What are the next steps for a patient experiencing tingling in the feet and arms/hands, along with tachycardia, after starting topiramate (topiramate) and Wegovy (semaglutide)?

From the Guidelines

The patient experiencing tingling in the feet and arms/hands along with tachycardia after starting topiramate and Wegovy should immediately contact their healthcare provider and consider temporarily discontinuing both medications until evaluated. These symptoms could indicate potential adverse effects from either medication or their combination. Topiramate can cause paresthesia (tingling sensations) as a common side effect, while semaglutide (Wegovy) may occasionally cause increased heart rate 1. The patient should monitor their heart rate and document when symptoms occur. During the medical evaluation, the provider may check electrolytes, particularly potassium and magnesium levels, as imbalances can contribute to these symptoms. They may also assess vitamin B12 status, as deficiency can cause peripheral neuropathy, which might be exacerbated by these medications.

Some key points to consider in the management of this patient include:

• The potential for topiramate to cause cognitive impairment, constipation, dry mouth, palpitations, paresthesias, dysgeusia, and irritability 1
• The need for caution in patients with a history of cardiovascular disease or uncontrolled hypertension when using phentermine-topiramate ER 1
• The importance of monitoring for signs of pancreatitis, thyroid cancer, and acute gallbladder disease in patients taking semaglutide (Wegovy) 1
• The recommendation to discontinue antiobesity medication if the patient has not lost at least 5% of their baseline body weight after 12 weeks on the maintenance dose 1

The provider might consider reintroducing one medication at a time at lower doses after symptoms resolve to determine which drug is causing the adverse effects. These symptoms warrant prompt attention as they could indicate serious conditions like peripheral neuropathy or cardiac issues that need proper management to prevent long-term complications. It is essential to follow up with the patient in about 3 months to reevaluate their condition and adjust the treatment plan as necessary.

From the FDA Drug Label

Paresthesia (usually tingling of the extremities), an effect associated with the use of other carbonic anhydrase inhibitors, appears to be a common effect of Topiramate In the majority of instances, paresthesia did not lead to treatment discontinuation.

The patient is experiencing tingling in the feet and arms/hands, which is a known side effect of topiramate, referred to as paresthesia.

• The next steps would be to monitor the patient's symptoms and consider adjusting the dose or discontinuing the medication if the symptoms are severe or persistent.
• It is also important to investigate the cause of the tachycardia, as it is not a commonly reported side effect of topiramate, and may be related to another factor, such as the concomitant use of Wegovy (semaglutide) 2.

From the Research

Next Steps for Patient Experiencing Tingling and Tachycardia

The patient is experiencing tingling in the feet and arms/hands, along with tachycardia, after starting topiramate and Wegovy. The following steps can be considered:

• Monitor the patient's symptoms and adjust the dosage or discontinue the medication if necessary 3, 4
• Consider alternative treatments for migraine prevention, such as other antiepileptic drugs or lifestyle modifications 5, 6
• Evaluate the patient's overall health and medical history to determine the best course of treatment 7

Potential Side Effects of Topiramate

Topiramate has been associated with several side effects, including:

• Paresthesia (tingling or numbness in the hands and feet) 3, 4
• Cognitive problems, such as difficulty with concentration or memory 3, 7
• Fatigue, nausea, anorexia, and taste perversion 4
• Increased risk of renal stones and metabolic acidosis 3

Importance of Patient Monitoring

Regular monitoring of the patient's symptoms and side effects is crucial to determine the effectiveness and safety of topiramate treatment 3, 5, 6, 4, 7

• Patients should be advised to report any changes in their symptoms or side effects to their healthcare provider
• Healthcare providers should regularly assess the patient's response to treatment and adjust the dosage or discontinue the medication if necessary