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Related Experiment Videos

Topiramate titration and tolerability.

V Biton1, K R Edwards, G D Montouris

  • 1Arkansas Epilepsy Program, Little Rock 72205, USA. aeprog@swbell.net

The Annals of Pharmacotherapy
|February 24, 2001
PubMed
Summary
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A gradual initiation of topiramate therapy, using a 50/50 titration schedule, significantly improved tolerability for partial-onset seizures compared to a faster 100/200 schedule. This enhanced tolerability did not compromise seizure reduction efficacy.

Area of Science:

  • Neurology
  • Clinical Pharmacology

Background:

  • Topiramate is an established adjunctive therapy for partial-onset seizures.
  • Titration rate can influence treatment tolerability and adherence.

Purpose of the Study:

  • To compare the tolerability and efficacy of two topiramate titration rates in adults with partial-onset seizures.
  • To evaluate the impact of titration speed on treatment-emergent adverse events and therapeutic response.

Main Methods:

  • A multicenter, double-blind trial randomized 188 patients to either a 50/50 mg/d weekly increment or a 100/200 mg/d weekly increment schedule.
  • Patients were followed after a two-week baseline phase, with maximum dosage achieved in three or eight weeks.

Main Results:

  • The 50/50 titration schedule significantly reduced adverse events leading to therapy changes (p=0.048) and treatment interruptions/withdrawals (p=0.040).

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  • Central nervous system effects were the most common adverse events.
  • Therapeutic response, including median seizure reduction (42% vs. 33%) and proportion of patients with 50% seizure reduction (42% vs. 38%), was comparable between groups.

    • Conclusions:

    • Gradual topiramate initiation enhances patient tolerability.
    • Slower titration does not delay the therapeutic benefits of topiramate for seizure control.