Pitomate Dosage/Direction for Use

Administer without regard to meals. It is not recommended to crush, break or chew the tablets. Do not abruptly discontinue therapy; taper dosage gradually to prevent rebound effects.
Dosage in adult patients: Epilepsy, monotherapy in Partial-onset seizure and primary generalized tonic-clonic seizure: Usual dosage: 400 mg/day in 2 divided doses.
Initiate 25 mg daily (in the evening) or 25 mg twice daily in the first week, may increase weekly by 50 mg daily up to 100 mg twice daily in the forth week of therapy. The further dosage titration may increase weekly by 100 mg daily up to the recommended 200 mg twice daily.
Epilepsy, adjunctive therapy in Partial-onset seizure, primary generalized tonic-clonic seizure or Lennox-Gastaut syndrome: The usual maintenance dose of Topiramate is 100-200 mg twice daily. The dosage is generally not exceeded 400 mg daily.
Initiate 25 mg once or twice daily for 1 week, may increase weekly by 25 mg daily up to 50 mg daily until response.
Migraine prophylaxis: Initiate 25 mg once daily (in evening); may increase weekly by 25 mg daily up to the recommended dose of 100 mg daily given in 2 divided doses. Increased intervals between dose adjustments may be considered. Doses more than 100 mg per day have shown no additional benefit.
Dosage in pediatric patients: Epilepsy, monotherapy in Partial-onset seizure and primary generalized tonic-clonic seizure: Children 2 to <10 years: Initiate 25 mg once daily (in evening); may increase to 25 mg twice daily in week 2; thereafter, may increase by 25 to 50 mg daily at weekly intervals over 5 to 7 weeks up to the minimum recommended maintenance dose (as stated in the table as follows) and further increase by 25 to 50 mg daily at weekly intervals up to following maximum recommended maintenance dose if the additional seizure control is needed or the therapy is tolerated. (See Table 2.)

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Children ≥10 years and Adolescents: Refer to adult dosing.
Epilepsy, adjunctive therapy in Partial-onset seizure, primary generalized tonic-clonic seizure, or Lennox-Gastaut syndrome: Children 2 to Adolescents <17 years: Initiate 25 mg once daily (based on a range of 1 to 3 mg/kg/day, in evening) for 1 week; may increase every 1 to 2 weeks in increments of 1 to 3 mg/kg/day up to the recommended dose of 5 to 9 mg/kg in two divided doses.
Adolescents >17 years: Refer to adult dosing.
Migraine prophylaxis: Adolescents >12 years: Refer to adult dosing.
Dosage in geriatric patients: Most older adults have creatinine clearances <70 mL/minute/1.73 m²; obtain a serum creatinine and calculate creatinine clearance prior to initiation of therapy. An initial dose of 25 mg/day may be recommended, followed by incremental increases of 25 mg at weekly intervals until an effective dose is reached; refer to adult dosing for titration schedule.
Dosage in hepatic impairment: Use with caution. The clearance of Topiramate may be reduced.
Dosage in renal impairment: CrCl <70 mL/minute/1.73 m²: Administer 50% dose and titrate more slowly. In the patients with hemodialysis, supplemental dose may be needed during hemodialysis.