Topamax 200 mg tablet daily.
Harm reduction strategies
Dosage adjustment, monitoring, and use of alternative drugs should be made to achieve clinical effect.
Use of alternative therapy with topamax may be required if the dose of main active ingredient is not sufficiently lowered.
Adverse reactions or discontinuation syndrome
In clinical trials of topamax (200 mg daily), a mild but clinically significant adverse reaction reported in 2% to 12% of patients was headache.
Clinical trials have shown an increased incidence of discontinuation episodes among topamax users (15% to 23% in placebo-controlled trials), with these rates ranging from 9% to 32% in the first year of therapy (range: 1% to 15%).
In placebo controlled trials, discontinuation was associated with an increase of headache in 24% to 52% of patients receiving topamax and a decrease of headache in 12% to 38% of patients receiving placebo. 
The most commonly reported treatment–eligibility and discontinuation symptom in the placebo-controlled trials was headache, occurring in 14% topamax available in uk to 27% of the patients receiving treatment. Other treatment-specific discontinuation symptoms, including nausea, dizziness, and fatigue, have been observed in 2% to 10% of patients receiving topamax.
Most discontinuations or treatment-seeking symptoms in the placebo-controlled trials were reported after 12 months of therapy. Most symptoms resolved and were no longer reported during the second year of therapy .
Treatment-emergent adverse reactions
During clinical trials, a total of 23 (4%) patients discontinued therapy because of treatment-emergent adverse reactions.
Of the 23 patients, (83%) discontinued therapy because of transient headache lasting more than 1 hour in the first 2 weeks of treatment.
The most frequent treatment-emergent adverse reactions that led to discontinuation were nausea, headache, upper respiratory tract infection, or other symptoms (Figure 1).
Figure 1: Treatment-emergent adverse reactions, by year of therapy
In a review of placebo-controlled trials topamax in healthy volunteers, topamax-related symptoms were reported by 5% to 27% of participants experiencing a serious adverse effect during the trial. A treatment-emergent adverse reaction was observed in 21.7% of patients receiving placebo, and 8.1% to 18.5% were receiving topamax.
In a placebo-controlled trial patients with acute spinal cord injury (spinal injury), topamax was administered in combination with doxazosin to topamax online uk prevent neuropathic pain caused by a spinal cord injury. After the first month, 6% to 20% of patients received topamax and 0.9% to 6% of those receiving doxazosin.
The most common reported treatment–emergent adverse reactions (≥ 1% of)
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