Topamax Dosage/Direction for Use

Dosing in Monotherapy Epilepsy: Adults and Pediatric Patients 10 Years of Age and Older: The recommended dose for TOPAMAX monotherapy in adults and pediatric patients 10 years of age and older is 400 mg/day in two divided doses. The dose should be achieved by titration according to the following schedule (see Table 4).

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Pediatric Patients 2 to 9 Years of Age: Dosing in patients 2 to 9 years of age is based on weight. During the titration period, the initial dose of TOPAMAX is 25 mg/day nightly for the first week. Based upon tolerability, the dosage can be increased to 50 mg/day (25 mg twice daily) in the second week. Dosage can be increased by 25-50 mg/day each subsequent week as tolerated. Titration to the minimum maintenance dose should be attempted over 5-7 weeks of the total titration period. Based upon tolerability and clinical response, additional titration to a higher dose (up to the maximum maintenance dose) can be attempted at 25-50 mg/day weekly increments. The total daily dose should not exceed the maximum maintenance dose for each range of body weight (see Table 5).

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Dosing in Adjunctive Therapy Epilepsy: Adults (17 Years of Age and Older): The recommended total daily dose of TOPAMAX as adjunctive therapy in adults with partial onset seizures or Lennox-Gastaut Syndrome is 200 to 400 mg/day in two divided doses, and 400 mg/day in two divided doses as adjunctive treatment in adults with primary generalized tonic-clonic seizures. TOPAMAX should be initiated at 25 to 50 mg/day, followed by titration to an effective dose in increments of 25 to 50 mg/day every week. Titrating in increments of 25 mg/day every week may delay the time to reach an effective dose. Doses above 400 mg/day have not been shown to improve responses in adults with partial-onset seizures.
Pediatric Patients 2 to 16 Years of Age: The recommended total daily dose of TOPAMAX as adjunctive therapy for pediatric patients 2 to 16 years of age with partial-onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome is approximately 5 to 9 mg/kg/day in two divided doses. Titration should begin at 25 mg/day (or less, based on a range of 1 to 3 mg/kg/day) nightly for the first week. The dosage should then be increased at 1- or 2-week intervals by increments of 1 to 3 mg/kg/day (administered in two divided doses), to achieve optimal clinical response. Dose titration should be guided by clinical outcome. The total daily dose should not exceed 400 mg/day.
Dosing for the Preventive Treatment of Migraine: The recommended total daily dose of TOPAMAX as treatment for adults for the preventive treatment of migraine is 100 mg/day administered in two divided doses (Table 6). The recommended titration rate for TOPAMAX for the preventive treatment of migraine is as follows: See Table 6.

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Dose and titration rate should be guided by clinical outcome. If required, longer intervals between dose adjustments can be used.
Administration Information: TOPAMAX can be taken without regard to meals.
Because of the bitter taste, tablets should not be broken.
Dosing in Patients with Renal Impairment: In patients with renal impairment (creatinine clearance less than 70 mL/min/1.73 m²), one-half of the usual adult dose of TOPAMAX is recommended [see Use in the Elderly and Renal Impairment under Precautions; Pharmacology: Pharmacokinetics under Actions].
Dosing in Patients Undergoing Hemodialysis: To avoid rapid drops in topiramate plasma concentration during hemodialysis, a supplemental dose of TOPAMAX may be required. The actual adjustment should take into account 1) the duration of dialysis period, 2) the clearance rate of the dialysis system being used, and 3) the effective renal clearance of topiramate in the patient being dialyzed [see Patients Undergoing Hemodialysis under Precautions and Pharmacology: Pharmacokinetics under Action].