AI Article Synopsis
- The study aimed to analyze metabolic issues in patients taking topiramate and how these issues may change after stopping the drug.
- A review of medical records identified 93 patients; results showed that while on topiramate, patients had lower citrate levels and higher urinary pH, increasing their risk for calcium phosphate stones.
- After discontinuing topiramate, patients showed significant improvements in citrate excretion and normalization of pH, indicating that these metabolic disturbances can reverse once the medication is stopped.
Article Abstract
Objective: To understand the metabolic disturbances of stone formers currently taking topiramate and to examine the reversibility of these disturbances with cessation of the medication.
Materials And Methods: All progress notes written by 5 endourologists from a single academic center were retrospectively reviewed from January 2010 to July 2020 containing the words "topiramate" or "topamax." Inclusion criteria were age >18 and presence of either a 24-hour urine sample or stone analysis while on topiramate. In addition, a subgroup of 18 patients with 24-hour urine samples before and after stopping topiramate were identified.
Results: A total of 93 patients were identified and included for final analysis. Twenty-four hour urine samples were available in 67 patients and showed mean citrate excretion of 331 ± 322 mg/d, mean pH of 6.6 ± 0.5, and mean calcium phosphate supersaturation of 1.9 ± 1.1. In the subgroup analysis urinary citrate excretion increased from 225 mg/d to 614 mg/d (P <.01) and pH decreased from 6.59 ± 0.54 to 6.33 ± 0.47 (P = .06) after stopping topiramate. In addition, 114 stone events occurred in 73 distinct patients, with 50% of stones either pure or majority (≥50%) calcium phosphate by composition.
Conclusion: Hypocitraturia and elevated pH is seen during topiramate use with resultant higher rate of calcium phosphate stone formation compared to the general population. Stopping topiramate leads to significant increase in citrate excretion and normalization of pH. These metabolic disturbances appear to be reversible with medication cessation.
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| http://dx.doi.org/10.1016/j.urology.2022.01.027 | DOI Listing |
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