Posted by Mitch on July 29, 2001, at 14:24:06
In reply to Re: Topamax: Something New, posted by Elzabeth on July 29, 2001, at 0:31:22
> Dear Ones ~ thank you and bless you for writing. It means a great deal, and I hope to find relief from Topamax, although lately, I've been so depressed, I'm wondering if I don't need more picking up on the bottom end (in addition to assistance with that top-end stress). This weekend was my 30th high school reunion. Ugh. I survived. Guess I won't need to do THAT again for another 30 years .... Anyhow, I delayed starting this new Rx so I could have a well-needed drink .... Plan to start my trial in the a.m. My dose starts at 25 mg/twice daily for a week. Then it increases to 100 mg daily for a week, and finally 200 mg. daily (therapeutic range?) I'll let you know how it goes. I especially appreciate the input I've received on cognitive effects, as I can't bare to have my mental powers diminished any greater than what I suffer already -- pushing 50. Good Lord. We all need the best intellectual grasp we can find, to assist this often arduous task of living with depression. Thank you all again for writing. By the way, I'm still a bit unfamiliar with how to post things here .... Here's hoping this works. XXX, E.
Elzabeth,
I found an article on medscape that recommends very slow dose increase with Topamax and from I read that has been incorporated into the PDR insert. Here is a snippet from that article:
.....Since the publication of the article entitled, "Treatment of Epilepsy in the New Millennium," several important dosing titration schedule changes have been recommended. Clinicians should be alerted to these dosing changes in order to treat patients with epilepsy optimally and safely.
As previously noted topiramate has been associated with cognitive and behavioral symptoms, along with other neurotoxicities, during titration and with high dosages. For this reason, the manufacturer (Ortho McNeil Pharmaceutical, Inc.) recommended a new titration schedule, which is now part of the prescribing information. Therapy should be started at 25-50 mg/day and titrated to an effective dosage in increments of 25-50 mg/week. Starting at lower dosages may make a substantial difference in some patients with regard to neurotoxicity. In children, titration should begin at 0.5 mg/kg/day instead of 1 mg/kg/day and increased by this same amount (0.5 mg/kg/day) at weekly intervals. More rapid titration does not produce life-threatening side effects, but it rather significantly increases the potential for neurotoxic side effects in some patients. Improved tolerability with slower titration was demonstrated in a long-term treatment protocol.
poster:Mitch
thread:71988
URL: http://www.dr-bob.org/babble/20010725/msgs/72376.html