Am J Kidney Dis

Topiramate and zonisamide linked to increased kidney stone risk

March 26, 2025

Study details: This retrospective cohort study analyzed data from Optum's de-identified Clinformatics Data Mart Database (CDM) and Medicare enrollees. The study included 1,122,301 participants with 187,032 users of topiramate or zonisamide between 2011 and 2019. The primary outcome was symptomatic stone events, defined as emergency department visits, hospitalizations, or surgeries for kidney stones.

Results: The unadjusted cumulative incidence of symptomatic stone events was higher in users (2.9% and 2.0% in the CDM and Medicare cohorts, respectively) compared with nonusers (1.2% and 1.3%, respectively; P<0.001). After adjusting for confounders, topiramate and zonisamide users had significantly higher hazard ratios (HR) of experiencing symptomatic stone events (HR 1.58, 95% confidence interval [CI] 1.49-1.68 for CDM; HR 1.22, 95% CI 1.11-1.34 for Medicare). Younger adults and higher doses of topiramate were associated with a stronger risk.

Clinical impact: Clinicians should carefully weigh the risks and benefits of prescribing topiramate or zonisamide, particularly in younger adults and at higher doses, due to the increased risk of symptomatic kidney stones.

Source:

Salka BR, et al. (2025, February 27). Am J Kidney Dis. Associations of Topiramate and Zonisamide Use With Kidney Stones: A Retrospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/40023213/