – minimize risk of developing stone by making your child drink more water.

There are some other side-effects you need to be aware about

Some of these side effects may be noticed when you start taking the medicine, and most of the times they will be able to settle down within a course of week or as the body gets used to the medicine. Continue to give Topiramate to your child as your doctor has directed you to.

Your child may feel dizzy or unusually sleepy, or their behaviour may change drastically.

Your child may have sensation of vomiting (nausea) or vomiting.

These problems may be avoided by starting with a small dose with food and gradually increasing the dosage given. Rarely, it can also cause word finding difficulties. If your child starts developing skin Rash, Stop Medications right there and SEEK IMMEDIATE MEDICAL ADVICE from your DOCTOR Sometimes your child may experience other side-effects that are not listed above. If you notice any abnormalities with your child’s body or behavior, do not hesitate and immediately contact your doctor.

Despite this long list of side effects, Topiramate is a very effective anti-epileptic (anticonvulsant) medicine and has very little effect on the child’s alertness levels, behaviour and learning abilities.

Is it OKAY to use other medicines while consuming topiramate?

Medications like ibuprofen, paracetamol, antibiotics or any of the other over the counter medicines can be given when necessary, except the ones your doctor has prohibited you from.

Consult with your doctor before giving any other medicines to your child. This includes herbal or complementary medicines.

Some other medicines used to treat epilepsy may affect how well Topiramate works or may cause side effects. If your child is experiencing more fits or seizures, or any other side effects after using other medications, talk to your doctor immediately.

Where should I keep the medication?

Keep the medicine in a cupboard, secured away from heat and direct sunlight. It is not a must to keep the medicine in the refrigerator though.

Make sure the medicine is out of your child’s reach.

Store the medication in the same box it was packed in.

For more information please refer to the manufacturer’s information leaflet.

References :

1. IAP Drug Formulary Web Update 2020(3) Edition 58, https://www.iapdrugformulary.com/Home 2. Consumer Medicines Information (CMI), https://www.tga.gov.au/consumer-medicines-information-cmi 3. British National Formulary for Children (BNFC) 4. Food and Drug Administration, USA https://www.fda.gov