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Topamax Metabolic Acidosis Symptoms

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A lecture on the differential diagnosis of a normal anion gap metabolic acidosis, focusing on renal tubular acidosis, but also covering diarrhea, saline infusion, hyperkalemia, kidney failure, and ureteral diversion

Hyperchloremic, Normal Anion-gap, Metabolic Acidosis Due To Topiramate

Hyperchloremic, Normal Anion-Gap, Metabolic Acidosis Due to Topiramate Kathryn D. Mathews, PharmD; Jennifer E. Stark, PharmD, BCPS Am J Health Syst Pharm.2008;65(15):1430-1434. The metabolic adverse effects of topiramate have been well documented in the pediatric population,[ 4 , 5 ] but case reports in the adult population are limited.[ 6 , 7 , 8 , 9 , 10 , 11 ] Published reports that evaluated topiramate-associated hyperchloremic, normal anion-gap, metabolic acidosis were identified via a MEDLINE search (1966-May 2007) and included six cases in adults. Search terms included topiramate, metabolic acidosis, Topamax, and hyperchloremia. The first case involved a 22-year-old mentally handicapped man with a history of recurrent respiratory infections who developed metabolic acidosis after four months of taking topiramate 800 mg daily for Lennox-Gastaut syndrome.[ 6 ] The patient had symptoms of fatigue, lethargy, hypotonia, and hyperventilation. His arterial blood gas revealed a pH of 7.3 (reference range, 7.35-7.45), and his serum bicarbonate concentration was 19 meq/L (reference range, 22-26 meq/L). Metabolic acidosis resolved after withdrawal of topiramate, although the authors di Continue reading >>

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  1. meriheart

    This was from a post by JulieRN on 9/5/06. She did such a great job, I wanted it here for the record.
    Metabolic Acidosis:
    Definition
    Metabolic acidosis is a pH imbalance in which the body has accumulated too much acid and does not have enough bicarbonate to effectively neutralize the effects of the acid.
    Description
    Metabolic acidosis, as a disruption of the body's acid/base balance, can be a mild symptom brought on by a lack of insulin, a starvation diet, or a gastrointestinal disorder like vomiting and diarrhea. Metabolic acidosis can indicate a more serious problem with a major organ like the liver, heart, or kidneys. It can also be one of the first signs of drug overdose or poisoning.
    Causes and symptoms
    Metabolic acidosis occurs when the body has more acid than base in it. Chemists use the term "pH" to describe how acidic or basic a substance is. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is a base; the higher the number, the stronger the base. Blood pH is slightly basic (alkaline), with a normal range of 7.36-7.44.
    Acid is a natural by-product of the breakdown of fats and other processes in the body; however, in some conditions, the body does not have enough bicarbonate, an acid neutralizer, to balance the acids produced. This can occur when the body uses fats for energy instead of carbohydrates. Conditions where metabolic acidosis can occur include chronic alcoholism, malnutrition, and diabetic ketoacidosis. Consuming a diet low in carbohydrates and high in fats can also produce metabolic acidosis. The disorder may also be a symptom of another condition like kidney failure, liver failure, or severe diarrhea. The build up of lactic acid in the blood due to such conditions as heart failure, shock, or cancer, induces metabolic acidosis. Some poisonings and overdoses (aspirin, methanol, or ethylene glycol) also produce symptoms of metabolic acidosis.
    In mild cases of metabolic acidosis, symptoms include headache, lack of energy, and sleepiness. Breathing may become fast and shallow. Nausea, vomiting, diarrhea, dehydration, and loss of appetite are also associated with metabolic acidosis. Diabetic patients with symptoms of metabolic acidosis may also have breath that smells fruity. The patient may lose consciousness or become disoriented. Severe cases can produce coma and death.
    Diagnosis
    Metabolic acidosis is suspected based on symptoms, but is usually confirmed by laboratory tests on blood and urine samples. Blood pH below 7.35 confirms the condition. Levels of other blood components, including potassium, glucose, ketones, or lactic acid, may also be above normal ranges. The level of bicarbonate in the blood will be low, usually less than 22 mEq/L. Urine pH may fall below 4.5 in metabolic acidosis.
    Treatment
    Treatment focuses first on correcting the acid imbalance. If the patient is diabetic, insulin may be administered. Drugs to regulate blood pressure or heart rate, to prevent seizures, or to control nausea and vomiting might be given. Vital signs like pulse, respiration, blood pressure, and body temperature will be monitored. The underlying cause of the metabolic acidosis must also be diagnosed and corrected.
    OK, THAT WAS A DIRECT QUOTE OF METABOLIC ACIDOSIS, NOW LET ME TELL YOU THE DIFFERENCE BETWEEN THAT AND KETO-ACIDOSIS (DIET CAUSED).
    First let me differentiate between Metabolic Acidosis and Keto-Acidosis. BIG DIFFERENCE!!!
    Metabolic Acidosis is a life threatening state that if left untreated can cause death. Yes, Topamax had an alert on 12/18/03 by the FDA added that it "can cause decreased serum bicarbonate" as a risk (this is Metabolic Acidosis). However, this is really only to alert patients that have a predisposed medical condition that puts them at risk of metabolic acidosis already such as: Diabetics, renal disease, respiratory disorders, status epilepticus, diarrhea, vomiting, surgery, or a ketogenic diet (such as Atkins). Here is a link to define Metabolic Acidosis: www.findarticles.com/p/ar...2601000894
    If one is in Metabolic Acidosis for a long period of time undiagnosed it can result in Kidney stones, ostolysis (bone) (which might be something our members that are complaining of bone pain might want to get checked out for). Severe can cause respiratory failure or death. Metabolic Acidosis is a side effect of keto-acidosis, but by itself, in no way causes weight loss.
    Now for the Keto-Acidosis. This is a state that one goes into to cause weight loss. This is the Atkins diet theory. Low carb, high protein. It is similar (but not exact) to what happens to a diabetic when they are in Diabetic Ketosis, however we "cause" it to happen by our diet. Topamax DOES NOT CAUSE THIS. This can only be brought on by diet or starvation. Again, Metabolic Acidosis is a side effect when we are in Keto-Acidosis. We need to watch for the severe signs and symptoms while in this state. Keto-Acidosis CAUSES WEIGHT LOSS. Our body uses carbs for energy, when we don't have them our body then uses fat. The bi-product when we are (burning) using fat is Ketones in our urine. Thus - Keto-Acidosis.
    In general: Topamax does not cause one to go into Metabolic Acidosis (for the most part) but it can be a risk to some patients. Metabolic Acidosis DOES NOT cause weight loss. It can be life threatening if severe, and should be monitored for periodically by your PCP while on Topamax.
    Keto-Acidosis is the Atkins type of Acidosis that most people are familiar with. NO Topamax does not cause this either. Diet is the only thing that can bring this state on. Being in Keto-Acidosis puts you at increased risk of Metabolic Acidosis.
    I hope I was able to explain this so everyone was able to understand, if not let me know. I will try again!!!
    Julie
    >

