Topiramate is rapidly and well absorbed. Food intake has no clinically significant effect on its bioavailability, which is about 80%. Connection with the plasma protein-13-17%. Average distribution for single doses up to 1200 mg. This figure depends on gender: women, these values constitute 50% of the values observed in men, which is associated with higher levels of fat tissue in women. Metabolized about 20% of topiramate. Up to 50% of topiramate is metabolized in patients concurrently taking other anti-epileptic drugs testosterone capsules that induce metabolizing enzymes. From the plasma, urine and feces of man identified six virtually inactive metabolites topiramate. Unmodified topiramate and its metabolites are mainly excreted through the kidneys. Plasma clearance of about 20-30 ml / min.
After a single dose, it is linear pharmacokinetics, plasma clearance is constant, and the area under the curve “concentration / time” in doses ranging from 100 to 400 mg increases proportionally with dose joint pain bodybuilding. During normal renal patients may require 4-8 days to reach equilibrium plasma concentrations. The average value of the maximum concentration after repeated oral administration of 100 mg twice a day topiramate is 6.76 g / ml. The half-life after multiple-dose of 50 and 100 mg twice a day is 21 hours.
In patients with impaired renal function (creatinine clearance <60 mL / min) reduced plasma and renal clearance of topiramate; in patients with end-stage renal failure, reduced plasma clearance of topiramate.Plasma clearance of topiramate is unchanged in elderly patients, in the absence of violations of certain functions of the kidneys. Plasma testosterone capsules clearance of topiramate is decreased in patients with moderate and severe hepatic impairment.
The pharmacokinetics of topiramate in children, as in adults, is linear. Clearance does not depend on the drug dose, the equilibrium concentration in the plasma increases proportionally with dose. However, children have higher values of clearance and a shorter half-life. Consequently, the concentration of topiramate in plasma when receiving identical doses per kg body weight may be lower dynabolon in children compared to adults. As in adults, the reception inducing liver enzymes topiramate reduces the equilibrium concentration in the blood plasma.
Topiramate is effectively cleared from the blood plasma by hemodialysis.
- monotherapy of epilepsy in children 3 years of age and adults (including patients with newly installed epilepsy);
- adjuvant therapy in children from 3 years and adults with lack of effectiveness of AEDs first choice for partial or generalized tonic-clonic seizures, as well as seizures in the background testosterone capsules syndrome.
- hypersensitivity to any component of the drug;
- Children under 3 years of age;
- pregnancy and lactation.
Precautions: hepatic or renal insufficiency, nefrourolitiaz (including past or family history), hypercalciuria.
Dosing and Administration
General Inside, swallowing the tablet whole without chewing, regardless of the meal. It is recommended to start treatment with low doses with a subsequent increase to the effective dose to the optimal control of seizures.
In the combined therapy
Adults: minimum effective dose of 200 mg / day. The usual daily dose of 200-400 mg (2 receptions). The maximum daily dose of 1600 mg. Treatment starts with 25-50 mg daily at bedtime for one week. The dose was then increased to 25-50 mg per day for 1-2 weeks, with a multiplicity of receiving two times a day. At intolerance of such a dosing regimen, the dose is increased by a smaller amount, or over large intervals. The dose and dosing frequency buy sustanon is selected depending on the clinical effect.
Children over 3 years: the recommended daily dose is 5-9 mg / kg body weight, divided into 2 doses. Treatment started with a dose of 25 mg at bedtime for one week. The dose was then increased to 3.1 mg / kg / day for 1-2 weeks, with a multiplicity of receiving two times a day, to achieve optimal clinical effect.
Adults: treatment is initiated with 25 mg at bedtime for one week. The dose was then increased to 25-50 mg per day for 1-2 weeks, with testosterone capsules a multiplicity of receiving two times a day. At intolerance of such a dosing regimen, the dose is increased by a smaller amount, or over large intervals. The dose and dosing frequency is selected depending on the clinical effect. The recommended starting dose of topiramate monotherapy in adults with newly diagnosed epilepsy is 100 mg / day, the maximum recommended dose – 500 mg / day. These doses are recommended for all adults, including the elderly with normal renal function.
Children aged 3 years: treatment starts with a dose of 0.5-1 mg / kg body weight per night for 1 week. The dose was then increased by 0.5-1 mg / kg / day for 1-2 weeks, the dosing frequency – 2 times a day.At intolerance of such a dosing regimen, the dose is increased by a smaller amount, or over large intervals. The dose and dosing frequency is selected depending on the clinical effect. The recommended dose range -3-6 mg / kg body weight. Children with recently established partial seizures molar mass of co2 can be assigned up to 500 mg per day.
Neurological and psychiatric disorders: anxiety, dizziness, headache, disturbances of speech and vision, psychomotor retardation, ataxia, fatigue, difficulty concentrating, confusion, paresthesia, drowsiness, abnormal thinking, diplopia, anorexia, nystagmus, depression, perversion of taste sensations , agitation, cognitive impairment, emotional lability, ataxia, lethargy, psychotic symptoms, aggressive behavior, suicidal ideation or attempts; additional children – personality disorder, increased salivation, hyperkinesia, hallucinations. Gastrointestinal disorders: dyspepsia, nausea, abdominal pain, diarrhea, dry mouth, increased liver enzymes, hepatitis, liver failure.
On the part of the eye: may cause myopia syndrome accompanied by increased intraocular pressure, a sharp decline in visual acuity and pain in the eyes. Myopia, reducing the depth of the anterior chamber of the eye, eye redness of the mucous membrane and increased intraocular pressure, mydriasis. A possible mechanism is an increase in data breaches supratsiliarnogo effusion that leads to a shift forward of the lens and iris, and, as a consequence – the development of secondary angle-closure glaucoma.
Skin and mucous membranes: erythema multiforme, pemphigus, Stevens-Johnson syndrome and toxic epidermal necrolysis.