Am J Kidney Dis

Topiramate and zonisamide linked to increased kidney stone risk in large cohort study

June 27, 2025

Clinicians should be aware of the heightened nephrolithiasis risk when prescribing topiramate or zonisamide, particularly in patients with other stone risk factors. Consideration of alternative therapies or preventive strategies (e.g., hydration, citrate supplementation) may be warranted in high-risk individuals.

Study details: This retrospective cohort study analyzed data from two large U.S. administrative databases—Clinformatics Data Mart (CDM) and Medicare—to assess the association between topiramate or zonisamide use and symptomatic kidney stone events. Adults initiating either drug were compared to matched nonusers, with follow-up for ED visits, hospitalizations, or surgeries related to nephrolithiasis.

Results: Use of topiramate or zonisamide was significantly associated with increased risk of symptomatic kidney stones. In the CDM cohort, the adjusted hazard ratio (HR) was 1.58 (95% CI, 1.49–1.68), and in the Medicare cohort, HR was 1.22 (95% CI, 1.11–1.34). Risk was elevated across indications, including migraine and seizure disorders.

Source:

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