Patient/caregiver was educated on contraindications for using Topamax as follows:
- Topamax, by increasing loss of bicarbonate ions from the body, can result in excess of acid ions in the body, which consequently can lead to a dangerous acidotic condition called metabolic acidosis. Individuals with dehydration and diarrhea also suffer significant loss of bicarbonate ions and are naturally prone for developing metabolic acidosis. Use of Topamax in such individuals can tip the acid-base balance easily, to favor a state of excess acid in the body and result in metabolic acidosis. So, Topamax must be avoided or used with caution in individuals with dehydration and diarrhea, with periodical monitoring for development of symptoms of metabolic acidosis.
- Topamax is poorly metabolized by the body and is mainly excreted by the kidneys. Individuals with renal disease cannot excrete Topamax 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 Topamax by these individuals can further contribute to the metabolic acidosis state, thus complicating the clinical condition. So, Topamax could be avoided or used with extreme caution in individuals with compromised renal function, with periodical monitoring for renal functions, development of other toxic and acidosis symptoms.
