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Topiramate no prescription needed online
Generic Topamax
DRUG CLASS AND MECHANISM: Topiramate is an oral drug that is used to
prevent the seizures of epilepsy. (It is an anti-epileptic or anti-seizure drug).
It is used primarily among patients who are not controlled by other
anti-epileptic drugs. About 1 in 4 Americans diagnosed with epilepsy has
seizures that resist treatment with other anti-epileptic drugs. Topiramate also
prevents migraine headaches.
Seizures are due to the abnormal activity ("firing") of nerves in the brain,
and the abnormal activity spreads to smaller or larger portions of the brain.
Although topiramate's exact mechanism of action is unknown, scientific studies
suggest that it may alter neurotransmitters within the brain. Neurotransmitters
are chemicals that nerves manufacture and use to communicate with other nearby
nerves. By altering the production or action of the neurotransmitters,
topiramate may suppress the abnormal activity of the nerves in the brain that
cause the seizures or may prevent the abnormal activity from spreading to other
nerves. Other studies suggest that topiramate may suppress the nerves directly (i.e.,
not by altering neurotransmitters) and make them less likely to fire. The FDA
approved topiramate as a tablet in 1997. The Sprinkle Capsules were approved in
October, 1998.
STORAGE: Topiramate tablets should be stored at room temperature,
59-86°F (15-30 ° C). Sprinkle capsules should be stored at or below 77 ° F (25
°C).
PRESCRIBED FOR: Seizures may be classified as either partial if they
involve only a small portion of the brain or generalized if they involve more of
the brain. Topiramate is used in combination with other anti-seizure drugs among
adults and children aged 2-16 years with partial seizures or generalized
tonic-clonic seizures (in which there is prolonged contraction of the muscles of
the body that causes rigidity as well as jerking motions). Topiramate sprinkle
capsules are approved for treatment without other drugs in patients 10 years of
age and older. Topiramate also is used in patients two years of age and older
with seizures associated with the Lennox-Gastaut Syndrome, a severe form of
epilepsy which accounts for up to 10 percent of all cases of childhood epilepsy.
Children with Lennox-Gastaut Syndrome experience delays in their development and
up to dozens of different, mixed types of seizures a day. The most common types
of seizures in this syndrome are tonic (stiffening of the body, with the eyes
rolling upwards, dilation of the pupils and shallow, irregular breathing),
atonic (brief loss of muscle tone and consciousness, causing abrupt falls),
myoclonic (sudden muscle jerks), and absence (staring spells).
Topiramate also is approved for the prevention of migraine headaches in
adults.
DOSING: Most commonly, topiramate is started in low doses, 25 or 50 mg
per day, and then increased slowly, under a doctor's orders, by 25 to 50 mg per
week until an effective daily dose is reached. This slow approach to treatment
reduces side effects.
In children, the starting dose is up to 25 mg (1 to 3 mg/kg/day), taken
nightly for the first week. The dose is then increased at 1 or 2 week intervals
by 1 to 3 mg/kg/day.
Although the usual adult dose is 200 mg twice daily, some adult patients may
begin to see a clinical response at 200 mg per day. Some patients need doses
higher than 200 mg daily. In children, the usual dose is 2.5 to 4.5 mg/kg twice
daily.
Patients should maintain an adequate fluid intake in order to minimize the
risk of kidney stones.
DRUG INTERACTIONS: The following medications, when taken with
topiramate, increase the risk of kidney stones: acetazolamide (Diamox),
dorzolamide (Trusopt), methazolamide (Neptazane), dichlorphenamide (Daranide).
Carbamazepine (Tegretol) and phenytoin (Dilantin) markedly decrease the
amount of topiramate in the body by increasing its elimination from the body. As
a result, topiramate may lose effectiveness unless doses are increased.
Topiramate may decrease the amount of estrogen in the body in women taking
oral contraceptives, possibly increasing the chances of unwanted pregnancy.
Patients with seizure disorders taking anticonvulsant medications, including
topiramate, may develop nerve toxicity from a chemical, 4'-O-methylpyridoxine,
found as a contaminant in some ginkgo preparations.
PREGNANCY: Topiramate has been associated with abnormalities of the
fetus (teratogenicity) in experimental animal studies. No data on fetal effects
of topiramate exists in humans.
NURSING MOTHERS: Topiramate is excreted in the milk of lactating rats.
It is not known whether topiramate is excreted in human milk or if it has
important effects on nursing infants.
SIDE EFFECTS: In adults, the most common side effects of topiramate
are tiredness, dizziness, coordination problems, speech problems, changes in
vision or double vision, difficulty with memory, and sensory distortion.
In children, the most common side effects are drowsiness, tiredness, loss of
appetite, nervousness, difficulty with concentration/attention, weight decrease,
aggressive reaction and difficulty with memory.
Since topiramate was approved, there have been 23 cases reported (as of
8-17-01) of a sudden onset of vision and eye problems. Symptoms have typically
occurred within the first month of therapy, with patients reporting an acute
onset of decreased vision and/or eye pain. Eye examination revealed myopia (nearsightedness),
redness, decreased depth of the anterior chamber of the eye and elevated ocular
pressure, with or without dilation of the pupils. Fluid accumulation within the
eye may displace the lens and iris anteriorly causing secondary angle closure
glaucoma. If patients develop this syndrome, the treatment is to discontinue
topiramate as rapidly as possible, according to the judgment of the treating
physician.
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