domingo, 13 de abril de 2014

Topiramato profilaxis migraña titulacion

Topiramato
profilaxis migraña en adolescentes.
AdultPediatric
Dosing Forms & Strengths
Partial-Onset or Primary Generalized Tonic-Clonic Seizures
Monotherapy
Topamax, Topamax Sprinkles: 25 mg PO q12hr initially; may increase by 50 mg/day at weekly intervals to 200 mg PO q12hr
Trokendi XR, Qudexy XR: 50 mg PO qDay initially; may increase by 50 mg/day at weekly intervals for first 4 weeks, then 100 mg/day for weeks 5 to 6; target dose is 200-400 mg/day for partial onset seizures and 400 mg/day for generalized seizures
Adjunctive therapy
Topamax, Topamax Sprinkles: 25-50 mg/day PO initially; increase by 25-50 mg/day at weekly intervals to 100-200 mg q12hr for partial onset seizures and 200 mg q12hr for generalized tonic/clonic seizures
Trokendi XR, Qudexy XR: 25-50 mg PO qDay initially; increase by 25-50 mg/day at weekly intervals to achieve effective dose; not to exceed 200-400 mg/day for partial onset seizures or 400 mg/day for generalized tonic-clonic seizures
Lennox-Gastaut Syndrome
Indicated as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS)

Topamax, Topamax Sprinkles: 25-50 mg/day PO initially; increase by 25-50 mg/day at weekly intervals to 100-200 mg q12hr

Trokendi XR, Qudexy XR: 25-50 mg PO qDay initially; increase by 25-50 mg/day at weekly intervals to achieve effective dose; not to exceed 200-400 mg/day

Migraine Headache (Topamax)
Indicated for prophylaxis of migraine headache

Titrate over 4 wk to achieve a dose of 50 mg PO BID

Week 1: 25 mg PO qHS

Week 2: 25 mg PO BID

Week 3: 25 mg PO in the morning and 40 mg HS

Week 4: 50 mg PO BID

Guide dose/titration rate by clinical outcome; if needed, use longer intervals between dose adjustments

Dosing Modifications
Renal impairment
CrCl <70 mL/min: Reduce dose by 50%
Hemodialysis: Cleared by hemodialysis at rate 4-6 times greater than normal; prolonged period of dialysis may decrease topiramate serum concentrations
Hepatic impairment
Clearance may decrease; monitor
Cluster Headache (Off-label)
Prophylaxis

Initial: 25 mg PO qDay for 7 days

Increase by 25 mg/day every week to no more than 200 mg/day

Alcoholism (Off-label)
Initial: 25 mg PO qDay week 1

May increase to maximum 300 mg/day by weeks 5-14; may divide 300 mg dose q8hr (case reports)

Maintenance: 200 mg/day divided q12hr or 300 mg/day divided q8hr

Injectable topiramate (Orphan)
Orphan designation for Captisol-enabled topiramate injection for the treatment of partial onset or primary generalized tonic-clonic seizures in hospitalized patients with epilepsy or those being treated in an emergency care setting who are unable to take oral topiramate

Orphan sponsor
Ligand Pharmaceuticals, Inc.; 11119 North Torrey Pines Road, Suite 200; La Jolla, CA 92037



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