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Narrative Review of Topiramate: Clinical Uses and Pharmacological Considerations

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Abstract

Due to the diverse mechanisms of action of antiseizure drugs, there has been a rise in prescriptions of these drugs for non-epileptic pathologies. One drug that is now being used for a variety of conditions is topiramate. This is a narrative review that used PubMed, Google Scholar, MEDLINE, and ScienceDirect to review literature on the clinical and pharmacologic properties of topiramate. Topiramate is a commonly prescribed second-generation antiseizure drug. The drug works through multiple pathways to prevent seizures. In this regard, topiramate blocks sodium and calcium voltage-gated channels, inhibits glutamate receptors, enhances gamma-aminobutyric acid (GABA) receptors, and inhibits carbonic anhydrase. Topiramate is approved by the Food and Drug Administration (FDA) for epilepsy treatment and migraine prophylaxis. Topiramate in combination with phentermine is also FDA-approved for weight loss in patients with a body mass index (BMI) > 30. The current target dosing for topiramate monotherapy is 400 mg/day and 100 mg/day to treat epilepsy and migraines, respectively. Commonly reported side effects include paresthesia, confusion, fatigue, dizziness, and change in taste. More uncommon and serious adverse effects can include acute glaucoma, metabolic acidosis, nephrolithiasis, hepatotoxicity, and teratogenicity. Related to a broad side effect profile, physicians prescribing this drug should routinely monitor for side effects and/or toxicity. The present investigation reviews various anti-seizure medications before summarizing indications of topiramate, off-label uses, pharmacodynamics, pharmacokinetics, adverse effects, and drug-drug interactions.

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article.

Medical Writing and Editorial Assistance

The authors did not receive any medical writing or editorial assistance for this article.

Author Contributions

Study concept and design: Nathan Z. Pearl, Caroline P. Babin, Nicole T. Catalano, James C. Blake, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye. Analysis and interpretation of data: Nathan Z. Pearl, Caroline P. Babin, Nicole T. Catalano, James C. Blake, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye. Drafting of the manuscript: Nathan Z. Pearl, Caroline P. Babin, Nicole T. Catalano, James C. Blake, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye. critical revision of the manuscript for important intellectual content: Nathan Z. Pearl, Caroline P. Babin, Nicole T. Catalano, James C. Blake, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye. statistical analysis: Nathan Z. Pearl, Caroline P. Babin, Nicole T. Catalano, James C. Blake, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye.

Disclosures

Nathan Z. Pearl has nothing to disclose. Caroline P. Babin has nothing to disclose. Nicole T. Catalano has nothing to disclose. James C. Blake has nothing to disclose. Shahab Ahmadzadeh has nothing to disclose. Sahar Shekoohi has nothing to disclose. Alan D. Kaye has nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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Authors and Affiliations

  1. School of Medicine, LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA, 70112, USA

    Nathan Z. Pearl, Caroline P. Babin, Nicole T. Catalano & James C. Blake

  2. Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Shahab Ahmadzadeh, Sahar Shekoohi & Alan D. Kaye

  3. Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Alan D. Kaye

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Correspondence to Sahar Shekoohi.

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Pearl, N.Z., Babin, C.P., Catalano, N.T. et al. Narrative Review of Topiramate: Clinical Uses and Pharmacological Considerations. Adv Ther 40, 3626–3638 (2023). https://doi.org/10.1007/s12325-023-02586-y

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