Patient/caregiver was educated on precautions to be exercised while taking topiramate as follows:
- Individuals following keto diet and diabetic patients, especially individuals with poorly controlled grossly elevated blood sugars, can develop ketosis, secondary to increased fat metabolism. In these individuals, secondary to lack of insulin, glucose could not be transported into the cells and so, is not available for metabolism and cellular needs. The cells depend on fat, as an alternate fuel, to meet the metabolic demand. Consequently, the cells produce ketone bodies, as end-products of fat metabolism. Increased production of these ketone bodies can also lead to increased acid ions in the body and developing metabolic acidosis. Use of topiramate in these individuals can significantly increase the risk for acidosis and so, must be used with caution, with periodical monitoring of labs, blood sugar control, and close watch for development of symptoms of metabolic acidosis. Diabetic individuals taking topiramate must observe extra caution towards compliance with intake of antidiabetic medications prescribed and dietary recommendations made. Observe compliance with log maintenance of every day blood sugar readings for an easy follow-up. Report any poorly controlled blood sugars to your physician, for any appropriate changes to be made in your plan of care.
- Topiramate is poorly metabolized by the body and is mainly excreted by the kidneys. Individuals with renal disease cannot excrete topiramate normally, which allows the medication to stay in blood circulation for longer time, resulting in toxicity and consequent side-effects. Also, individuals with compromised renal function can present with elevated acid ions in the blood and intake of topiramate by these individuals can further contribute to the metabolic acidosis state, thus complicating the clinical condition. So, periodical monitoring of renal functions could be ordered while taking topiramate and observing compliance with the labs ordered can help prevent symptoms of acidosis and toxicity from developing.
