Topiramate is a recently developed antiepileptic medication that is becoming more widely prescribed because of its efficacy in treating refractory seizures. Urologists should be aware that this medication can cause metabolic acidosis in patients secondary to inhibition of carbonic anhydrase. In addition, a distal tubular acidification defect may result, thus impairing the normal compensatory drop in urine pH. These factors can lead to the development of calcium phosphate nephrolithiasis. We report the first two cases of topiramate-induced nephrolithiasis in the urologic literature.
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Topiramate and metabolic acidosis: an evolving story.
Hosp Pract (1995)
December 2017
a Harvard Medical School , Massachusetts General Hospital, Boston , MA , USA.
Topiramate is an anticonvulsant that is being increasingly used for a number of different off-label indications. Its inhibition of carbonic anhydrase isoenzymes can lead to metabolic acidosis, elevated urine pH, reduced urine citrate, and hypercalciuria, thereby creating a milieu that is ripe for calcium phosphate stone formation. In this review, we describe a case of topiramate-induced metabolic acidosis.
View Article and Find Full Text PDFTopiramate induced metabolic acidosis and kidney stones - a case study.
Biochem Med (Zagreb)
June 2017
Department of Clinical Biochemistry, Tomas Bata Hospital in Zlín a. s., Zlín, Czech Republic.
Introduction: The aim of this study is to present a case of 44 years old woman with topiramate induced metabolic acidosis and kidney stones.
Materials And Methods: The laboratory features of topiramate caused renal tubular acidosis in blood and urine during topiramate treatment, with correction of metabolic acidosis by potassium citrate, and after topiramate withdrawal are presented. Differential diagnosis of all possible causes of metabolic acidosis is discussed.
Alkali replacement raises urinary citrate excretion in patients with topiramate-induced hypocitraturia.
Br J Clin Pharmacol
January 2016
Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Aims: The aims of this study were to assess (1) the magnitude and temporality of decreased urinary citrate excretion in patients just starting topiramate and (2) the effect of alkali replacement on topiramate-induced hypocitraturia.
Methods: Study 1 was a prospective, non-intervention study in which patients starting topiramate for headache remediation provided pre- and post-topiramate 24 h urine collections for measurement of urine citrate. Study 2 was a clinical comparative effectiveness study in which patients reporting to our stone clinic for kidney stones and who were treated with topiramate were prescribed alkali therapy.
Topiramate-induced nephrolithiasis.
Clin Case Rep
June 2015
Section Neuropediatrics, University Hospital of Saarland Homburg, Saarland, Germany.
Nephrolithiasis is a less common side effect of the antiepileptic drug topiramate. We report the case of a 3-year-old boy who presented to the emergency department with abdominal pain; examinations revealed a large calcification in the left kidney. Regular ultrasound examinations are recommended in children using topiramate.
View Article and Find Full Text PDFTopiramate is an approved drug to treat seizures, but its indications have been extended to other diseases of the nervous system and as an adjuvant to chronic pain. We present four cases of topiramate-induced nephrolithiasis from 2006-2012 in women whose treatment was prescribed for pain control and as a mood stabilizer at doses of 250-300 mg/day. In two cases, the lithiasis was caused by calcium phosphate (patite) and in the other two cases by oxalate and calcium phosphate.
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