{"id":52171,"date":"2023-09-20T09:30:00","date_gmt":"2023-09-20T09:30:00","guid":{"rendered":"https:\/\/medsname.com\/topamac\/"},"modified":"2026-05-01T10:49:12","modified_gmt":"2026-05-01T10:49:12","slug":"topamac","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/topamac\/","title":{"rendered":"Topamac"},"content":{"rendered":"

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\u26a1 R\u0103spuns rapid \u2014 Topamac \u2014 topiramat 25 mg \/ 50 mg, anticonvulsivant cu multiple indica\u021bii<\/h3>\n

Topamac con\u021bine topiramat 25 mg \/ 50 mg, un anticonvulsivant autorizat pentru epilepsie \u0219i profilaxia migrenei<\/strong> \u0219i utilizat off-label \u00een tulbur\u0103rile de consum de alcool, managementul ponderii \u0219i tulburarea de alimentare compulsiv\u0103<\/strong>. Titrare lent\u0103 (cre\u0219teri s\u0103pt\u0103m\u00e2nale de 25 mg) pe 8 s\u0103pt\u0103m\u00e2ni limiteaz\u0103 efectele secundare cognitive (\u201ctopa-dopa\u201d). Ajustat la func\u021bia renal\u0103. Riscul de malforma\u021bii orale (fisura palatina) \u00een sarcin\u0103. Monitoriza\u021bi apari\u021bia pietrelor renale, glaucom, acidoz\u0103 metabolic\u0103.<\/p>\n<\/div>\n

\nCe beneficii ofer\u0103 MedsBase:<\/strong> Produc\u0103tor certificat WHO-GMP \u00b7 Ambalaj discret \u00b7 Livrare la nivel mondial \u00b7 Peste 1.400 de recenzii verificate ale clien\u021bilor<\/a>\n<\/div>\n

\ud83d\udce6 Fiecare comand\u0103 este acoperit\u0103 de politica noastr\u0103 de Politica noastr\u0103 de Reexpediere Garantat\u0103<\/strong><\/a> \u2014 dac\u0103 coletul dumneavoastr\u0103 nu sose\u0219te \u00een 20 de zile lucr\u0103toare, \u00eel relivr\u0103m.<\/p>\n

De ce s\u0103 comanzi de la MedsBase<\/h3>\n

Medicamentele noastre generice sunt procurate de la produc\u0103tori certifica\u021bi WHO-GMP \u0219i expediate la nivel mondial \u00een ambalaje discrete \u0219i simple \u2014 f\u0103r\u0103 denumirea medicamentului pe exteriorul coletului. Pl\u0103\u021bile cu cardul sunt procesate printr-un procesor reglementat (descrierile de pe extrasul de cont includ un procesor de pl\u0103\u021bi cu card reglementat \u2014 niciodat\u0103 \u201cMedsBase\u201d sau numele vreunui medicament). Accept\u0103m \u0219i criptomonede \u0219i transferuri bancare SEPA. Fiecare comand\u0103 este sus\u021binut\u0103 de Politica noastr\u0103 de Asigurare pentru Relivrare.<\/p>\n

Ce este Topamac?<\/h2>\n

Topamac este un anticonvulsivant cu multiple indica\u021bii care con\u021bine topiramat 25 mg \/ 50 mg<\/strong> (comprimate filmate), furnizat de Cipla. Este autorizat la adul\u021bi \u0219i copii pentru crizele par\u021biale \u0219i crizele tonico-clonice generalizate<\/strong> (monoterapie sau adjunctiv) \u0219i pentru profilaxia migrenei<\/strong>. Dovezi off-label sus\u021bin utilizarea \u00een tulburarea de consum de alcool, tulburarea de alimenta\u021bie compulsiv\u0103, hipertensiunea intracranian\u0103 idiopatic\u0103, tremorul esen\u021bial \u0219i tulburarea bipolar\u0103<\/strong> \u2014 de\u0219i cele mai solide dovezi neautorizate sunt pentru TCA (Johnson 2007).<\/p>\n

