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Topiramate (Topamax) versus Other Medications
Topiramate vs. Carbamazepine
- Efficacy:
- Epilepsy: Both agents have similar effectiveness for initial
treatment of newly diagnosed epilepsy: time to exit, time to first
seizure, and the proportion of patients seizure-free during the
last 6 months of treatment 2.
In the open trial comparing monotherapy with topiramate versus carbamazepine
the percentage of free seizure patients was greater in topiramate
group than carbamazepine 4.
- Side effects and tolerability: Topiramate 100 mg/day
is associated with the fewest discontinuations due to adverse events
2.
Most common adverse events associated with topiramate are somnolence,
weight loss and with carbamazepine are somnolence, dizziness and seizure
discontrol 4.
Topiramate vs. Valproate
- Efficacy:
- Epilepsy: Both anticonvulsants have similar effectiveness
for initial treatment of newly diagnosed epilepsy: time to exit,
time to first seizure, and the proportion of patients seizure-free
during the last 6 months of treatment 2.
- Prevention of migraine: Topiramate appears to be equivalent
in efficacy and safety to sodium valporate. Both agents cause significant
decrease in duration, monthly frequency, and intensity of headache
5.
- Side effects and tolerability: Topiramate 100 mg/day
is associated with the fewest discontinuations due to adverse events
2.
Topiramate vs. Fluvoxamine
Pathological gambling: In the comparison study of the effectiveness
of topiramate versus fluvoxamine in the treatment of PG the CGI-improvement
(Clinical Global Impression-Improvement) score was significantly better
for the topiramate group 3.
Topiramate vs. Gabapentin
The study evaluated the cognitive effects of topiramate and gabapentin.
Topiramate impaired cognitive test performance, whereas gabapentin had
minimal effects 6.
Further reading
References
- 1. Physicians’ Desk Reference, 59th ed; Thomson PDR: Montvale, NJ;
2005.
- 2. Privitera MD, Brodie MJ, Mattson RH, Chadwick DW, Neto W, Wang
S; EPMN 105 Study Group. Topiramate, carbamazepine and valproate monotherapy:
double-blind comparison in newly diagnosed epilepsy. Acta Neurol Scand.
2003 Mar;107(3):165-75. PubMed
- 3. Dannon PN, Lowengrub K, Gonopolski Y, Musin E, Kotler M. Topiramate
versus fluvoxamine in the treatment of pathological gambling: a randomized,
blind-rater comparison study. Clin Neuropharmacol. 2005 Jan-Feb;28(1):6-10.
PubMed
- 4. Rese'ndiz-Aparicio JC, Rodri'guez-Rodri'guez E, Contreras-Bernal
J, Ceja-Moreno H, Barraga'n-Pe'rez E, Garza-Morales S, Malago'n-Valde'z
J, Ortega-Gonza'lez F. A randomised open trial comparing monotherapy
with topiramate versus carbamazepine in the treatment of paediatric
patients with recently diagnosed epilepsy. Rev Neurol. 2004 Aug 1-15;39(3):201-4.
PubMed
- 5. Shaygannejad V, Janghorbani M, Ghorbani A, Ashtary F, Zakizade
N, Nasr V. Comparison of the effect of topiramate and sodium valporate
in migraine prevention: a randomized blinded crossover study. Headache.
2006 Apr;46(4):642-8. PubMed
- 6. Salinsky MC, Storzbach D, Spencer DC, Oken BS, Landry T, Dodrill
CB Effects of topiramate and gabapentin on cognitive abilities in
healthy volunteers. Neurology. 2005 Mar 8;64(5):792-8. PubMed
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