Patient/caregiver was educated on contraindications for using topiramate as follows:
- Metabolic acidosis induced by topiramate intake can result in increased bone dissolution and loss of calcium and phosphate minerals from the bone, resulting in demineralization of bone. This can lead to weakened skeletal framework, osteoporosis, and fractures with slightest injury. Individuals with history of osteoporosis are at increased risk for skeletal injury and fractures with topiramate use. So, topiramate is better avoided or used with caution, with periodical labs and bone scans ordered, in individuals with history of osteoporosis.
- Topiramate use, over a prolonged period of time, secondary to increased bone dissolution, demineralization, and loss of calcium and phosphate minerals from the bone, can lead to formation of renal calcium stones, resulting in episodes of severe back and groin pain. The kidney stones thus formed can also obstruct the urine flow, resulting in difficulty passing urine, painful urination, retention of urine, and consequent increased risk for development of UTIs. So, topiramate is better avoided or used with caution, in individuals with history of renal stones, obstruction to urine flow, and frequent UTIs.
- Topiramate use, especially in individuals with history of anxiety and bipolar disorder, carries risk of deterioration of mood disorders and worsening of clinical symptoms of mood disorders. Individuals can present with complaints such as, feeling low, anxiety, panic attacks, trouble sleeping, gross appetite changes, impulsiveness, agitation, aggression, and suicidal thoughts. So, topiramate must be used with caution in such individuals, with periodical monitoring for symptoms of worsening mood and behavior.
