July is National Cleft and Craniofacial Awareness and Prevention Month. This oral condition may develop in babies whose mothers smoke, have diabetes, or take certain medications. The FDA warns that Topiramate, used occasionally to treat orofacial pain disorders, can increase the risk of babies being born with cleft lips and/or palates when used during pregnancy. Keep reading to learn more about Topiramate’s oral side effects and major drug interactions:
Generic Name: Topiramate
Brand Name(s): Topamax, Qudexy, Eprontia, Qudexy XR, Trokendi XR
Pronunciation: toe PYRE a mate
About this drug:
Topiramate is an anticonvulsant that is used to treat certain types of seizures in adults or children at least 2 years old with epilepsy.
It is also used for the prevention of migraine headaches in patients at least 12 years old.
This medication may be used off-label for sleep-related eating disorders, nightmares, post-traumatic stress disorder, and alcohol dependence.
Dentistry-related tidbits:
Topiramate is often used as a second-line treatment following Lamotrigine in the treatment of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA).
Topiramate may cause taste changes and xerostomia. Consider prescribing a fluoride supplement if the patient has an increased risk of caries and increasing the frequency of dental exams.
This medication may increase body temperature and decrease sweating. If the patient has signs of dehydration in the office, offer them a glass of water.
The seizure threshold may be lowered if Topiramate is combined with Alcohol, Lidocaine and Lidocaine topical (Xylocaine), antivirals (e.g. Valacyclovir), Penicillin antibiotics, cephalosporin antibiotics, quinolone antibiotics, the oxazolidinone antibiotic Linezolid, the nitroimidazole antibiotic Metronidazole, the NSAID Ketorolac, and the muscle relaxant Methocarbamol.
Monitor blood pressure and pulse when administering local anesthetic with Epinephrine to a patient taking Topiramate as this combination may increase the risk of cardiac arrhythmias, QT prolongation, and hypokalemia.
The use of Alcohol, Marijuana, narcotics, benzodiazepines, muscle relaxants, or any other sedating medication in combination with this medication may increase the risk of CNS and/or respiratory depression or diminished psychomotor function.
Avoid prescribing Aspirin, Aspirin-containing products, Salsalate, and Diflunisal in combination with Topiramate to avoid the risk of Salicylate toxicity, metabolic acidosis, and CNS toxicity.
Exercise caution when prescribing steroids or the antifungal Amphotericin in combination with Topiramate to avoid an increase in the risk of hypokalemia. Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Topiramate works by blocking voltage dependent sodium channels, increasing GABA (the inhibitory neurotransmitter) and decreasing glutamate (the excitatory neurotransmitter) activity to avoid neural excitability, thus preventing seizures.
Topiramate may cause metabolic acidosis which can cause kidney stones, weak bones, harm to an unborn baby, and growth problems in children.
Patients who are on birth control pills and are taking Topiramate should use a backup non-hormonal medication for 1 month after stopping Topiramate as this combination may decrease the effectiveness of the birth control pills.
Some patients taking this medication may have thoughts of suicide or self-harm.
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