Dosing and titration of Topamax
The initial adult dosage is 25 to 50 mg/day, in two divided doses. The target dosage is 200 to 400 mg/day, also in two doses. Up to 1000 mg daily has been given to patients also taking enzyme-inducing drugs.
A 2002 study (Guberman 2002) found that Topamax was effective as adjunctive therapy in adults with partial-onset seizures at a dose of 200 mg/day when it was added to an enzyme-inducing AED (carbamazepine), and it was well tolerated.
In patients with renal insufficiency, doses should be reduced by half.
Therapeutic blood levels have not been established. Adjustments should depend on clinical response.
