Topomax/topiramate
anticonvulsant
for seizures, migraine prevention, alcohol dependence
for bipolar (off label, Cochrane review doesn't agree with this use)
trials ongoing for PTSD and "infantile spasms"
lots more off label uses
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000998
http://www.rxlist.com/topamax-drug.htm
DANGER: avoid ketone metabolism while on this drug, risk of metabolic acidosis
SE: suicidality in 1/500
SE: weight loss (often given along with other pharm causing wt gain)
SE: reduced ability to sweat
http://en.wikipedia.org/wiki/Topiramate
good oral absorption but 70% excreted in urine unmetabolized
if utilized it is by hydroxylation, hydrolysis, and glucuronidation-->6 metabolites
many many other drugs will influence and be influenced by this one: the hepatic balancing act
MOA: unknown
four properties (wiki today)
may contribute to topiramate's antiepileptic and antimigraine efficacy
1) blockage of voltage-dependent sodium channels
2) augmentation of gamma-aminobutyrate acid activity at some subtypes of the GABA-A receptors
3) antagonism of AMPA/kainate subtype of the glutamate receptor
4) inhibition of the carbonic anhydrase enzyme, particularly isozymes II and IV
5?) action on mitochondrial permeability transition pores
6) topiramate is the only anticonvulsant that does not induce apoptosis in young animals at doses needed to produce an anticonvulsant effect