At the beginning of the treatment the patient should take 25 mg of the drug tamoxifin at bedtime for 1 week. Then the dose is increased at intervals of 1 – 2 weeks at 25 or 50 mg (daily dose is divided into two steps). If the patient can not tolerate a dose escalation mode, it is possible to increase the intervals between increasing dose or increase the dose more slowly. In the selection of dose should be guided by clinical effect. The initial dose of topiramate monotherapy in adults is 100 mg per day and the maximum daily dose should not exceed 500 mg. Some patients with refractory forms of epilepsy tolerate topiramate monotherapy at doses up to 1000 mg per day. These dosing recommendations apply to all adults, including elderly patients without renal disease.
Children under 2 years of age in the first week of treatment should be given topiramate at a dose of 0.5-1 mg / kg body weight before bedtime. The dose was then increased at intervals of 1-2 weeks at 0.5-1 mg / kg per day (daily dose is divided into two steps). If a child can not tolerate such a dose escalation mode, it is possible to increase the dose more gradually or increase the interval between increasing the dose. The size of the dose and the speed of its increase should be determined by clinical outcome.
The recommended dose range of topiramate monotherapy in children over the age of 2 years is 100-400 mg / day. Children with newly diagnosed partial seizures can be assigned up to 500 mg per day.
The recommended total daily dose of topiramate for prophylaxis of migraine is 100 mg, taken in 2 divided doses. At the beginning of the treatment the patient should take 25 mg of the drugtamoxifinat bedtime for 1 week. Thereafter, the dosage is increased at intervals of 1 week to 25 mg per day. If the patient can not tolerate such a regime of increasing doses, then you can increase the interval between increases in the dose or increase the dose more slowly. In the selection of dose should be guided by clinical effect.
In some patients, a positive result is obtained at a daily dose of 50 mg topiramate. In clinical studies, patients received different daily doses of topiramate, but not more than 200 mg per day.
Special patient groups
- Renal Insufficiency
Patients with moderate or severe renal impairment may require dose reduction.It is recommended to use half the recommended initial and maintenance dose.
Since topiramate is tamoxifin removed from plasma by hemodialysis, in the days of hemodialysis should be given an additional , equal to about half of the daily dose.An extra dose should be divided into two doses taken at the beginning and after the end of hemodialysis.Additional dose may vary depending upon the characteristics of the equipment used to perform hemodialysis.
- Hepatic impairment
Patients with hepatic impairment topiramate should be used with caution.
The most common adverse reactions (frequency of which was greater than 5% and greater than that in the placebo group, at least one of the indications in the controlled clinical trials of topiramate) include: anorexia, decreased appetite, slow thinking, depression, violations of free speech, insomnia, disorders motor coordination, impaired concentration, dizziness, dysarthria, dysgeusia, hypoesthesia, lethargy, memory impairment, nystagmus, paresthesia, somnolence, tremor, diplopia, blurred vision, diarrhea, nausea, fatigue, irritability and a decrease in body weight.
Infections and infestations: Very common: nasopharyngitis *.
Violations of the blood and lymphatic system: common: anemia; rare: leucopenia, lymphadenopathy, thrombocytopenia, eosinophilia; rare: neutropenia *.
Violations of the immune system: common tamoxifin: hypersensitivity; Frequency not known: Allergic edema *, conjunctival edema *.
Violations of the metabolism and nutrition: Common: anorexia, decreased appetite; rare: metabolic acidosis, hypokalemia, increased appetite, polydipsia; rare: hyperchloraemic acidosis.