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Re: Kramer: Topiramate and glaucoma

Posted by Dr. Kramer on April 2, 2002, at 12:47:39

In reply to Kramer: Topiramate and glaucoma, posted by Elayne on April 2, 2002, at 7:04:10

> Dr. Kramer,
> Have you changed the way you use topiramate since its association with cases of acute glaucoma came to light?
>
> What do you think is the underlying mechanism that is responsible for this association?
>
> Thanks so much for your help.

Not really. I explain all the risks to a patient, obviously, but it's still pretty rare, and usually resolves with rapid discontinuation of the med, so if the patient or their caregiver knows to look for it, you're usually okay.

I have no idea what the mechanism is. Best guess I could make is that the fact that it's a carbonic anhydrase inhibitor, might make it cause a slight precipitate in the ocular fluid, kind of like mini kidney stones in the eye, but I don't have any data for that, i.e., I made it up.


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