Pitomate Special Precautions

Do not discontinue abruptly. For seizure disorders, the daily dosage should be decreased in weekly intervals by 50-100 mg in adults and over a 2-8 week period in pediatric patients. For migraine prophylaxis, the daily dosage should be decreased in weekly intervals by 25-50 mg.
Use with caution in patients with renal impairment, hepatic impairment; clearance may be reduced. Dosage adjustment may be required.
Topiramate exhibits weak carbonic anhydrase inhibitory properties and may increase the risk of renal calculus. Oligohidrosis (decreased sweating) and anhidrosis have been reported in association with the use of Topiramate. Decreased sweating and hyperthermia (rise in body temperature) may occur especially in young children exposed to high ambient temperatures. Adequate hydration while using topiramate is very important. Hydration can reduce the risk of developing nephrolithiasis, especially in predisposed patients. Proper hydration prior to and during activities such as exercise or exposure to warm temperature may reduce the risk of heat-related adverse events.
Patients should be monitored for signs/symptoms of depression, suicide tendencies and other unusual behavior changes.
Topiramate has been associated with acute myopia and secondary angle closure glaucoma in adults and children, typically within 1 month of initiation; discontinue in patients with acute onset of decreased visual acuity and/or ocular pain.
Topiramate may be associated with hyperchloremic nonanion gap metabolic acidosis due to inhibition of carbonic anhydrase and increased renal bicarbonate loss. Metabolic acidosis may occur at dosage as low as 50 mg/day. Monitor serum bicarbonate as well as potential complications of chronic acidosis. Consider dose reduction or discontinuation (by tapering dose) in patients with persistent or severe metabolic acidosis. If treatment is continued, consider alkali supplementation.
Topiramate may be associated with hyperammonemia with or without encephalopathy. The risk for hyperammonemia with Topiramate appears dose-related. In patients who develop unexplained lethargy, or changes in mental status, it is recommended to consider hyperammonemic encephalopathy and measuring ammonia levels.
A dietary supplement or increased food intake may be considered if the patient is losing weight while on this medication.