Abstract
1It is also indicated for migraine prophylaxis in adults. 1,2 An off-label use of topiramate is as a mood stabilizer (with no associated weight gain) in rapid-cycling and mixed bipolar episodes. 3-7 The mechanisms of action of topiramate suggest a broad spectrum of anticonvulsant activity, including blockade of voltage-gated sodium and calcium channels, increase in inhibitory transmission via enhancement of -aminobutyric acid‐stimulated chloride currents, decrease in excitatory transmission via blockade of the adenosine monophosphate-kainate subtype of the glutamate receptor, and weak inhibition of carbonic anhydrase. 8-11 Despite the benefits of topiramate as listed above, includ ing weight neutrality, patients are still prone to discontinue their medications. This problem is highly prevalent among patients with mental health conditions, most notably schizophrenia and bipolar disorders. In particular, patients may abruptly discontinue their antiepileptic medications secondary to experiencing adverse effects, even if they have been made aware of the poten tial for such adverse effects through education provided by a pharmacist. Prescribers and other health care providers must be aware of potential adverse effects that may arise with the commencment and maintenance of antiepileptic therapy.
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