Possible removal of topiramate by continuous renal replacement therapy.
BACKGROUND
Topiramate is primarily renally eliminated and requires dosage adjustment based upon renal function. While there is data to suggest drug removal during intermittent hemodialysis (IHD), little is known regarding its clearance and dosing during continuous renal replacement therapy (CRRT).


METHODS
We describe a 59-year-old man with refractory status epilepticus who was started on continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure while receiving topiramate with a series of serum concentrations to assess for removal during CVVHDF.


CONCLUSIONS
Our data suggest clinically important amounts of topiramate are removed by CRRT, and higher topiramate dosage may be needed for these patients instead of the current recommended 50% of normal dosage. Unfortunately, there is no antiepileptic drug dosing recommendation when used during CRRT due to the paucity of data. This case highlights a need for research evaluating the effect of CRRT on AED elimination in order to optimize therapy for seizure control.
Browning
Linda
L
Detroit Receiving Hospital, Department of Pharmacy, Detroit, Michigan, USA.
Parker
Dennis
D
Liu-DeRyke
Xi
X
Shah
Aashit
A
Coplin
William M
WM
Rhoney
Denise H
DH
D000927:Anticonvulsants / Q000378:metabolism* / Q000627:therapeutic use; D003128:Coma / Q000209:etiology; D004351:Drug Resistance; D004569:Electroencephalography; D017809:Fatal Outcome; D005632:Fructose / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D006440:Hemofiltration / Q000009:adverse effects*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D013226:Status Epilepticus / Q000188:drug therapy; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose