Oral contraceptives: in a drug interaction study with oral contraceptives, which used a combination product containing norethisterone (1 mg) and ethinyl estradiol (35 micrograms), in doses of 50-800 mg per day did not have a significant impact on the effectiveness of norethisterone and doses 50-200 mg per day – the efficiency of ethinyl estradiol. A significant dose-dependent reduction in the effectiveness of ethinyl estradiol was observed at doses of the per day. The clinical significance of these changes is not clear. The risk of reducing the effectiveness of contraceptives and increasing “breakthrough” bleeding should be considered in patients taking oral contraceptives in combination with andriol review . Patients receiving estrogensoderzhaschie contraceptives, you must report any changes in the timing and nature of menstruation. Contraceptive effectiveness may be reduced even in the absence of “breakthrough” bleeding.
Lithium: from healthy volunteers observed a decrease lithium AUC by 18% while receiving topiramate at a dose of 200 mg per day. In patients with manic-depressive psychosis use of topiramate at dosages up to 200 mg per day did not affect the pharmacokinetics of lithium, but at higher doses (up to 600 mg per day) lithium AUC was increased by 26%. With simultaneous use of topiramate and lithium should monitor the concentration of the latter in the blood plasma.
Risperidone: Studies of drug interactions, performed with single and multiple doses of topiramate in healthy volunteers and patients with bipolar disorder yielded similar results. With simultaneous application of topiramate at dosages of 250 or 400 mg per day of risperidone AUC received at doses 1.6 mg per day, respectively reduced by 16% and 33%. At the same pharmacokinetics of 9-hydroxyrisperidone is not changed, and pharmacokinetics of the total active ingredients (risperidone and 9-hydroxyrisperidone) changed insignificantly. Changing the systemic exposure of risperidone / 9-hydroxyrisperidone and topiramate had no clinically significant, and this interaction is unlikely to be of clinical significance.
Hydrochlorothiazide: drug interaction was evaluated in healthy volunteers in the separate and joint appointment of hydrochlorothiazide (25 mg) and topiramate (96 mg). The results showed that while taking topiramate and hydrochlorothiazide is an increase in the maximum concentration of topiramate by 27% and the area under the curve “concentration-time” by 29% of topiramate. The clinical relevance of these studies identified. Appointment of hydrochlorothiazide patients taking topiramate may require adjustment of the dose of topiramate. Pharmacokinetic parameters of hydrochlorothiazide has not andriol review been subjected to significant change with concomitant topiramate therapy.
Metformin: drug interaction was evaluated in healthy volunteers, metformin, or a combination of metformin and topiramate. The results showed that while receiving topiramate, metformin and an increase of maximum concentration and area under the curve “concentration-time” metformin 18% and 25% respectively, whereas metformin clearance while the appointment with topiramate decreased by 20%.Topiramate does not affect the time to maximum concentration of metformin in plasma. The clearance of topiramate while the use of metformin is reduced. The extent of the revealed changes of clearance has not been studied. The clinical significance of the impact of metformin on the pharmacokinetics of topiramate is unclear. If you add or remove in patients receiving metformin should investigate the condition of patients with diabetes.
Pioglitazone: drug interaction was evaluated in healthy volunteers at separate and simultaneous use of pioglitazone and topiramate. It was found a decrease in area under the curve “concentration-time” of pioglitazone by 15%, without changing the maximum concentration of the drug. These changes were not statistically significant. For active gidroksimetabolita pioglitazone it was also showed a reduction in peak concentration and area under the curve “concentration-time” by 13% and 16% respectively, while for the active ketometabolita revealed reduction and the maximum concentration, and area under “concentration-time” curve 60 %. The clinical significance of these data is not clear. With the simultaneous use and pioglitazone should investigate the condition of patients with diabetes mellitus.
Glibenclamide: a study was conducted of drug interactions for the study of the pharmacokinetics of glibenclamide (5 mg per day) at steady state, used alone or in conjunction with topiramate (150 mg daily) in patients with type 2 diabetes.
In the application of topiramate AUC of glibenclamide decreased by 25%. It was also reduced systemic exposure – 4-trans-3-gidroksiglibenklamida and cis gidroksiglibenklamida (respectively 13% and 15%).Glibenclamide did not affect the pharmacokinetics of topiramate in an equilibrium state. It was found statistically significant reduction in of pioglitazone by 15% with no change in Cmax. In the appointment of topiramate in patients receiving glyburide (glibenclamide or appointment of patients receiving topiramate), the patient should be carefully monitored to assess the condition of diabetes mellitus.
Other drugs: the simultaneous use of the drug andriol review with drugs, predisposing to nephrolithiasis, may increase the risk of kidney stones. During treatment should avoid the use of drugs, predisposing to nephrolithiasis, andriol review as they can cause physiological changes that promote nephrolithiasis.