Depakote Sprinkles and Topamax (Topiramate Sprinkle Capsules)

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using topiramate together with divalproex sodium may increase the risk of hyperammonemia, or elevated ammonia levels in the blood. Symptoms may be absent in mild cases of hyperammonemia, while lethargy, vomiting and mental changes may develop in more severe cases. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Coadministration of topiramate and valproic acid has been reported to decrease mean valproic acid systemic exposure (AUC) by 11% and topiramate AUC by 14%. The mechanism of interaction may involve increased metabolism of both drugs. Pharmacodynamically, concomitant administration of these agents may be associated with an increased risk of hyperammonemia, with or without encephalopathy, relative to topiramate alone and in patients who have tolerated either drug alone. In clinical investigational programs, hyperammonemia was observed in adolescents receiving topiramate monotherapy for migraine prophylaxis (incidence above normal: 26% for 50 mg/day and 41% for 100 mg/day vs. 22% for placebo) and in pediatric patients aged 1 to 24 months receiving adjunctive topiramate for partial onset epilepsy (9% to 10% for topiramate 5 to 25 mg/kg/day vs. 8% for placebo). Although topiramate is not indicated for use in infants and toddlers, valproic acid clearly produced a dose-related increase in the incidence of treatment-emergent hyperammonemia (above the upper limit of normal: 7% to 17% for 5 to 25 mg/kg/day vs. 0% for placebo). Markedly increased, dose-related hyperammonemia (0% for 5 mg/kg/day, 7% for 15 mg/kg/day and 8% for 25 mg/kg/day vs. 0% for placebo) also occurred in these patients. In addition, hypothermia with and without hyperammonemia has been reported after initiating topiramate or increasing the dosage. The mechanism is unknown.

MANAGEMENT: Pharmacologic response to topiramate and valproic acid should be monitored more closely following addition or withdrawal of one or the other drug. Dose adjustments may be required if an interaction is suspected. Patients should be advised to notify their physician if they experience loss of seizure control. Patients should also be monitored for clinical symptoms of hyperammonemic encephalopathy, which often include acute alterations in level of consciousness and/or cognitive function with lethargy or vomiting. Monitoring of ammonia levels should be considered if such symptoms occur. Signs and symptoms usually abate with discontinuation of either drug. Discontinuation of topiramate or valproic acid should be considered if hypothermia occurs. Patients should be monitored for symptoms such as lethargy, confusion, coma, and cardiovascular or respiratory system changes.

Depakote Sprinkles

Generic Name: divalproex sodium

Brand name: Depakote ER, Depakote Sprinkles, Depakene, Depacon, Depakote

Synonyms: Depakote Capsules

What is Depakote Sprinkles?

Topamax (Topiramate Sprinkle Capsules)

Generic Name: topiramate

Brand name: Qudexy XR, Topamax, Topamax Sprinkle, Topiragen, Trokendi XR, Qudexy XR Sprinkle

Synonyms: Topamax

What is Topamax (Topiramate Sprinkle Capsules)?