Epitomax, an antiepileptic drug of unusual structure, is a fructose derivative. Topiramate, sold under the brand name Epitomax among others, is a drug used to treat epilepsy and prevent migraines. It is not effective as an antimanic or antidepressant for bipolar disorder. It has also been used for alcohol addiction. For the treatment of epilepsy it includes generalized or focal seizures. It is used orally.
Common side effects include tingling, loss of appetite, fatigue, abdominal pain, hair loss, and concentration problems. Serious side effects can include suicide, elevated ammonia levels leading to encephalopathy, and kidney stones. Use during pregnancy can lead to harm to the baby, and use during breastfeeding is not recommended.
Epitomax was approved for medical use in the United States in 1996. Epitomax is used to treat epilepsy in children and adults, and it was originally used as an anticonvulsant. In children, it is indicated for the treatment of Lennox-Gasto syndrome, a disorder that causes seizures and developmental delays. It is most often prescribed for the prevention of migraine; it reduces the frequency of attacks.
In a 2019 Cochrane review comparing the effectiveness of epilepsy treatment between carbamazepine and topiramate (Epitomax), results showed that those who took carbamazepine were more likely to take the treatment longer and achieve remission 12 months earlier than those who took topiramate. No differences were found between the drugs in those with generalized or unclassified epilepsy. The most common side effects reported by participants during the trials were fatigue, “needles and needles” (a tingling sensation), headache, gastrointestinal problems, and anxiety or depression. These side effects were reported about the same number of times by people taking Epitomax or carbamazepine. For people with focal seizures, the reliability of the evidence was rated as moderate to high. For a small number of people with generalized or unclassified seizures, the reliability of the evidence was rated as low to moderate. The evidence was valid through May 2018.
In a 2019 Cochrane review of Epitomax for juvenile myoclonic epilepsy, results showed that Epitomax was better tolerated than valproate but was not more effective than valproate. Also, Epitomax appeared to work better than placebo, but this result was based on the small number of participants included. The quality of evidence from the included studies was very low, and the results should be interpreted with caution.
In a 2014 Cochrane review of the potential use of Epitomax as an adjunctive agent in pharmacoresistant epilepsy, results showed that for seizure reduction in drug-resistant focal epilepsy, Epitomax was three times more effective than placebo when used with other medications. However, the addition of Epitomax to the main treatment causes an increase in side effects such as problems with coordination (ataxia) and concentration, dizziness, drowsiness, fatigue, nausea, “wrong thinking”, skin irritation or numbness (paresthesia) and weight loss.