Topiramate

Alcohol use is contraindicated within 6 hours prior to and 6 hours after TROKENDI XR administration due to CNS depression risk.

Metformin is contraindicated with topiramate due to risk of metabolic acidosis.

Concurrent use as carbonic anhydrase inhibitor may increase severity of metabolic acidosis and increase risk of kidney stone formation.

Carbonic anhydrase inhibitor that may increase risk of lactic acidosis by decreasing serum bicarbonate and inducing metabolic acidosis.

Some patients may experience a large increase in amitriptyline concentration; dose adjustments should be based on clinical response rather than plasma levels.

Concomitant administration results in clinically significant decrease in plasma concentrations of topiramate. Dosage adjustment may be needed.

Decreases serum bicarbonate and induces metabolic acidosis; concomitant use may increase risk for lactic acidosis.

Concomitant use can result in hyperammonemia and encephalopathy.

Topiramate causes decreased serum bicarbonate and metabolic acidosis; concomitant use may increase risk of lactic acidosis.

Topiramate causes decreased serum bicarbonate and metabolic acidosis; concomitant use with TRIJARDY XR may increase risk of lactic acidosis.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and may increase risk of lactic acidosis when used with SYNJARDY or SYNJARDY XR.

Increases risk of lactic acidosis due to decreased serum bicarbonate and metabolic acidosis when used with metformin.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and may increase risk for lactic acidosis when used with glyburide and metformin hydrochloride.

Increases metabolism of contraceptive steroids, reducing contraceptive effectiveness and potentially resulting in unintended pregnancy or unscheduled bleeding.

Carbonic anhydrase inhibitors like topiramate decrease serum bicarbonate and induce metabolic acidosis, increasing risk of lactic acidosis when combined with linagliptin and metformin.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and may increase risk of lactic acidosis with metformin.

Carbonic anhydrase inhibitor that may increase risk of lactic acidosis by decreasing serum bicarbonate and inducing metabolic acidosis.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and may increase risk for lactic acidosis when used with metformin.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and may increase risk for lactic acidosis when used with metformin.

May reduce contraceptive effectiveness and result in unintended pregnancy or breakthrough bleeding by increasing metabolism of contraceptive steroids.

May decrease contraceptive effectiveness and increase breakthrough bleeding through CYP3A4 induction.

May decrease plasma concentrations of COCs and potentially diminish effectiveness or increase breakthrough bleeding.

Decreased contraceptive efficacy and increased breakthrough bleeding, especially at doses greater than 200 mg/day. Ethinyl estradiol exposure decreased 18-30% at topiramate doses of 200-800 mg/day.

Concomitant administration results in clinically significant decrease in plasma concentrations of topiramate. Dosage adjustment may be needed.

Carbonic anhydrase inhibitor decreases serum bicarbonate and increases lactic acidosis risk with metformin. Requires more frequent monitoring.

Carbonic anhydrase inhibitor causing metabolic acidosis. Concomitant use may increase risk of metformin-associated lactic acidosis.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and induces metabolic acidosis, increasing risk for lactic acidosis when used with JANUMET.

Concomitant use of topiramate and valproate may result in hyperammonemia and encephalopathy.

Associated with hypothermia and hyperammonemia with and without encephalopathy; monitor blood ammonia levels.

Concurrent use as carbonic anhydrase inhibitor may increase severity of metabolic acidosis and increase risk of kidney stone formation.

Decreases pioglitazone and active metabolite exposure. Monitor patients for adequate glycemic control when used concomitantly.

Weak CYP3A4 inducer resulting in decreased atogepant exposure; dosage adjustment may be needed with monitoring for reduced efficacy.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and may increase risk for lactic acidosis when used with INVOKAMET. Consider more frequent monitoring.

Should be used with extreme caution due to potential CNS depression and cognitive/neuropsychiatric adverse reactions.

Decreased contraceptive efficacy and increased breakthrough bleeding, especially at doses greater than 200 mg/day. Efficacy can be decreased even without breakthrough bleeding.

