Hallucinations and comorbid renal tubular acidosis caused by topiramate in a patient with psychiatric history
Department of psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong Province, People's Republic of ChinaGeneral hospital psychiatry (Impact Factor: 2.61). 05/2012; 35(2). DOI: 10.1016/j.genhosppsych.2012.04.008
Few studies have shown that topiramate may induce psychiatric symptoms and metabolic disorders, respectively. Here, we reported a 13-year-old female who presented with topiramate-induced hallucinations and comorbid renal tubular acidosis. She had a history of psychiatric illness and had been taking the medication for 3 months without prior side effects. After the discontinuation of topiramate, she was treated with supplementary potassium and sodium bicarbonate. Subsequently, her psychiatric symptoms and biochemical findings improved. Recognition of drug-induced psychotic symptoms and renal tubular acidosis is important during concomitant topiramate therapy in psychiatric clinic.
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ABSTRACT: The use of topiramate, which is prescribed for the management of epilepsy, for migraine headache prophylaxis and as a weight-loss agent, has been associated with the development of metabolic acidosis, hypokalaemia and renal stone disease. We systematically reviewed all the literature. The systematic review of the literature was realized using the principles underlying the UK Economic and Social Research Council guidance on the conduct of narrative synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Fourty-seven reports published between 1996 and 2013 were retained for the final analysis. Five case-control studies and 6 longitudinal studies addressed the effect of topiramate on acid-base and potassium balance. A significant tendency towards mild to moderate hyperchloremic metabolic acidosis (with bicarbonate ≤21.0 mmol/L in approximately every third case) and mild hypokalaemia (with potassium ≤3.5 mmol/L in 10% of the cases) was noted on treatment with topiramate, which was similar in children and adults. A single study observed that topiramate causes mild hyperuricaemia in male adults. A tendency towards hypocitraturia, a recognized promoter of renal stone formation, was noted in all patients on topiramate. Increasing evidence supports the use of topiramate. Topiramate is generally well tolerated and serious adverse events are rare. Nonetheless, the current systematic review of the literature indicates that its use is linked with the development of acidosis, hypokalaemia, hyperuricaemia and hypocitraturia.British Journal of Clinical Pharmacology 11/2013; 77(6). DOI:10.1111/bcp.12283 · 3.88 Impact Factor
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ABSTRACT: Topiramate (TPM) is a sulfamate-substituted monosaccharide that is structurally different from other antiepileptic drugs. TPM inhibits carbonic anhydrase activity, which is associated with loss of bicarbonate from the kidney and consequently metabolic acidosis or electrolyte imbalance. The objectives of the study were to investigate the influence of TPM therapy on bicarbonate and potassium levels in adult epileptic patients. Data were collected from 59 adult patients on monotherapy or co-therapy of TPM and other antiepileptic drugs. Serum bicarbonate and potassium levels were available from all patients. Steady-state TPM trough concentrations were determined in blood samples by high-performance liquid chromatography. Data analysis was performed by SPSS software (version 17, Chicago, IL). Patients were divided into group A (duration of therapy shorter than or equal to 5 years) and group B (duration of therapy longer than 5 years). Significant difference (P < 0.05) in serum bicarbonate levels was observed between these 2 groups. Bicarbonate levels were linearly related to the TPM therapy duration. No correlation was found between the TPM dose or patient age and bicarbonate or potassium levels, as well as between therapy duration and potassium level. Linear regression analysis showed no significant association among 54 available TPM trough concentrations and bicarbonate or potassium levels. Results highlight the frequent occurrence of lower bicarbonate level associated with prolonged TPM therapy. Monitoring bicarbonate levels in patients on long-term TPM therapy might be useful.Annals of Pharmacotherapy 05/2014; 48(8). DOI:10.1177/1060028014534397 · 2.06 Impact Factor
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