USING TOPIRAMATE IN PATIENTS WITH EPILEPSY - PRACTICAL ASPECTS

Clinical trials are important in determining the relative efficacy and safety of a new antiepileptic drug (AED); however, experience acquire d in clinical practice will eventually determine its position in the a ntiepileptic armamentarium. Topiramate (TPM), a new AED has been avail able in the United Kingdom since mid-1995 and a considerable number of patients have being treated. As a result of this experience, a number of changes have being made in the way TPM is used, particularly in th e starting doses and titration rates. This seems to have improved pati ents' tolerability of treatment, an important consideration if a drug is to be used to its optimum level, in this article, practical tips fo r the use of TPM are given and these include starting doses, titration rates, options for managing side effects occurring early in treatment , advice concerning the withdrawal of concomitant AEDs and indications for discontinuation of TPM. The need for adequate patient counseling regarding potential side effects and expectations of treatment is also reviewed.