Induces CYP3A4 and may decrease plasma concentrations of desogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness and increasing breakthrough bleeding.

Induces CYP3A4 enzyme, may decrease effectiveness of COCs or increase breakthrough bleeding.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

Enzyme inducer that may decrease effectiveness of COCs or increase breakthrough bleeding. Use back-up contraception.

CYP3A4 enzyme inducer that may decrease the effectiveness of the contraceptive or increase breakthrough bleeding.

Decreased contraceptive efficacy and increased breakthrough bleeding, especially at doses greater than 200 mg/day.

Topiramate decreases ethinyl estradiol exposure by 18-30% depending on dose, reducing contraceptive efficacy and increasing breakthrough bleeding.

May decrease plasma concentrations of etonogestrel and diminish contraceptive effectiveness or increase breakthrough bleeding.

CYP3A4 enzyme inducer that may decrease plasma concentrations of etonogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

Induces CYP3A4, may decrease plasma concentrations of CHCs and potentially diminish effectiveness or increase breakthrough bleeding.

May increase phenytoin serum levels; monitoring of phenytoin levels recommended.

Decreases glyburide Cmax by 22% and AUC by 25%; monitor for loss of glycemic control.

Carbonic anhydrase inhibitor that decreases serum bicarbonate and may increase risk for lactic acidosis with glyburide-metformin.

Topiramate Cmax and AUC increased; may require decrease in topiramate dose.

Topiramate decreases lamotrigine concentration by 13% at doses up to 400 mg/day.

Topiramate induces CYP3A4 and may decrease plasma concentrations of COCs, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

Topiramate induces CYP3A4 enzymes, potentially decreasing contraceptive effectiveness and increasing breakthrough bleeding.

Monitor lithium levels when used with high-dose topiramate.

Monitor patient for appearance or worsening of metabolic acidosis when co-administered with other carbonic anhydrase inhibitors.

May decrease effectiveness of medroxyprogesterone acetate through enzyme induction. Counsel use of back-up or alternative contraception.

Enzyme inducer that may decrease plasma concentrations of CHCs and potentially diminish effectiveness or increase breakthrough bleeding.

CYP3A4 inducer that may decrease the effectiveness of COCs or increase breakthrough bleeding.

Enzyme inducer that may decrease plasma concentrations of norethindrone and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

May decrease plasma concentrations and efficacy of contraceptive; may increase breakthrough bleeding.

Topiramate may increase amitriptyline concentration; amitriptyline dose adjustments should be made based on clinical response rather than plasma levels.

In the presence of topiramate, phentermine Cmax and AUC increase by 13% and 42% respectively.

May increase phenytoin serum levels; monitoring of phenytoin levels recommended.

Decrease in exposure of pioglitazone and its active metabolites; careful monitoring recommended.

Decreases pioglitazone and active metabolite exposure. Monitor patients for adequate glycemic control when used concomitantly.

May decrease exposure of pioglitazone and its active metabolites. Monitor patients for adequate glycemic control when used concomitantly.

Metabolic enzyme inducer that may decrease systemic concentrations of estrogen and/or progestin, potentially diminishing contraceptive effectiveness.

CYP3A4 inducer decreases plasma concentrations of ulipristal acetate and may decrease its effectiveness as emergency contraception.

Steady-state plasma concentrations of topiramate were not affected by concomitant lacosamide at any dose in clinical studies.

Levetiracetam had no effect on topiramate plasma concentrations in pediatric patients.

No significant pharmacokinetic interaction between rufinamide and topiramate.

7.6 Other Carbonic Anhydrase Inhibitors Concomitant use of topiramate, a carbonic anhydrase inhibitor, with any other carbonic anhydrase inhibitor (e.g., zonisamide, acetazolamide, or dichlorphenamide) may increase the severity of metabolic acidosis and may also increase the risk of kidney stone formation.

Potential interaction with topiramate as a standard antiepileptic drug; specific effect not evaluated.

Potential interaction with topiramate as a standard antiepileptic drug; specific effect not evaluated.