Topamax

Adult Dosing .

Dosage forms:  SPRINKLE CAP: 15 mg, 25 mg; TAB: 25 mg, 50 mg, 100 mg, 200 mg

partial seizures

[monotherapy]

Dose: 200 mg PO bid; Start: 25 mg PO bid x1wk, incr. by 50 mg/day qwk until 100 mg PO bid, then incr. by 100 mg/day qwk; Info: taper dose gradually to D/C

[adjunct tx]

Dose: 100-200 mg PO bid; Start: 25 mg PO qd-bid x1wk, incr. by 25-50 mg/day qwk; Info: doses >400 mg/day rarely more effective, may incr. ADR risk; taper dose gradually to D/C

seizures, primary generalized tonic clonic

[monotherapy]

Dose: 200 mg PO bid; Start: 25 mg PO bid x1wk, incr. by 50 mg/day qwk until 100 mg PO bid, then incr. by 100 mg/day qwk; Info: taper dose gradually to D/C

[adjunct tx]

Dose: 200 mg PO bid; Start: 25 mg PO qd-bid x1wk, incr. by 25-50 mg/day qwk; Info: taper dose gradually to D/C

seizures, Lennox-Gastaut syndrome

[adjunct tx]

Dose: 100-200 mg PO bid; Start: 25 mg PO qd-bid x1wk, incr. by 25-50 mg/day qwk; Info: taper dose gradually to D/C

migraine prophylaxis

[50 mg PO bid]

Start: 25 mg PO qhs x1wk, incr. by 25 mg/day qwk; Max: 200 mg/day; Info: taper dose gradually to D/C

sleep-related eating disorder (off-label)

[25-150 mg PO qhs]

Start: 25 mg PO qhs x1wk, then may incr. by 25 mg/day qwk; Info: taper dose gradually to D/C

alcohol dependence (off-label)

[200-300 mg/day PO divided bid]

Start: 25 mg PO qd x1wk, then incr. by 25-50 mg/day qwk; Info: taper dose gradually to D/C

essential tremor (off-label)

[150-300 mg/day PO divided qd-bid]

Start: 25-50 mg PO qhs x1-2wk, incr. by 25 mg/day q1-2wk; Max: 400 mg/day; Info: taper dose gradually to D/C

binge eating disorder (off-label)

[100-150 mg PO bid]

Start: 25 mg PO qd x1wk, incr. by up to 25-100 mg/day qwk; Max: 400 mg/day; Info: taper dose gradually to D/C

cyclic vomiting syndrome prophylaxis, moderate-severe (off-label)

[50 mg PO bid]

Start: 25 mg PO qd, incr. by 25 mg/day qwk; Info: taper dose gradually to D/C

renal dosing

[adjust dose amount]

CrCl <70: decr. usual dose by 50%

HD: decr. usual dose, amount not defined, on dialysis days admin. after dialysis; consider supplement if next maint. dose not due right after dialysis; PD: not defined

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised

Peds Dosing .

Dosage forms:  SPRINKLE CAP: 15 mg, 25 mg; TAB: 25 mg, 50 mg, 100 mg, 200 mg

partial seizures

[monotherapy, 2-9 yo, <11 kg]

Dose: 75-125 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 250 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, 12-22 kg]

Dose: 100-150 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 300 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, 23-31 kg]

Dose: 100-175 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 350 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, 32-38 kg]

Dose: 125-175 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 350 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, >39 kg]

Dose: 125-200 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 400 mg/day; Info: taper dose gradually to D/C

[monotherapy, 10 yo and older]

Dose: 200 mg PO bid; Start: 25 mg PO bid x1wk, incr. by 50 mg/day qwk until 100 mg PO bid, then incr. by 100 mg/day qwk; Info: taper dose gradually to D/C

[adjunct tx, 2-16 yo]

Dose: 5-9 mg/kg/day PO divided bid; Start: 1-3 mg/kg/dose up to 25 mg PO qhs x1wk, incr. by 1-3 mg/kg/day q1-2wk; Max: 400 mg/day; Info: taper dose gradually to D/C

seizures, primary generalized tonic clonic

[monotherapy, 2-9 yo, <11 kg]

Dose: 75-125 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 250 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, 12-22 kg]

Dose: 100-150 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 300 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, 23-31 kg]

Dose: 100-175 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 350 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, 32-38 kg]

Dose: 125-175 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 350 mg/day; Info: taper dose gradually to D/C

[monotherapy, 2-9 yo, >39 kg]

Dose: 125-200 mg PO bid; Start: 25 mg PO qhs x1wk, then 25 mg PO bid x1wk, then incr. by 25-50 mg/day qwk; Max: 400 mg/day; Info: taper dose gradually to D/C

[monotherapy, 10 yo and older]

Dose: 200 mg PO bid; Start: 25 mg PO bid x1wk, incr. by 50 mg/day qwk until 100 mg PO bid, then incr. by 100 mg/day qwk; Info: taper dose gradually to D/C

[adjunct tx, 2-16 yo]

Dose: 5-9 mg/kg/day PO divided bid; Start: 1-3 mg/kg/dose up to 25 mg PO qhs x1wk, incr. by 1-3 mg/kg/day q1-2wk; Max: 400 mg/day; Info: taper dose gradually to D/C

seizures, Lennox-Gastaut syndrome

[adjunct tx, 2 yo and older]

Dose: 5-9 mg/kg/day PO divided bid; Start: 1-3 mg/kg/dose up to 25 mg PO qhs x1wk, incr. by 1-3 mg/kg/day q1-2wk; Max: 400 mg/day; Info: taper dose gradually to D/C

migraine prophylaxis

[12 yo and older]

Dose: 50 mg PO bid; Start: 25 mg PO qhs x1wk, incr. by 25 mg/day qwk; Max: 200 mg/day; Info: taper dose gradually to D/C

renal dosing

[adjust dose amount]

CrCl <70: decr. usual dose by 50%

HD: decr. usual dose, amount not defined, on dialysis days admin. after dialysis; consider supplement if next maint. dose not due right after dialysis; PD: not defined

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised