Topamax caused psychosis in brother & sister; 75 mg twice a day in one, 25 mg twice a day the other

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Friday, June 06, 2008 7:37 am Email this article
Topamax (topiramate) can cause psychosis, that is a break from reality, according to a case report of a brother and sister who both experienced this side effect of the drug. The women were from a family with a history of familial essential tremor. 46-Year-Old Man

46-year-old man went to the emergency room with visual hallucinations and paranoid delusions for 8 days

The case report was of a 46-year-old man who went to the emergency medical assessment unit after having visual hallucinations and paranoid delusions for eight days.

He had a medical history of essential tremor that was being treated with Topamax (topiramate).

 

No History of Psychiatric Problems

He had no history of psychiatric symptoms

He had no history of psychiatric problems.

 

Symptoms Started

Symptoms started 2 days after reaching a dose of 75 mg twice a day

He had been slowly increasing his dose of the drug over the previous three months, and the psychosis began two days after he reached a dose of 75 mg twice a day ( 150 mg per day ).

 

Fully Recovered After One Week

He had fully recovered one week after stopping the drug

One week after stopping the drug, he had fully recovered and back to his normal self, and was discharged from the hospital.

 

Sister Had Psychosis Also

His sister experienced psychosis while taking the drug

When discussing what happened with the man, he noted that his sister had developed visual halucination while taking 25 mg twice a day ( 50 mg per day ) to prevent migraine headaches.

 

Risk of Psychosis Higher In Those With History of Psychosis

A history of psychiatric symptoms is a strong predictor of psychiatric adverse events

“The risk of this side effect may be greater in the general population as studies of topiramate exclude patients with past psychiatric history, and past psychiatric history is the strongest predictor for psychiatric adverse events,” the doctors noted.

 

Risk of Psychosis 6-12 Times Higher In Epileptics

A history of psychiatric symptoms is a strong predictor of psychiatric adverse events

“However, the risk of developing psychosis in patients with epilepsy is 6 to 12 times higher than in patients without epilepsy.”

 

Starting Dose

Starting dose and how slowly the dose in increased also predicts psychiatric adverse events

“There have been several other potential predictors of psychiatric adverse events investigated, such as starting dose and titration schedule,” the doctors went on to say.

“Our patient received the standard dose and titration, starting at 25 mg per day and increased in increments of 25 mg.”

REFERENCE

Jose RJP, Cairns A, Babbs C. Topiramate-induced psychosis in two members of the one family: A case report. Journal of Medical Case Reports. 2008 Jun 06, 2:195. http://www.jmedicalcasereports.com/content/2/1/195.

AUTHOR’S CONTACT INFORMATION

Ricardo Jorge Paixao Jose
Department of Medicine
Salford Royal NHS Foundation Trust
Stott Lane, Salford, M6 8HD, UK

Ricardo Jorge Paixao Jose
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Alastair Cairns
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Christopher Babbs
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Articles on the same subject can be found here:

• Topamax (topiramate)