Pharmacokinetics and Interaction Profile of Topiramate: Review and Comparison with Other Newer Antiepileptic Drugs

Johannessen, Svein I.

doi:10.1111/j.1528-1157.1997.tb04512.x

Cited by 68 publications

(58 citation statements)

References 25 publications

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“…5). In humans, TPM achieves peak serum concentrations in 1-4 h after oral dosing, with CSF concentrations, and presumably brain concentrations, reflecting free plasma levels (20,21,23,30,32). Figure 5 shows the estimated human brain and CSF TPM concentrations with the first dose and daily doses.…”

Section: Discussionmentioning

confidence: 99%

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Topiramate Rapidly Raises Brain GABA in Epilepsy Patients

Petroff¹,

Hyder

Rothman

et al. 2001

Epilepsia

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Summary: Purpose:The short-and long-term pharmacodynamic effects of topiramate (TPM) on brain ␥-aminobutyric acid (GABA) metabolism were studied in patients with complex partial seizures.Methods: In vivo measurements of GABA, homocarnosine, and pyrrolidinone were made of a 14-cc volume in the occipital cortex using 1 H spectroscopy with a 2.1-Tesla magnetic resonance spectrometer and an 8-cm surface coil. Fifteen patients (four men) were studied serially after the first, oral dose (100 mg) of TPM.Results: The first dose of TPM increased brain GABA within 1 h. Within 4 h, GABA was increased by 0.9 mM (95% CI, 0.7-1.1). Brain GABA remained elevated for Ն24 h. Pyrrolidinone and homocarnosine increased slowly during the first day. Daily TPM therapy (median, 300 mg; range, 200-500) increased GABA (0.3 mM; 95% CI, 0.1-0.5), homocarnosine (0.4 mM; 95% CI, 0.3-0.5), and pyrrolidinone (0.15 mM; 95% CI, 0.10-0.19), compared with levels before TPM. There was no dose response evident with daily TPM doses of 200-500 mg.Conclusions: TPM promptly elevates brain GABA and presumably offers partial protection against further seizures within hours of the first oral dose. Patients may expect to experience the effects of increased homocarnosine and pyrrolidinone within 24 h.

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Section: Discussionmentioning

confidence: 99%

“…The estimates are based on maximal plasma concentrations (20,21,32). A cerebrospinal fluid (CSF)/plasma TPM concentration ratio of 0.81 based on subdural microdialysis measurements of a patient receiving daily TPM therapy was used (23).…”

Section: Figmentioning

confidence: 99%

Topiramate Rapidly Raises Brain GABA in Epilepsy Patients

Petroff¹,

Hyder

Rothman

et al. 2001

Epilepsia

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“…For most patients, 90% of the maximal plasma concentration (CmaX) is achieved within 2 h after oral administration (34), with a dose-dependent range from 1.4 to 4.3 h (34). Mean values for C, , , and area under the concentration-time curve (AUC), reflections of drug absorption and clearance, increase linearly with respect to dose in adults (37). Topiramate can be administered without regard to food (34).…”

Section: Clinical Pharmacokineticsmentioning

confidence: 99%

Topiramate

Glauser

1999

Epilepsia

122

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“…For example, discontinuing enzyme-inducing agents such as phenytoin or phenobarbital may increase the plasma levels of drugs such as lamotrigine 30 or topiramate. 31 This might partially compensate for the antiepileptic effects of the drug being withdrawn, however, it could also cause side effects from the remaining drugs. Conversely, stopping valproate in a patient taking lamotrigine could result in sub-optimal lamotrigine levels.…”

Section: Controlled On Polytherapymentioning

confidence: 99%

Monotherapy versus Polytherapy in Epilepsy: a Framework for Patient Management

1998

Can. J. Neurol. Sci.

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ABSTRACT:The long-standing debate between proponents of monotherapy and those of polytherapy for treatment of epilepsy has been rekindled by the recent development of several new antiepileptic drugs. The likelihood of improved seizure control on polytherapy must be weighed against the risk of increased side effects, complex drug interactions and cost. Providing maximal seizure control while avoiding overtreatment is a challenge which requires an ongoing critical evaluation of each patient's management. This review provides a framework for decision-making by considering issues affecting the choice between monotherapy and polytherapy in five clinical situations: 1) newly diagnosed epilepsy; 2) seizures on monotherapy; 3) seizures controlled on polytherapy; 4) not controlled on polytherapy; 5) change in medical condition. RESUME: La monotherapie versus la polytherapie dans Pepilepsie: un cadre pour le traitement des patients. Le vieux debat entre les promoteurs de la monotherapie et ceux de la polytherapie dans le traitement de Pepilepsie a ete repris a cause du developpement recent de plusieurs nouveaux medicaments antiepileptiques. La probability d'un meilleur controle des crises par une polytherapie doit etre evaluee par rapport au risque d'effets secondaires plus importants, d'interactions medicamenteuses complexes et du cout de la medication. C'est un d6fi que d'arriver a un controle maximal des crises tout en evitant de surtraiter, ce qui demande une evaluation critique constante du traitement de chaque patient. Cette revue fournit un cadre pour la prise de decision en considerant les raisons qui influencent le choix entre la monotherapie et la polytherapie dans cinq situations cliniques: 1) un nouveau diagnostic d'epilepsie; 2) des crises sous monotherapie; 3) un controle des crises sous polytherapie; 4) une absence de controle sous polytherapie; 5) un changement dans l'etat medical du patient.Can. J. Neurol. Sci. 1998; 25: S9-S13

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Pharmacokinetics and Interaction Profile of Topiramate: Review and Comparison with Other Newer Antiepileptic Drugs

Cited by 68 publications

References 25 publications

Topiramate Rapidly Raises Brain GABA in Epilepsy Patients

Topiramate Rapidly Raises Brain GABA in Epilepsy Patients

Topiramate

Monotherapy versus Polytherapy in Epilepsy: a Framework for Patient Management

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