In some patients, especially with testosterone undecanoate oral a predisposition to nephrolithiasis, may increase the risk of kidney stones and the symptoms associated with it, such as renal colic, kidney pain, pain in the side. To reduce this risk, you need an adequate increase in the volume of fluid consumed. Risk factors for nephrolithiasis is a history of nephrolithiasis (including family), hypercalciuria, concomitant therapy with drugs that contribute to the development of nephrolithiasis.
Impaired Renal Function
Caution should be exercised when administering in patients with renal insufficiency (creatinine clearance <70 mL / min). This is due to the fact that these patients have reduced clearance of the drug.
Abnormal liver function
Patients with hepatic impairment topiramate should be used with caution because of the possible reduction in clearance of the drug.
Myopia and secondary angle-closure glaucoma
In applying the drug testosterone undecanoate oraldescribes a syndrome consisting of acute myopia with concomitant secondary angle-closure glaucoma. Symptoms include a sharp decline in visual acuity and / or pain in the eye. In ophthalmologic examination can be found myopia, flattening of the anterior chamber, flushing (redness) of the eyeball, increased intraocular pressure. Mydriasis can be observed. This syndrome may be associated with the secretion of fluid, resulting in the displacement of the lens and iris forward with the development of secondary angle-closure glaucoma. Symptoms usually appear within 1 month after the start . In contrast, primary open angle glaucoma, which is rare in patients under 40 years, secondary angle-closure glaucoma seen with topiramate in adults and children. If there is a syndrome consisting of myopia associated with angle-closure glaucoma, treatment includes discontinuation , as soon as the physician deems it feasible, and appropriate measures aimed at lowering intraocular pressure. Typically, these measures lead to a normalization of intraocular pressure.
Elevated intraocular pressure in the absence of any etiology adequate treatment can lead to serious complications, up to the loss of vision.
In the appointment of topiramate in patients with eye diseases in the anamnesis is necessary to estimate the ratio of the expected benefit to the possible risk of the application.
Defects in the visual field
Visual field defects have been observed in patients receiving topiramate, regardless of whether they have elevated intraocular pressure. In clinical trials, the majority of these cases were reversible, and visual field defects disappeared after discontinuation topiramate. If you have vision problems while taking topiramate should testosterone undecanoate oral consider discontinuation of therapy.
When using topiramate may occur hyperchloraemic not associated with a deficit of anions, metabolic acidosis (ie, decreased plasma concentrations of hydrocarbons below normal levels in the absence of respiratory alkalosis). This reduction in the concentration of hydrocarbons serum is a consequence of the inhibitory effect of topiramate on renal carbonic anhydrase. In most cases, reduced concentration of hydrocarbons takes place at the beginning of dosing, although this effect may occur in any period of topiramate treatment. The degree of concentration reduction is usually weak or moderate (mean value of 4 mmol / liter when using adult patients at a dose higher than 100 mg per day and about 6 mg per day per kg of body weight, when used in pediatric patients). In rare cases, patients had reduction in the concentration of hydrocarbons below the level of 10 mmol / l. Some diseases or treatment methods, predisposing to acidosis (such as renal disease, severe respiratory disorders, status epilepticus, diarrhea, surgery, ketogenic diet, taking certain medications) may be additional factors contributing to bicarbonate-lowering effects of topiramate.
In children, chronic metabolic acidosis can lead to slower growth. The effect of topiramate on growth and possible complications associated with the skeletal system, have not been studied systematically in children and in adults.
In view of the above, for testosterone undecanoate oral the treatment of topiramate recommended the necessary studies, including the identification of hydrocarbons concentration in the serum. In the case of the onset of symptoms of metabolic acidosis (eg, deep kussmaulevskoe breath, dyspnea, anorexia, nausea, vomiting, fatigue, tachycardia or fibrillation) recommended that a definition of hydrocarbons concentration in the serum. If you have metabolic acidosis and its persistence, it is recommended to reduce the dose or stop taking topiramate.
Cognitive impairment in epilepsy is multifactorial and may be due to the root cause of the disease directly from epilepsy or antiepileptic therapy. In adult patients treated with topiramate, there were cases of cognitive impairment, requiring dose reduction or discontinuation of therapy. Data on the effect of topiramate on cognitive function in children are scarce, and its effects require further study.
If the patient loses weight in the treatment , you should consider whether to supply power.
Effects on ability to drive and use machines
Acts on the central nervous system and may cause drowsiness, dizziness and other symptoms. It can also cause blurred vision. These adverse effects can be dangerous for patients to drive and moving machinery, especially at a time until it is established the patient’s reaction to the drug.