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NEUROLOGY

Impact of Topiramate on Serum Bicarbonate Concentrations in Adults

Pharmacy Resident, Department of Pharmacy, Medical University of South Carolina, Charleston, SC

Karen S Oles, PharmD MS BCPS CPP

Associate Professor, Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC

Reprints: Dr. Oles, Department of Neurology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1078, fax 336/713-7028, koles{at}wfubmc.edu

BACKGROUND: Topiramate is an antiepileptic medication with multiple pharmacologic effects, including inhibition of carbonic anhydrase activity. It is associated with metabolic acidosis in both children and adults.

OBJECTIVE: To evaluate the incidence and magnitude of the effect of topiramate on serum bicarbonate concentrations in an adult population.

METHODS: This was a retrospective cohort study. Data were evaluated to assess the relationship between serum bicarbonate concentrations before and during topiramate therapy.

RESULTS: Fifty-four patients (40 females) with a mean age of 47.6 years (range 19-89) were included in the study. Mean ± SD serum bicarbonate concentrations before and during topiramate therapy were 26.8 ± 2.9 mEq/L (range 21-36) and 21.7 ± 3.6 mEq/L (range 13-29), respectively, with a mean difference of 5.1 (95% CI 3.7 to 6.5; p < 0.001). Twenty-six patients (48%) had low serum bicarbonate concentrations while on topiramate, with a mean concentration of 18.8 mEq/L (range 13-21).

CONCLUSIONS: Topiramate was associated with metabolic acidosis in 48% of the patients studied, which did not result in clinically significant problems.

Key Words: metabolic acidosis, topiramate

Published Online, February 8, 2005. www.theannals.com, DOI 10.1345/aph.1E437

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