title: Clinical experience with topiramate dosing and serum levels in children 12 years or under with epilepsy.
abstract: Only a limited topiramate dosing range (5-9 mg/kg/day) is approved by the U.S. Food and Drug Administration (FDA). We reviewed our topiramate dosing (mg/kg/d) and corresponding serum levels (microg/mL) (n = 77) in 41 children who were treated to clinical response or tolerability. The patients were divided into older (6-12 years [n = 21]) and younger (< or = 5 years [n = 20]) groups. Topiramate was given as monotherapy (n = 9), with an enzyme-inducing antiepileptic drug (n = 16) (phebarbital, phenytoin, or carbamazepine), or as polytherapy (n =17) (another antiepileptic drug). In the older children, there was a good dosage to serum level correspondence. However, younger children on topiramate monotherapy or cotherapy with an enzyme-inducing antiepileptic drug had relatively lower serum levels, but the serum level was increased if they were on polytherapy without an enzyme-inducing drug. This study supports a wider dosing range (7-22 mg/kg/day) of topiramate and dosage escalation beyond the approved range. Serum levels are useful in guiding topiramate dosing, especially in young children.
authors.affiliation: Texas Comprehensive Epilepsy Program, Department of Neurology, University of Texas-Houston, 77030, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Schwabe
authors.forename: J W
authors.initials: JW
authors.lastname: Wheless
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D002648:Child; D016903:Drug Monitoring; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D000077236:Topiramate
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose