Analysis of Safety and Tolerability Data Obtained from Over 1,500 Patients Receiving Topiramate for Migraine Prevention in Controlled Trials

Abstract

Topiramate is generally safe and reasonably well tolerated for the prevention of migraine in adults. The most common topiramate-associated AEs were mild or moderate in severity and occurred more frequently during titration to target doses.

Anti-Obesity Therapy: from Rainbow Pills to Polyagonists

“…1). Topiramate is a sulphamate-substituted monosaccharide derived from D-fructose (Privitera, 1997;Shank and Maryanoff, 2008;Edvinsson and Linde, 2010) and is commonly used to treat epilepsy (Langtry et al, 1997;Privitera, 1997) and migraine (Storey et al, 2001;Adelman et al, 2008;Edvinsson and Linde, 2010;Linde et al, 2013). The use of topiramate for these clinical applications seems to reside in its ability to selectively decrease CNS neuronal activity via inhibition of certain neuronal Ca 2+ channels (Martella et al, 2008) as well as to modulate central glutamate and GABA signaling (White et al, 2000;Edvinsson and Linde, 2010).…”

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

“…Taste perversion, weight loss, and paresthesia were the most common adverse effects (online Appendix Table 14). Larger target doses of topiramate caused higher risk of dry mouth, paresthesia or fatigue, mood problems, nausea, and weight loss 92 and led to treatment withdrawal due to higher risk of anorexia, depression, paresthesia, and impaired memory. 92 Propranolol caused bothersome adverse effects leading to treatment discontinuation more often than placebo (Table 3).…”

Clinical pharmacology of topiramate in migraine prevention

“…The prevalence of migraine is the highest in obese patients and most migraine preventive medications are associated with some degree of weight gain [73]. This effect can, therefore, be an advantage for a large number of patients.…”

“…A reduction in CA activity impairs both reabsorption of HCO 3 -filtered by the proximal renal tubule and the excretion of H + in the distal renal tubule; this combination is called mixed renal tubular acidosis [78]. Only 1% of patients receiving topiramate have been reported to develop metabolic acidosis, although low serum bicarbonate was common in migraine patients treated either with 50 or 100 mg/day [73].…”

“…Paresthesia, usually tingling of the extremities, occurred with a frequency of 50% in migraine patients treated with topiramate 100 mg/day, but led to treatment discontinuation only in 8% of the patients. Peripheral CA inhibition by topiramate is thought to underlie the occurrence of paresthesia [73]. Migraine patients seem exceptionally susceptible to paresthesia compared with patients with other diseases [74].…”