Course Summary

Topiramate is a drug that has been widely studied for the treatment of various psychiatric and neurological disorders, particularly epilepsy, as well as for several off-label uses, including weight loss and the treatment of substance use disorder. The mechanisms through which topiramate acts are not fully understood; however, sufficient evidence exists to explain its anticonvulsant activity. The pharmacokinetic interactions of topiramate with other medications, especially other antiepileptics, and drugs affecting the central nervous system, should be carefully evaluated and monitored when prescribing topiramate.

Course Format

Homestudy

Course Syllabus

• Introduction
• Pharmacological Profile
  • Topiramate’s Multiple Mechanisms of Action
  • Dosing (Labeled)
  • Epilepsy
  • Migraine Prophylaxis
  • Dosing (Off-Label)
  • Hepatic and Renal Impairment: Dosing Adjustments
  • Special Populations: Geriatric and Pediatric Dosing Adjustments
• Clinical Application: Primary Indications and Efficacy
  • Epilepsy
  • Tonic-Clonic Seizures
  • Focal Onset Seizures
  • Lennox-Gastaut syndrome
  • Adjunctive and Alternative Treatments
  • Migraine Prophylaxis
  • Off-Label Uses
• Precautions, Contraindications and Adverse Effects
  • Precautions of AED Use
  • Contraindications and Adverse Effects
  • Pregnancy and Breastfeeding
  • Drug-Drug Interactions
• Toxicity: Diagnosis and Management
• Differential Diagnosis and Clinical Management
• Optimizing Safety: Patient Monitoring Parameters
• Clinical Pearls
• Role of the Interprofessional Healthcare Team
• Case Study 2: 44-year-old Male with Adverse Side Effects
• Differential Diagnosis
• Case Study 2: Topiramate-Induced Electrolyte Imbalance Leading to Central Pontine Myelinolysis
• Differential Diagnosis and Treatment Summary

Authors

Richard Daniels, PharmD, BCPS

Richard “Cole” Daniels earned his Doctor of Pharmacy(PharmD) from the Skaggs School of Pharmacy at the University of Montana in 2018. Throughout pharmacy school he completed a 3-year internship at Community Medical Center in Missoula, Montana in which he gained valuable experience in an acute care setting. Cole currently serves as a psychiatric clinical staff pharmacist at the Montana State Hospital. He has over 11 years of pharmacy experience having worked in several settings including retail, acute care, and inpatient psychiatric care. Cole has a diverse set of interests. However, acute care medicine, infectious disease, pain management, and asthma/COPD are a primary focus of his at the Montana State Hospital. He obtained board certification as a certified pharmacotherapy specialist in the Spring of 2022.

Elisabeth Gordon, BScPharm, RPh

Elisabeth Gordon earned her BSc(Pharm) from the University of British Columbia in 2004. After graduation, she worked in community retail pharmacies on Vancouver Island, before returning to her rural hometown of Salmon Arm. In 2016 and 2017, Elisabeth trained with Pallium Canada and Victoria Hospice to enhance her knowledge of end-of-life-care and palliative services. She is a volunteer medical supervisor for T1DOutreach, a peer support platform for adults living with type 1 diabetes, and a member of a Canadian peer support group for adults living with Birdshot Uveitis. Elisabeth enjoys working in a small, fast-paced rural pharmacy where she brings compassion and empathy to her everyday practice.