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$Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain$

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Intractable epistaxis associated with topiramate administration.

Robert L Page¹, Jacquelyn L Bainbridge

¹Department of Clinical Pharmacy, Schools of Pharmacy and Medicine, University of Colorado Health Sciences Center, Denver, 80262, USA. robert.page@uchsc.edu

The Annals of Pharmacotherapy

|July 11, 2006

Summary

Topiramate therapy can cause severe nosebleeds (epistaxis) in some patients, even leading to hospitalization. Discontinuing the medication typically resolves the epistaxis, suggesting a causal link.

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Area of Science:

Neurology
Pharmacology
Clinical Medicine

Background:

Topiramate is a widely used neuromodulator for migraines and seizures.
Its therapeutic applications have expanded to various neuropathic conditions.
Limited data exist on epistaxis as an adverse effect in older populations.

Observation:

A 61-year-old female patient developed severe, intractable epistaxis after initiating topiramate for neuropathy.
Epistaxis recurred upon topiramate re-challenge, resolving after discontinuation.
The patient required hospitalization and blood transfusion due to epistaxis and anginal pain.

Findings:

The Naranjo scale indicated probable causality between topiramate and epistaxis.
Topiramate's mechanism may involve modulation of calcium channels, similar to calcium-channel blockers, potentially affecting vascular smooth muscle and platelets.
This case suggests a potential association between topiramate and severe epistaxis, especially in conjunction with antiplatelet agents.

Implications:

Severe, intractable epistaxis should be considered a potential serious adverse reaction to topiramate.
Clinicians should monitor for epistaxis in patients prescribed topiramate, particularly those with cardiovascular disease or on antiplatelet medications.
This case highlights the need for vigilance regarding topiramate's side effect profile in diverse patient populations.