Cum ac\u021bioneaz\u0103 topiramatul<\/h2>\n

Topiramatul are multiple ac\u021biuni complementare \u00een SNC:<\/p>\n

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  • Blocarea canalelor de sodiu<\/strong> \u2014 reduce excitabilitatea neuronal\u0103 (efect anticonvulsiv)<\/li>\n
  • Poten\u021bierea GABA-A<\/strong> la un site non-benzodiazepinic \u2014 cre\u0219te tonul inhibitor<\/li>\n
  • Antagonism la receptorii glutamat AMPA\/kainat<\/strong> \u2014 reduce neurotransmisia excitatorie; se consider\u0103 a fi principalul mecanism pentru efectul \u00een TCA<\/li>\n
  • Inhibarea anhidrazei carbonice<\/strong> \u2014 explic\u0103 profilul de efecte adverse: acidoz\u0103 metabolic\u0103, pietre renale \u0219i pierdere \u00een greutate<\/li>\n
  • Modularea canalului de calciu dependent de tensiune<\/strong><\/li>\n<\/ul>\n

    Combina\u021bia dintre antagonismul AMPA al glutamatului \u0219i poten\u021bierea GABA-A este considerat\u0103 a atenua circuitul dopaminergic de recompens\u0103 care determin\u0103 pofta de alcool \u0219i m\u00e2ncatul compulsiv \u2014 aceea\u0219i cale pe care naltrexonul o \u021binteste prin receptorii opioizi.<\/p>\n

    Cum se utilizeaz\u0103 Topamac<\/h2>\n

    Titrare lent\u0103 este esen\u021bial\u0103 \u2014 escaladarea rapid\u0103 produce efecte adverse cognitive inacceptabile (fenomenul \u201ctopa-dopa\u201d: dificult\u0103\u021bi \u00een g\u0103sirea cuvintelor, \u00eencetinire mintal\u0103, confuzie). Titrare standard de 8 s\u0103pt\u0103m\u00e2ni:<\/p>\n\n\n\n\n\n\n\n\n\n\n
    S\u0103pt\u0103m\u00e2na<\/th>\nDoza de diminea\u021b\u0103<\/th>\nDoza de sear\u0103<\/th>\nTotal zilnic<\/th>\n<\/tr>\n<\/thead>\n
    1<\/td>\n\u2014<\/td>\n25 mg<\/td>\n25 mg<\/td>\n<\/tr>\n
    2<\/td>\n25 mg<\/td>\n25 mg<\/td>\n50 mg<\/td>\n<\/tr>\n
    3<\/td>\n25 mg<\/td>\n50 mg<\/td>\n75 mg<\/td>\n<\/tr>\n
    4<\/td>\n50 mg<\/td>\n50 mg<\/td>\n100 mg<\/td>\n<\/tr>\n
    5\u20138<\/td>\ncre\u0219tere cu 25 mg\/s\u0103pt\u0103m\u00e2n\u0103<\/td>\ncre\u0219tere cu 25 mg\/s\u0103pt\u0103m\u00e2n\u0103<\/td>\np\u00e2n\u0103 la 200 mg\/zi<\/td>\n<\/tr>\n
    Doz\u0103 de \u00eentre\u021binere<\/td>\nvariaz\u0103<\/td>\nvariaz\u0103<\/td>\nvariaz\u0103 \u00een func\u021bie de indica\u021bie (vezi mai jos)<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n
    Indica\u021bie<\/th>\nDoza \u021bint\u0103 de \u00eentre\u021binere<\/th>\nNote<\/th>\n<\/tr>\n<\/thead>\n
    Profilaxia migrenei<\/td>\n50\u2013100 mg\/zi \u00een dou\u0103 doze divizate<\/td>\nAdesea eficient la 100 mg; doze mai mari cresc rata efectelor adverse f\u0103r\u0103 beneficii suplimentare semnificative<\/td>\n<\/tr>\n
    Epilepsie la adul\u021bi (adjuvant)<\/td>\n200\u2013400 mg\/zi \u00een dou\u0103 doze divizate<\/td>\n\u00centre\u021binere obi\u0219nuit\u0103; unii pacien\u021bi tolereaz\u0103 p\u00e2n\u0103 la 1.600 mg\/zi<\/td>\n<\/tr>\n
    Tulburare de consum de alcool (off-label)<\/td>\nTitrat la 200\u2013300 mg\/zi<\/td>\nOff-label<\/strong> \u2014 Studiul Johnson din 2007 a utilizat o doz\u0103 \u021bint\u0103 de 300 mg; doze mai mici (100\u2013150 mg) sunt uneori eficiente cu mai pu\u021bine efecte adverse cognitive<\/td>\n<\/tr>\n
    Tulburare de alimentare compulsiv\u0103 (off-label)<\/td>\n200\u2013400 mg\/zi<\/td>\nOff-label; exist\u0103 o combina\u021bie licen\u021biat\u0103 de FDA de fentermin\u0103+topiramat pentru pierderea \u00een greutate<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Lua\u021bi cu sau f\u0103r\u0103 alimente. Hidratarea adecvat\u0103 reduce substan\u021bial riscul de pietre la rinichi (\u021binti\u021bi > 2 L ap\u0103 zilnic). Odat\u0103 ce doza de \u00eentre\u021binere este atins\u0103, tratamentul este de obicei continuat timp de cel pu\u021bin 6\u201312 luni pentru AUD, nedeterminat pentru profilaxia cronic\u0103 a crizelor sau migrenelor.<\/p>\n

