Treatment Guidelines

1. Topiramate is primarily excreted unchanged in urine and has no effect on liver enzymes.

2. The starting dose is 25-50 mg/day, increasing at increments of 25-50 mg per week to a target dose of 200-400 mg/day, given in single dose or bid.

3. Plasma levels of topiramate can be reduced up to 50% when combined with carbamazepine and to a lesser degree with valproate. Topiramate can reduce clearance of phenytoin and impair the efficacy of oral contraceptives.

4. Therapeutic effects are seen in 2-4 weeks.

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