The combined use of topiramate and valproic acid in patients undergoing well each drug separately, accompanied by hyperammonemia with or without encephalopathy her. In most cases, the signs and symptoms disappear after withdrawal of one of the drugs. This adverse event is not due to pharmacokinetic interactions. Communication between the application and hyperammonemia topiramate alone or in combination andriol testocaps for sale with other drugs has not been established.
When coadministered topiramate and valproic acid can occur hypothermia (body temperature inadvertent descent below 35 ° C) in combination with or independently of hyperammonemia. This phenomenon may occur after the beginning of co-administration of topiramate and valproic acid and by increasing the daily dose of topiramate.
Additional studies of drug interactions: to assess potential options for drug interaction between topiramate and other medicines have been a number of clinical studies.
Antiepileptic drugs, including, should be withdrawn gradually to minimize the possibility of increasing the frequency of seizures. In clinical studies, the dose was reduced to 50-100 mg weekly intervals for adults with epilepsy therapy and 25-50 mg in adults receiving per day for migraine prophylaxis. The children in clinical studies gradually abolished within 2-8 weeks. If medically necessary rapid abolition , it is recommended to carry out appropriate control of the patient’s condition.
As in the case of other antiepileptic drugs, some patients taking topiramate observed increase in seizure frequency or new types of seizures. This phenomenon may be a consequence of an overdose, reducing the concentration of antiepileptic drugs used together, the progression of the disease or a paradoxical effect.
rate of excretion by the kidneys depending on renal function and is not dependent on age. Patients with moderate to severe renal impairment to achieve sustained plasma concentrations may require 10 to 15 days as opposed to 4-8 days in patients with normal renal function.
As with any disease, the scheme selection of the dose should be guided by clinical effect (ie, the degree of control of seizures, no side effects), and bear in mind that in patients with impaired renal function to establish a stable plasma concentration for each dose may be needed a longer time.
When topiramate therapy may experience andriol testocaps for sale oligogidroza (decreased sweating) and anhidrosis. Reducing sweating and hyperthermia (increased body temperature), subject to high ambient temperatures can occur in children environment. In this regard, when it is important to topiramate therapy adequate fluid intake volume increase that can reduce the risk of nephrolithiasis, as well as the side effects that may occur under the influence of physical activity or elevated temperatures.
Mood disorders / depression
In the treatment of topiramate observed increased incidence of mood disorders and depression.
When using antiepileptic drugs, including , increased risk of suicidal ideation and suicidal behavior in patients taking these drugs for any of the indications.
In double-blind clinical trials, the incidence of the phenomena associated with suicide (suicidal ideation, suicide attempt, suicide), was 0.5% in patients treated with topiramate (46 people out of 8652), which is about 3 times higher than in patients receiving placebo (0.2% in 4045 from 8 people). One case of suicide was recorded in the double-blind study of bipolar disorder in a patient receiving topiramate.
Thus, andriol testocaps for sale it is necessary to monitor the status of patients for signs of suicidal thoughts and prescribe appropriate treatment. It should advise patients (and, if necessary, persons who take care of patients), immediately seek medical help in case of signs of suicidal thoughts or suicidal behavior.