Topiramate and Death
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Topiramate and Death

Q: I am interested in learning about Topamax, but I have seen some warnings about deaths being possible related to it. Do you have any information regarding this? The only information I saw at your site [Dr. Ivan's, she's referring to] regarding Topamax and death was for overdosing on the medication.

Hello Lisa
If you read this link from Dr. Ivan, then you know most of we really know so far, including re: risk.  Searching (using PUB MED, which you can do too) "topiramate fatalities" yielded no results; "topiramate risks" came up with the following abstract, among others.

Anticonvulsant hypersensitivity syndrome, a potentially fatal but rare reaction, manifests as rash, fever, tender lymphadenopathy, hepatitis, and eosinophilia. To manage hypersensitivity syndrome successfully, one must recognize the symptoms early, stop the offending drug immediately, and substitute a safe, alternative anticonvulsant medication. Hypersensitivity syndrome has not been described in patients taking benzodiazepines or the newer anticonvulsants gabapentin or topiramate, and these appear to be safe substitutes for drugs that cause the reaction.
Another search using Google for "topiramate death" yielded this list of adverse events. Note that this is the part of the list that refers to events occurring at less than 1% frequency, with no placebo comparison of frequency.  That means you don't really know whether "sudden death", which is on the list as "rare", is from topiramate or not -- people do just keel over now and then, unfortunately, even on no med's.  The link for the whole text of what follows is .
Other Adverse Events Observed During All Clinical Trials

Events are classified within body system categories and enumerated in order of decreasing frequency using the following definitions: frequent occurring in at least 1/100 patients; infrequent occurring in 1/100 to 1/1000 patients; rare occurring in fewer than 1/1000 patients

Body as a Whole: Frequent: fatigue, fever, malaise. Infrequent: syncope, halitosis, abdomen enlarged. Rare: alcohol intolerance, substernal chest pain, sudden death.

There -- now you know as much as any psychiatrist whom you might see would know.  Try those approaches to get similar information on other drugs in the future.

Dr. Phelps

Published November, 2000

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