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Isolation precautions nursing mnemonics (contact, droplet, airborne precautions) for the NCLEX exam. In this video, I will give you 3 easy to remember isolation precaution mnemonics that will help you remember the diseases that are included in droplet, contact, and airborne precautions ALONG with what type of special PPE (personal protective equipment) you must wear at all time while following standard precautions. Be sure to watch the video to find out the mnemonics and don't forget to take the isolation precautions free NCLEX review quiz. Isolation Precautions Review Quiz: http://www.registerednursern.com/isol... Lecture Notes: http://www.registerednursern.com/isol... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Nursing Job Search: http://www.registerednursern.com/nurs... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... All of our videos in a playlist: https://www.youtube.com/watch?v=pAhHx... Popular Playlists: NCLEX Reviews: https://www.youtube.com/playlist?list... Fluid & Electrolytes: https://www.youtube.com/playlist?list... Nursing Skills: https://www.youtube.com/playlist?list... Nursing School Study Tips: https://www.youtube.com/playlist?list... Nursing School Tips & Questions" https://www.youtube.com/playlist?list... Teaching Tutorials: https://www.youtube.com/playlist?list... Types of Nursing Specialties: https://www.youtube.com/playlist?list... Healthcare Salary Information: https://www.youtube.com/playlist?list... New Nurse Tips: https://www.youtube.com/playlist?list... Nursing Career Help: https://www.youtube.com/playlist?list... EKG Teaching Tutorials: https://www.youtube.com/playlist?list... Personality Types: https://www.youtube.com/playlist?list... Dosage & Calculations for Nurses: https://www.youtube.com/playlist?list... Diabetes Health Managment: https://www.youtube.com/playlist?list...

