Topamax Dosage Question

[Guest]

I dont think I have seen an answer regarding dosing up dated 7/1/05. I am rather petite and was wondering if it is necessary to go all the way up in mgs.

I am starting to feel very numb all over. I had been doing well on 150mg. I did however go up to 200mg and on my 3rd day started to feel my entire face go numb. It is very odd. I also feel my feet as well as my hands numb/tingle which have been a side effect for awhile now as well. The face has been just a bit odd though. Well should I stick to the dosing up anyway or drop back to the 150mg? My Nurse Practictioner has very little experience with topamax and would like all the help she can get. thanks sonya

[Guest]

Topamax Dosage Question

Hi, Sonya.

Sorry your questions went unanswered for this long.

Tingling of the extremities is a well documented side effect of topiramate and usually passes. Are you still experiencing this problem with your face? I think it would be fine to hold at your current level or even decrease to a lower dose, particularly given your weight, and see how you feel. Topamax does have a variety of symptoms that we try to minimize while you get the benefit of receptor control so the cravings can be held in check.

Are you working all elements of the program: hypnotherapy tapes as advised, exercise, kudzu, avoiding sugar? Topamax provides a strong, basic foundation to give that extra control in balancing the glutamate and GABA in the brain. However, I have noticed that some of my patients de-emphasize the critical core and put too much focus on Topamax titration. It is not necessary to achieve the full 300 mg. dosing, particularly if you are experiencing ill effects, so long as the other elements of the program are adhered to.

About the 12 week study: you are probably aware that Topamax does not cure this disease and I advise those who believe that to be true to rethink their relationship with alcohol. I also encourage both patients and physicians to review Chapter Six of the My Way Out book regarding long term maintenance. I also stated in the foreword that my mother, who battled alcohol addiction, forgot late in life who her daughter was, but she never lost the desire for that "little drink". This is a lifelong program.

Also keep in mind that Topamax is not the only drug known for its effectiveness in the medical treatment of alcohol dependence. Naltrexone is available in oral form and in a one-month injection with or without Acamprosate (Campral). If you find the side effects of topiramate too harsh, you may wish to substitute with one of the other meds.

Thanks for the questions and good luck to you.

--Dr. Garcia