    Ajustare doz\u0103 renal\u0103<\/h2>\n\n\n\n\n\n\n\n\n
    eGFR (mL\/min\/1,73 m\u00b2)<\/th>\nAjustare<\/th>\n<\/tr>\n<\/thead>\n
    > 70<\/td>\nStandard<\/td>\n<\/tr>\n
    30\u201370<\/td>\nReducere cu 50%<\/strong>; titrare mai lent\u0103<\/td>\n<\/tr>\n
    < 30<\/td>\nReducere cu 50%, monitorizare atent\u0103<\/td>\n<\/tr>\n
    Hemodializ\u0103<\/td>\nDoz\u0103 suplimentar\u0103 post-dializ\u0103 (eliminat\u0103 semnificativ)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Efecte secundare (titrare lent\u0103 este cheia tolerabilit\u0103\u021bii)<\/h2>\n
      \n
    • \u00cencetinire cognitiv\u0103, dificultate \u00een g\u0103sirea cuvintelor (\u201ctopa-dopa\u201d)<\/strong> \u2014 efectul secundar limitator de doz\u0103; se reduce cu titrare mai lent\u0103 \u0219i doz\u0103 \u021bint\u0103 mai mic\u0103<\/li>\n
    • Parestezii<\/strong> (furnic\u0103turi \u00een degete \u0219i buze) \u2014 foarte frecvente, de obicei u\u0219oare; reduse prin diet\u0103 bogat\u0103 \u00een potasiu<\/li>\n
    • Pierdere \u00een greutate<\/strong> \u2014 consistent\u0103 \u0219i substan\u021bial\u0103 (medie ~5% din greutatea corporal\u0103); de obicei binevenit\u0103 dar poate fi problematic\u0103 la pacien\u021bii cu IMC sc\u0103zut<\/li>\n
    • Nefrolitiaza (pietre la rinichi)<\/strong> \u2014 risc de ~1,5%; inhibarea anhidrazei carbonice cre\u0219te pH-ul urinei \u0219i scade citratul. Riscul se reduce prin hidratare adecvat\u0103; evita\u021bi la pacien\u021bi cu istoric de pietre dac\u0103 exist\u0103 alte op\u021biuni<\/li>\n
    • Glaucom cu unghi \u00eenchis acut<\/strong> \u2014 rar dar urgen\u021b\u0103 oftalmologic\u0103, de obicei \u00een prima lun\u0103; durere ocular\u0103, vedere \u00eence\u021bo\u0219at\u0103, ochi ro\u0219u = \u00eentrerupe\u021bi medicamentul \u0219i c\u0103uta\u021bi evaluare oftalmologic\u0103 imediat\u0103<\/li>\n
    • Acidoz\u0103 metabolic\u0103<\/strong> (bicarbonat sc\u0103zut) \u2014 u\u0219oar\u0103 \u0219i asimptomatic\u0103 \u00een majoritatea cazurilor; verifica\u021bi nivelul de baz\u0103 + bicarbonat periodic<\/li>\n
    • Oligohidroz\u0103 \u0219i hipertermie<\/strong> \u2014 transpira\u021bie redus\u0103, \u00een special la copii; precau\u021bie \u00een climat cald<\/li>\n
    • Tulbur\u0103ri de dispozi\u021bie, depresie, idei suicidare \u2014 semnal de clas\u0103 la anticonvulsivante; monitoriza\u021bi<\/li>\n
    • Anorexie, alterarea gustului (b\u0103uturile carbogazoase au gust plat \u2014 clasic \u0219i reversibil)<\/li>\n<\/ul>\n
      Risc de sarcin\u0103.<\/strong> Topiramatul este asociat cu un risc crescut de 2\u20133 ori pentru fisuri orale<\/strong> (fisur\u0103 labial\u0103\/fisur\u0103 palatin\u0103) atunci c\u00e2nd este utilizat \u00een primul trimestru \u0219i cu greutate redus\u0103 la na\u0219tere. Femeile \u00een v\u00e2rst\u0103 fertil\u0103 necesit\u0103 contracep\u021bie eficient\u0103<\/strong> \u2014 topiramatul la doze > 200 mg\/zi reduce eficacitatea contraceptivelor orale prin induc\u021bia CYP3A4, astfel \u00eenc\u00e2t este recomandat\u0103 o pilul\u0103 cu estrogen mai ridicat, DIU sau metode de barier\u0103. Dac\u0103 se planific\u0103 o sarcin\u0103, trece\u021bi la un alt anticonvulsivant (lamotrigin\u0103, levetiracetam) \u00eenainte de concep\u021bie. Registrul de sarcin\u0103 pentru medicamentele antiepileptice continu\u0103 s\u0103 monitorizeze rezultatele.<\/div>\n

