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Intentional Topiramate Ingestion in an Adolescent Female

Assistant Clinical Professor of Pharmacy Practice and Adjunct Assistant Professor of Pediatrics, Harrison School of Pharmacy, Auburn University, Auburn, AL; School of Medicine, University of South Alabama, Mobile, AL

Michael D Reed, PharmD

Professor of Pediatrics, Division of Pediatric Pharmacology and Critical Care, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, OH

Reprints: Michael D Reed PharmD, Department of Pediatrics, Rainbow Babies and Children's Hospital, 11100 Euclid Ave., MS RBC 6010, Cleveland, OH 44106-6010, fax 216/844-5122, mdr2{at}case.edu

OBJECTIVE: To describe an intentional topiramate ingestion by an adolescent and warn of the potential for topiramate abuse.

CASE SUMMARY: A 17-year-old female intentionally ingested approximately eight 100-mg topiramate tablets for the purpose of "getting high." Soon after ingestion, she was found at school obtunded and nonresponsive. Upon transfer to the emergency department, she became combative and aggressive with evolving neurologic abnormalities including incoherence, confusion, disorientation, and significant speech impairments including echolalia. Approximately 24 hours after ingestion, the patient had completely recovered without requiring specific treatment or experiencing sequelae.

DISCUSSION: The clinical effects following acute topiramate intoxication appear consistent with the drug's known pharmacologic properties. There are few other reports of topiramate ingestions and most cases have had mild outcomes.

CONCLUSIONS: Due to the multifactorial effects topiramate may have upon the central nervous system and its anorectic effect, abuse of this drug by adolescents should be considered upon presentation of an adolescent with mental status changes.

Key Words: speech impairment, topiramate, toxicity

Published Online, August 3, 2004. www.theannals.com, DOI 10.1345/aph.1D572

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