Topamax Precautions And Warnings

Join the conversation. register now or log in Topamax can have a drug interaction with other medicines or not be a good drug for you if you have certain medical conditions. Its important to know all of the medicines that you or your family member takes. Use the migraine journal to keep a list of all medicines to share with your doctor. Only your doctor can prescribe prescription medicines for you. Do not stop taking any medicine without speaking to your doctor. Topamax can cause serious side effects including: Hyperammonemia (high levels of ammonia in the blood) Metabolic acidosis (increased acid levels in the body) Encephalopathy (brain disease, damage, or other problems) Secondary angle closure glaucoma (fluid buildup inside of the eye, which can lead to blindness) Sudden problems with vision (difficulty seeing clearly) Learn about Topamax and Serious Eye Problems (including Open Angle Glaucoma) Have an extreme sensitivity to topiramate (the active ingredient in Topamax formulations). This could lead to reactions from severe itching and hives to potentially deadly shock. Topamax should be used with caution if you: Have or have had kidney problems, including kidney stones People Continue reading >>

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Popular Questions

  1. meriheart

    This was from a post by JulieRN on 9/5/06. She did such a great job, I wanted it here for the record.
    Metabolic Acidosis:
    Definition
    Metabolic acidosis is a pH imbalance in which the body has accumulated too much acid and does not have enough bicarbonate to effectively neutralize the effects of the acid.
    Description
    Metabolic acidosis, as a disruption of the body's acid/base balance, can be a mild symptom brought on by a lack of insulin, a starvation diet, or a gastrointestinal disorder like vomiting and diarrhea. Metabolic acidosis can indicate a more serious problem with a major organ like the liver, heart, or kidneys. It can also be one of the first signs of drug overdose or poisoning.
    Causes and symptoms
    Metabolic acidosis occurs when the body has more acid than base in it. Chemists use the term "pH" to describe how acidic or basic a substance is. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is a base; the higher the number, the stronger the base. Blood pH is slightly basic (alkaline), with a normal range of 7.36-7.44.
    Acid is a natural by-product of the breakdown of fats and other processes in the body; however, in some conditions, the body does not have enough bicarbonate, an acid neutralizer, to balance the acids produced. This can occur when the body uses fats for energy instead of carbohydrates. Conditions where metabolic acidosis can occur include chronic alcoholism, malnutrition, and diabetic ketoacidosis. Consuming a diet low in carbohydrates and high in fats can also produce metabolic acidosis. The disorder may also be a symptom of another condition like kidney failure, liver failure, or severe diarrhea. The build up of lactic acid in the blood due to such conditions as heart failure, shock, or cancer, induces metabolic acidosis. Some poisonings and overdoses (aspirin, methanol, or ethylene glycol) also produce symptoms of metabolic acidosis.
    In mild cases of metabolic acidosis, symptoms include headache, lack of energy, and sleepiness. Breathing may become fast and shallow. Nausea, vomiting, diarrhea, dehydration, and loss of appetite are also associated with metabolic acidosis. Diabetic patients with symptoms of metabolic acidosis may also have breath that smells fruity. The patient may lose consciousness or become disoriented. Severe cases can produce coma and death.
    Diagnosis
    Metabolic acidosis is suspected based on symptoms, but is usually confirmed by laboratory tests on blood and urine samples. Blood pH below 7.35 confirms the condition. Levels of other blood components, including potassium, glucose, ketones, or lactic acid, may also be above normal ranges. The level of bicarbonate in the blood will be low, usually less than 22 mEq/L. Urine pH may fall below 4.5 in metabolic acidosis.
    Treatment
    Treatment focuses first on correcting the acid imbalance. If the patient is diabetic, insulin may be administered. Drugs to regulate blood pressure or heart rate, to prevent seizures, or to control nausea and vomiting might be given. Vital signs like pulse, respiration, blood pressure, and body temperature will be monitored. The underlying cause of the metabolic acidosis must also be diagnosed and corrected.
    OK, THAT WAS A DIRECT QUOTE OF METABOLIC ACIDOSIS, NOW LET ME TELL YOU THE DIFFERENCE BETWEEN THAT AND KETO-ACIDOSIS (DIET CAUSED).
    First let me differentiate between Metabolic Acidosis and Keto-Acidosis. BIG DIFFERENCE!!!
    Metabolic Acidosis is a life threatening state that if left untreated can cause death. Yes, Topamax had an alert on 12/18/03 by the FDA added that it "can cause decreased serum bicarbonate" as a risk (this is Metabolic Acidosis). However, this is really only to alert patients that have a predisposed medical condition that puts them at risk of metabolic acidosis already such as: Diabetics, renal disease, respiratory disorders, status epilepticus, diarrhea, vomiting, surgery, or a ketogenic diet (such as Atkins). Here is a link to define Metabolic Acidosis: www.findarticles.com/p/ar...2601000894
    If one is in Metabolic Acidosis for a long period of time undiagnosed it can result in Kidney stones, ostolysis (bone) (which might be something our members that are complaining of bone pain might want to get checked out for). Severe can cause respiratory failure or death. Metabolic Acidosis is a side effect of keto-acidosis, but by itself, in no way causes weight loss.
    Now for the Keto-Acidosis. This is a state that one goes into to cause weight loss. This is the Atkins diet theory. Low carb, high protein. It is similar (but not exact) to what happens to a diabetic when they are in Diabetic Ketosis, however we "cause" it to happen by our diet. Topamax DOES NOT CAUSE THIS. This can only be brought on by diet or starvation. Again, Metabolic Acidosis is a side effect when we are in Keto-Acidosis. We need to watch for the severe signs and symptoms while in this state. Keto-Acidosis CAUSES WEIGHT LOSS. Our body uses carbs for energy, when we don't have them our body then uses fat. The bi-product when we are (burning) using fat is Ketones in our urine. Thus - Keto-Acidosis.
    In general: Topamax does not cause one to go into Metabolic Acidosis (for the most part) but it can be a risk to some patients. Metabolic Acidosis DOES NOT cause weight loss. It can be life threatening if severe, and should be monitored for periodically by your PCP while on Topamax.
    Keto-Acidosis is the Atkins type of Acidosis that most people are familiar with. NO Topamax does not cause this either. Diet is the only thing that can bring this state on. Being in Keto-Acidosis puts you at increased risk of Metabolic Acidosis.
    I hope I was able to explain this so everyone was able to understand, if not let me know. I will try again!!!
    Julie
    >