      Interac\u021biuni medicamentoase<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
      Medicament\/clas\u0103<\/th>\nEfect<\/th>\nAc\u021biune<\/th>\n<\/tr>\n<\/thead>\n
      Contraceptive orale (combinate)<\/td>\nEficacitate redus\u0103 la doze > 200 mg\/zi de topiramat<\/td>\nUtiliza\u021bi pilul\u0103 cu estrogen mai ridicat, DIU sau metode de barier\u0103<\/td>\n<\/tr>\n
      Carbamazepin\u0103<\/td>\nScade nivelul topiramatului (induc\u021bie CYP3A4)<\/td>\nPoate fi necesar\u0103 o doz\u0103 mai mare de topiramat<\/td>\n<\/tr>\n
      Fenitoin\u0103<\/td>\nScade nivelul topiramatului; cre\u0219te u\u0219or nivelul fenitoinei<\/td>\nMonitoriza\u021bi nivelurile<\/td>\n<\/tr>\n
      Al\u021bi inhibitori ai anhidrazei carbonice (acetazolamid\u0103, zonisamid\u0103, diclorfenamid\u0103)<\/td>\nRisc cumulat de acidoz\u0103 metabolic\u0103 \u0219i pietre<\/td>\nEvita\u021bi combina\u021bia<\/td>\n<\/tr>\n
      Litiu<\/td>\nModific\u0103ri variabile ale nivelului de litiu<\/td>\nMonitoriza\u021bi litiul mai frecvent dup\u0103 schimbarea dozei<\/td>\n<\/tr>\n
      Valproat<\/td>\nAmbele pot provoca encefalopatie hiperamonemic\u0103<\/td>\nPrecau\u021bie; verifica\u021bi amoniacul dac\u0103 apare confuzie<\/td>\n<\/tr>\n
      Alcool<\/td>\nDeteriorarea cognitiv\u0103 este aditiv\u0103; alcoolul amplific\u0103 efectul topiramatului asupra conducerii<\/td>\nConsilia\u021bi pacientul<\/td>\n<\/tr>\n
      Metformin\u0103<\/td>\nAmbele cresc lactatul; teoretic, risc de acumulare de acid lactic<\/td>\nMonitoriza\u021bi; de obicei sigur<\/td>\n<\/tr>\n
      Hidroclorotiazid\u0103<\/td>\nCre\u0219te nivelul de topiramat<\/td>\nMonitoriza\u021bi efectele adverse<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      Contraindica\u021bii \u0219i popula\u021bii speciale<\/h2>\n