Topiramate (Topamax)

TOPIRAMATE (TOPAMAX^®)

Primary Use

Topiramate is a novel agent used to treat patients with various types of epilepsy and migraine headaches. It is used off label as a ‘magic’ weight reduction medication and to treat bipolar disorder and clinical depression.

Clinical Concerns

Recent case reports by Banta et al. (2001) have included almost 100 reports of a classic acute angle closure glaucoma syndrome (Fraunfelder, Fraunfelder and Keates, 2004).

In the Registry series:

•   Patients range from 3 to 53 years of age

•   Time to onset of reaction ranges from 3 to 14 days after the start of oral therapy

WHO Classification

Certain

•   Acute glaucoma (mainly bilateral)

•   Anterior chamber shallowing

•   Ocular hyperemia

•   Increased ocular pressure

•   Mydriasis

•   Suprachoroidal effusions

•   Visual field defects – acute glaucoma

•   Ocular pain

•   Acute myopia (up to 6–8 diopters)

Probable/Likely

•   Blepharospasm

•   Oculogyric crisis

•   Retinal bleeds

•   Uveitis

Possible

•   Teratogenic effects, including ocular malforma-tions.

•   Scleritis.

•   Decreased vision.

Before the syndrome was recognized, most patients were treated with laser or peripheral iridectomy, which we now know is not beneficial.

Guidelines for Following Patients

•   Patients should stop the medication.

•   Hyperosmotic therapy.

•   Cycloplegic.

•   Topical antiglaucoma medication.