Topiramate--preventive treatment for migraine headache symptoms


Topamax (topiramate)  100-200 mg per day are indicated for migraine.  This drug originally had an indication for treatment of epilepsy but Topamax was approved in the Fall of 2004 for preventive treatment of migraine also. It is one of the secondary drugs that may be used for treatment of benign essential or familial tremor.  It is also used for treatment of bipolar disorder. The dose is 25 mg a night for a week and then increasing the dose to 25 mg twice a day for the second week.  The third week dose is 25 mg in the morning and two 25 mg tabs at night.  The fourth week the patient should switch to 50 mg twice a day.  The patient should then stay on this dose for several months to judge the effect on migraine reduction.  A large European study couldn’t confirm topiramate risk for causing kidney stones but it is still on the PI (product information) note from the FDA.

Side effects: psychomotor slowing, somnolence, word finding difficulty, numbness, weight loss, insomnia, anxiety, decreased sweating and hyperthermia, secondary angle closure glaucoma, kidney stones-especially in men, and metabolic acidosis. 

The mean plasma half life of Topamax is 21 hours and it should be taken twice a day or every 12 hours.  For migraine-common doses are 100-200 mg a day.  For treatment of benign essential tremor-doses between 50-100 mg may be used.

Trokendia XR or Qudexy XR (topiramate long lasting).  These are a once a day new drugs with a no co-pay card so that patients with insurance pay nothing.  Regular topiramate taken every 12 hours goes above and below the treating drug levels so there are more side effects of treatment, but Trokendia XR and Qudexy XR stay within the middle of the drug level.  They can be started just like topiramate above, tapering up from 25 mg/week 1 by 25 mg once a day till 100 mg is reached at week 4.  In general, Trokendia XR and Qudexy XR are better tolerated with fewer side effects.  They come in ER doses of 25, 50, 100, and 200 mg.  Qudexy also has a 150 mg size pill.  Current FDA indications are for epilepsy and migraine.