Brand Name(s):Topamax

Indication:Migraine prophylaxis in adults



Review Date:May-20

Refer to NICE Guidance CG150 September 2012

Titration should begin with 25 mg in the evening for one week. The dose should be subsequently increased in increments of 25 mg/day, administered at 1-week intervals. If the patient is unable to tolerate the titration regimen, longer intervals between the dose adjustments may be used.

The recommended total daily dose of topiramate as prophylactic treatment for migraine is 100 mg/day divided into two administrations. Higher doses did not result in any increased benefit. Some patients may experience a benefit at a total daily dose of 50 mg/day. The dose and its adjustment should be guided by clinical outcome.

Topiramate (Topamax) Summary of Product Characteristics 20/04/2009

CSM advice
Topiramate has been associated with acute myopia with secondary angle-closure glaucoma, typically occurring within 1 month of starting treatment. Choroidal effusions resulting in anterior displacement of the lens and iris have also been reported. The CSM advises that if raised intra-ocular pressure occurs: seek specialist ophthalmological advice;use appropriate measures to reduce intra-ocular pressure; stop topiramate as rapidly as feasible

BNF 55 March 2008