- Most commonly, topiramate immediate release tablets and sprinkles are started in low doses, 25 or 50 mg per day, and then increased slowly by 25 to 50 mg per week until an effective daily dose is reached for treatment of seizures. For children 10 years or older and adults the dose may be increased by 100 mg in week 5 and 6 when topiramate is used alone. This slow approach to treatment reduces side effects. The recommended final adult dose is 200-400 mg administered as two divided doses daily.
- In children, the starting dose is up to 25 mg (1 to 3 mg/kg/day), taken nightly for the first week. The dose is then increased at 1 or 2 week intervals by 1 to 3 mg/kg/day administered in two divided doses. The target dose is 5 to 9 mg/kg per day in two divided doses.
- Migraine is treated 25 mg nightly for the first week then increased by 25 mg weekly up to a maximum dose of 100 mg administered in two divided doses.
- Patients should maintain an adequate fluid intake in order to minimize the risk of kidney stones.
- The recommended dose for extended release capsules is 200-400 mg once daily.
NURSING MOTHERS: Topiramate is excreted in human milk at levels 10% to 20% the levels in the mother's blood.
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