Patient/caregiver was educated on contraindications for using Topamax as follows:
- 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 Topamax in these individuals can significantly increase the risk for acidosis and so, must be avoided or used with caution, with periodical monitoring of labs, blood sugar control, and close watch for development of symptoms of metabolic acidosis.
- Individuals following ketogenic diet, with very little carbohydrate and high fat in their meal, can be at increased risk for metabolic acidosis, following Topamax use. Secondary to poor carbohydrate intake and nonavailability of glucose, the cells in these individuals majorly depend on fat, as an alternate fuel for metabolic demands. 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. So, Topamax must be avoided or used with caution in individuals following a keto diet, with periodical monitoring for urinary ketones and development of symptoms of metabolic acidosis.