  2. -> Continue reading
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Topiramate Induces Type 3 Renal Tubular Acidosis By Inhibiting Renal Carbonic Anhydrase

Topiramate induces type 3 renal tubular acidosis by inhibiting renal carbonic anhydrase Nephrology Dialysis Transplantation, Volume 21, Issue 10, 1 October 2006, Pages 29952996, Anne Sacr, Franois Jouret, Daniel Manicourt, Olivier Devuyst; Topiramate induces type 3 renal tubular acidosis by inhibiting renal carbonic anhydrase, Nephrology Dialysis Transplantation, Volume 21, Issue 10, 1 October 2006, Pages 29952996, We report a case of mixed (type 3) renal tubular acidosis (RTA) associated with the anti-convulsant drug topiramate used for migraine prophylaxis. A 47-year-old woman treated with topiramate (150 mg/day) since 12 months for invalidating migraine was referred for a metabolic acidosis evidenced in a routine blood sampling. She complained of muscle weakness and bone pain. Clinical examination showed weight loss (6 kg in 4 months) and joint sensitivity. Blood analyses confirmed a mild hyperchloraemic metabolic acidosis (plasma , 19.0 mEq/l; plasma anion gap, 8 mEq/l) with hypokalaemia (3.2 mEq/l) and normal renal function. Plasma before topiramate administration was normal. The urine pH was 6.0 with a positive urinary anion gap (UAG, +39 mEq/day), positive 2 -microglobulinu Continue reading >>

