topiramate

Question 1

important SE (eyes)

Answer 1

Topiramate has been associated with acute myopia with secondary angle-closure glaucoma, typically occurring within 1 month of starting treatment. Choroidal effusions resulting in anterior displacement of the lens and iris have also been reported. If raised intra-ocular pressure occurs: seek specialist ophthalmological advice; use appropriate measures to reduce intra-ocular pressure and stop topiramate as rapidly as feasible.

Question 2

Topiramate has been associated with acute myopia with secondary angle-closure glaucoma, typically occurring within …..

Answer 2

1 month starting

Question 3

latest MHRA advice re use in pregnancy

Answer 3

do not use in FoCBP unless conditions of PPP met

identify all new and existing FofCB on topiramate and explain the PPP, provide Patient Guide, complete Risk Awareness Form

use in pregnancy CI in migraine prophylaxis

only use in epilepsy & pregnant if no suitable alternative treatment

Question 4

what is it used for (4)

Answer 4

generalised tonic clonic seizures
focal seizures with or without secondary generalisation
lennox-gastaut syndrome
migraine prophylaxis

Question 5

True or false - topiramate must be dispensed in full packs

Answer 5

ensure whole pack dispensing wherever possible
all packs dispensed to FoFB should have warning symbol on carton or via sticker
provide patient card and check if using highly effective contraception

Question 6

when does risk awareness form need to be signed

Answer 6

at treatment initiation
at each annual review

Question 7

myopia meaning

Answer 7

nearsightedness (cant see things far away)

Question 8

a patient mentions in conversation that they need to book in for an eye check because they cant see objects far away as well anymore. they are on topiramate. what could this mean?

Answer 8

Topiramate has been associated with acute myopia with secondary angle-closure glaucoma, typically occurring within 1 month of starting treatment.

f raised intra-ocular pressure occurs: seek specialist ophthalmological advice; use appropriate measures to reduce intra-ocular pressure and stop topiramate as rapidly as feasible.

Question 9

how long to use highly effective contraception for topiramate

Answer 9

Highly effective contraception must be used during and for at least 4 weeks after stopping treatment.

Question 10

if used during pregnancy, what do you need to monitor

Answer 10

careful prenatal monitoring should be performed.

Question 11

does it affect oral contraception?

Answer 11

Yes
reduced efficacy of CHC, cyproterone + ethinylestradiol (co-cyprinidiol), desogestrel, LNGSTL, ulipristal etc

Question 12

interaction with zonisamide

Answer 12

Topiramate potentially increases the risk of overheating and dehydration when given with Zonisamide. Manufacturer advises avoid in children.

Question 13

interaction with carbamazepine

Answer 13

Topiramate increases the risk of carbamazepine toxicity when given with Carbamazepine.