Patient/caregiver was educated on precautions to be exercised while taking Topamax 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 Topamax 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 Topamax 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.
- Periodical labs could be drawn to evaluate the safe therapeutic blood levels of Topamax, renal function, diabetic control, urinary ketones, and accumulation of ammonia in the body. Observe compliance with any lab draws ordered.