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Popular Questions

  1. meriheart

    This was from a post by JulieRN on 9/5/06. She did such a great job, I wanted it here for the record.
    Metabolic Acidosis:
    Definition
    Metabolic acidosis is a pH imbalance in which the body has accumulated too much acid and does not have enough bicarbonate to effectively neutralize the effects of the acid.
    Description
    Metabolic acidosis, as a disruption of the body's acid/base balance, can be a mild symptom brought on by a lack of insulin, a starvation diet, or a gastrointestinal disorder like vomiting and diarrhea. Metabolic acidosis can indicate a more serious problem with a major organ like the liver, heart, or kidneys. It can also be one of the first signs of drug overdose or poisoning.
    Causes and symptoms
    Metabolic acidosis occurs when the body has more acid than base in it. Chemists use the term "pH" to describe how acidic or basic a substance is. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is a base; the higher the number, the stronger the base. Blood pH is slightly basic (alkaline), with a normal range of 7.36-7.44.
    Acid is a natural by-product of the breakdown of fats and other processes in the body; however, in some conditions, the body does not have enough bicarbonate, an acid neutralizer, to balance the acids produced. This can occur when the body uses fats for energy instead of carbohydrates. Conditions where metabolic acidosis can occur include chronic alcoholism, malnutrition, and diabetic ketoacidosis. Consuming a diet low in carbohydrates and high in fats can also produce metabolic acidosis. The disorder may also be a symptom of another condition like kidney failure, liver failure, or severe diarrhea. The build up of lactic acid in the blood due to such conditions as heart failure, shock, or cancer, induces metabolic acidosis. Some poisonings and overdoses (aspirin, methanol, or ethylene glycol) also produce symptoms of metabolic acidosis.
    In mild cases of metabolic acidosis, symptoms include headache, lack of energy, and sleepiness. Breathing may become fast and shallow. Nausea, vomiting, diarrhea, dehydration, and loss of appetite are also associated with metabolic acidosis. Diabetic patients with symptoms of metabolic acidosis may also have breath that smells fruity. The patient may lose consciousness or become disoriented. Severe cases can produce coma and death.
    Diagnosis
    Metabolic acidosis is suspected based on symptoms, but is usually confirmed by laboratory tests on blood and urine samples. Blood pH below 7.35 confirms the condition. Levels of other blood components, including potassium, glucose, ketones, or lactic acid, may also be above normal ranges. The level of bicarbonate in the blood will be low, usually less than 22 mEq/L. Urine pH may fall below 4.5 in metabolic acidosis.
    Treatment
    Treatment focuses first on correcting the acid imbalance. If the patient is diabetic, insulin may be administered. Drugs to regulate blood pressure or heart rate, to prevent seizures, or to control nausea and vomiting might be given. Vital signs like pulse, respiration, blood pressure, and body temperature will be monitored. The underlying cause of the metabolic acidosis must also be diagnosed and corrected.
    OK, THAT WAS A DIRECT QUOTE OF METABOLIC ACIDOSIS, NOW LET ME TELL YOU THE DIFFERENCE BETWEEN THAT AND KETO-ACIDOSIS (DIET CAUSED).
    First let me differentiate between Metabolic Acidosis and Keto-Acidosis. BIG DIFFERENCE!!!
    Metabolic Acidosis is a life threatening state that if left untreated can cause death. Yes, Topamax had an alert on 12/18/03 by the FDA added that it "can cause decreased serum bicarbonate" as a risk (this is Metabolic Acidosis). However, this is really only to alert patients that have a predisposed medical condition that puts them at risk of metabolic acidosis already such as: Diabetics, renal disease, respiratory disorders, status epilepticus, diarrhea, vomiting, surgery, or a ketogenic diet (such as Atkins). Here is a link to define Metabolic Acidosis: www.findarticles.com/p/ar...2601000894
    If one is in Metabolic Acidosis for a long period of time undiagnosed it can result in Kidney stones, ostolysis (bone) (which might be something our members that are complaining of bone pain might want to get checked out for). Severe can cause respiratory failure or death. Metabolic Acidosis is a side effect of keto-acidosis, but by itself, in no way causes weight loss.
    Now for the Keto-Acidosis. This is a state that one goes into to cause weight loss. This is the Atkins diet theory. Low carb, high protein. It is similar (but not exact) to what happens to a diabetic when they are in Diabetic Ketosis, however we "cause" it to happen by our diet. Topamax DOES NOT CAUSE THIS. This can only be brought on by diet or starvation. Again, Metabolic Acidosis is a side effect when we are in Keto-Acidosis. We need to watch for the severe signs and symptoms while in this state. Keto-Acidosis CAUSES WEIGHT LOSS. Our body uses carbs for energy, when we don't have them our body then uses fat. The bi-product when we are (burning) using fat is Ketones in our urine. Thus - Keto-Acidosis.
    In general: Topamax does not cause one to go into Metabolic Acidosis (for the most part) but it can be a risk to some patients. Metabolic Acidosis DOES NOT cause weight loss. It can be life threatening if severe, and should be monitored for periodically by your PCP while on Topamax.
    Keto-Acidosis is the Atkins type of Acidosis that most people are familiar with. NO Topamax does not cause this either. Diet is the only thing that can bring this state on. Being in Keto-Acidosis puts you at increased risk of Metabolic Acidosis.
    I hope I was able to explain this so everyone was able to understand, if not let me know. I will try again!!!
    Julie
    >

  2. -> Continue reading
read more

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