![]() ![]() Topamax/Topiramate Users? Here's my story - what's yours? I just started topamax 25 mg at night for weight loss a week ago today and I've lost 6lbs. Topamax (Topiramate) - Reviews, Ratings, Comments by. Valium, Xanax, Clozapam.all with little or no success.
Topamax: Weight Loss Plus . It is strange that one of the very few psychotropics to cause weight loss is closely related to sugar, but there you have it. It is only approved as adjunctive therapy for seizure treatment by the FDA. Like many of the newer generation of putative mood stabilizers, Topamax enhances the activity of the neurotransmitter GABA, and monkeys around with sodium channels in the neurons, limiting repetitive firing. Topamax is approved to treat epilepsy and prevent migraines. A: According to the Topamax package insert, weight loss is one of the drug's most common side effects. However, weight gain is also a side effect of Topamax. I'm taking Topamax and Phentermine to approximate Qnexa, the weight loss drug. But Topamax is not a weight loss. Learn about Qsymia, an FDA-approved weight-loss prescription medicine that may help some patients lose weight and keep it off. But authorities are quick to admit that we haven’t a clue as to how Topamax actually works. Before wading into the muddy waters of whether Topamax is effective for bipolar disorder, let’s look at one thing that everybody can agree on: Topamax causes weight loss. Both the more extensive epilepsy literature and the recent psychiatric studies consistently report average weight losses from 5 to 1. In the bipolar disorder studies, significant weight loss occurred pretty quickly, often within 5 to 1. In this sense, Topamax is a definite crowd- pleaser for our patients, whether it helps to stabilize their mood or not. In terms of efficacy, TCR. All of the published studies have been open- label, either retrospective chart reviews or prospective open- label trials. While TCR often slams drugs that have no better quality of evidence than this, we have to admit that there is an impressive number of published trials, and that the results are pretty consistently positive for Topamax (1). The typical result is that Topamax add- on results in improvement in 5. These trials are usually pretty short, in the range of 4 to 1. One longer term study is worth describing, because it was done well and it provides some potential clinical guidelines for our use of Topamax. Susan Mc. Elroy and her colleagues at the University of Cinncinatti devised a study to see whether adding Topamax to the existing regimens of bipolar patients would make any difference (2). All of the 5. 6 subjects had failed prior mood stabilizer trials. Topamax was added gingerly to their regimens, starting with 2. ![]() QD and was increased by 2. These patients were then regularly assessed with standard rating scales, and the mean duration of treatment was about 7 months; the average final dose of Topamax was 2. QD. The results were fairly dramatic, in that adjunctive Topamax worked great for the 6. One irksome finding, however, was that there was a 5. Most of these patients did not drop out because of side effects but rather because they weren’t getting better quickly enough. As any clinician knows who works with the bipolar population, long- term stick- to- it- iveness with a given medication is not a cardinal feature: the disease simply causes too much suffering to allow for patience. The bottom- line from the Mc. Elroy study: use Topamax as add- on for your bipolar patients when they have some manic component to their presentation; it’s unlikely to be helpful when they are depressed. A nice chart review published by Marcotte and colleagues reviewed the results of adding Topamax to the regimens of 5. ![]() Topamax was started at 2. BID, and was increased by 5. BID. The response was good, with 6. Interestingly, most responders noted improvement within 3 days of starting the medication, although other studies have reported longer kick- in periods. Thus, Topamax appears to deserve a niche in our armamentarium, especially for treatment- refractory patients. What are its problems? Its biggest ones have earned it the nickname “Dopamax: ”side effects of cognitive slowing and sedation. The PDR lists rates of psychomotor slowing, memory loss, and confusion as 1. Anecdotally, real world office practice figures are probably higher than these. The “Dopamax” effects tend to be dose- related, so titrate slowly, and be prepared to stop at the first sign of a response. Most clinicians shoot for a dose range of 1. QD to maximize response while minimizing side effects. An odd side effect of Topamax is the development of kidney stones in 1- 2% of patients taking it, which is about 3 times higher than the rate in the general population. This is apparently caused by the fact that Topamax is a weak carbonic anhydrase inhibitor. Also, Topamax is a weak 3. A4 inducer, and can decrease the levels of oral contraceptives dangerously. As a final note, these days, you can’t really discuss Topamax without mentioning Zonegram (zonisamide). This is because Zonegram, like Topamax, is a novel anticonvulsant with some data for efficacy in bipolar disorder (3) and which is great for weight loss. A recent JAMA study of obese, psychiatrically healthy, patients documented a whopping average weight loss of 2. Zonegram after 8 months, vs. Like Topamax, Zonegram can cause fatigue, cognitive impairment, and kidney stones. Unlike Topamax, however, Zonegram is a sulfa, so be wary of using it in patients with sulfa allergies. TCR VERDICT: When you need to addon, think Topamax. ![]() ![]() How Does Topamax Work For Weight LossReferences. 1. Mc. Elroy SL, Suppes T, Keck PE, et. ![]() Open- label adjunctive topiramate in the treatment of bipolar disorders. Use of topiramate, a new anti- epileptic as a mood stabilizer. Kanba S, Yagi G, Kamijima K. The first open study of zonisamide, a novel anticonvulsant, shows efficacy in mania. Prog Neuropsychopharmacol Biol Psychiatry. Gadde KM, Franciscy DM, Wagner HR II, et al. Zonisamide for weight loss in obese adults. Related. This article originally appeared in: This article was published in print 9/2. Volume: Issue 1: 9.
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