What are the effects of Topamax (topiramate) on adolescents?

From the Guidelines

Topamax (topiramate) should be considered for adolescent migraine prevention, with a target dose of 50-100 mg twice daily, after discussing the evidence and potential side effects with patients and families. When prescribing topiramate to adolescents, it is essential to start with a lower dose and gradually increase it to minimize side effects, such as cognitive slowing, tingling sensations, and decreased appetite 1. The medication has been shown to be effective in reducing the frequency and severity of migraine attacks, but its use should be carefully weighed against potential risks, including teratogenic effects, and patients should be advised to use effective birth control methods and take folate 1.

Key Considerations

• Topiramate is one of several options for migraine prevention in adolescents, including amitriptyline combined with cognitive behavioral therapy, and propranolol 1.
• The choice of preventive treatment should be individualized, taking into account the patient's medical history, lifestyle, and preferences 1.
• Regular follow-up appointments are crucial to assess the effectiveness of topiramate and manage potential side effects, such as mood changes, kidney stones, and weight loss 1.

Potential Side Effects

• Cognitive slowing and tingling sensations are common side effects of topiramate, and patients should be monitored for these effects 1.
• Decreased appetite and weight loss are also potential side effects, and patients should be encouraged to maintain a healthy diet and lifestyle 1.
• Topiramate can increase the risk of kidney stones, and patients should be advised to stay well-hydrated while taking the medication 1.

From the FDA Drug Label

The most common dose-related adverse events at dosages of 5 to 9 mg/kg/day in controlled trials in pediatric patients with partial onset seizures, primary generalized tonic-clonic seizures, or Lennox-Gastaut syndrome, that were seen at greater frequency in topiramate-treated patients were: fatigue, somnolence, anorexia, nervousness, difficulty with concentration/attention, difficulty with memory, aggressive reaction, and weight decrease [see Table 9]. Table 5: Incidence of Treatment-Emergent Adverse Events in the Monotherapy Epilepsy Trial in Children Ages 10 up to 16 Yearsa Where Rate was at Least 5% in the 400 mg/day Topiramate Group and Greater Than the Rate in the 50 mg/day Topiramate Group Safety and effectiveness in patients below the age of 2 years have not been established for the adjunctive therapy treatment of partial onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome. Safety and effectiveness in patients below the age of 10 years have not been established for the monotherapy treatment of epilepsy

Topamax and Adolescent:

• The drug label provides information on the safety and effectiveness of topiramate in pediatric patients, including adolescents.
• The most common adverse events in pediatric patients treated with topiramate were fatigue, somnolence, anorexia, nervousness, difficulty with concentration/attention, difficulty with memory, aggressive reaction, and weight decrease.
• Safety and effectiveness in patients below the age of 2 years have not been established for the adjunctive therapy treatment of partial onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome.
• Safety and effectiveness in patients below the age of 10 years have not been established for the monotherapy treatment of epilepsy.
• Topiramate is associated with metabolic acidosis, which may cause osteomalacia/rickets and reduce growth rates in pediatric patients 2.

From the Research

Topamax and Adolescent Use

• There is limited information available on the use of Topamax in adolescents for migraine prophylaxis in the provided studies.
• However, the studies suggest that Topamax is effective in preventing migraine attacks in adults, with a significant reduction in headache frequency and severity 3, 4, 5, 6.
• The American Academy of Neurology and the American Headache Society recommend Topamax as a first-line treatment for migraine prevention in adults, along with other medications such as divalproex sodium, sodium valproate, metoprolol, propranolol, and timolol 6.
• A study comparing the effects of low-dose Topiramate and sodium valproate in migraine prophylaxis found that Topiramate was effective in reducing headache frequency, intensity, and duration, with a responder rate of 71.6% 5.
• Another study found that Topiramate was significantly more effective than levetiracetam in reducing headache frequency, but the difference in responder rate was not significant 7.

Safety and Efficacy

• The studies suggest that Topamax can cause serious side effects, particularly in women of childbearing potential, and should be used with caution 3.
• The evidence does not provide information on the safety and efficacy of Topamax in adolescents, and further studies are needed to determine its effectiveness and potential risks in this population.
• The available evidence is based on studies in adult populations, and the results may not be generalizable to adolescents 3, 4, 7, 5, 6.