The Risk and Management of Kidney Stones From the Use of Topiramate and Zonisamide in Migraine and Idiopathic Intracranial Hypertension

Possible Drug-Associated Sialolithiasis From the Bicarbonate Anhydrase Inhibitor Topiramate: A Case Report and Literature Review

“…1,2 As an hCA inhibitor, topiramate can affect the acid/base balance and is well known to be associated with nephrolithiasis, with multiple case reports and retrospective and prospective studies establishing a 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 close connection. 3,4 Studies of the incidence of symptomatic renal stones in topiramate-treated patients have reported an annual incidence of 2.1% 4 and a 4-year incidence of 10.7%, 5 notably larger than the lifetime incidence of 5.2% in the general population. 3 Although the increas...…”

“…3,4 Studies of the incidence of symptomatic renal stones in topiramate-treated patients have reported an annual incidence of 2.1% 4 and a 4-year incidence of 10.7%, 5 notably larger than the lifetime incidence of 5.2% in the general population. 3 Although the increased risk of nephrolithiasis with topiramate treatment is well established, the present report outlines an analogous risk for the development of sialolithiasis, and the possible mechanisms for stone development in the salivary gland are discussed. Numerous placebo-controlled clinical studies have found topiramate to be effective for migraine prophylaxis.…”

Topiramate Extended-Release Options: A Focus on Efficacy and Safety in Epilepsy and Comorbidities

“…The CAI in the proximal and distal renal tubules and the resultant renal tubular acidosis are believed to be the causes for the stones. 51 Calcium carbonate and oxalate stones are most commonly reported with TPM use. Despite the above, studies have not shown a clear and consistent relationship between dosage and duration of therapy with TPM and the incidence of renal stones.…”

Long‐Term Use and Safety of Migraine Preventive Medications

“…General recommendations for stone prevention include adequate hydration and low‐sodium diet for all patients on topiramate. Potassium citrate therapy may be considered in patients who develop metabolic acidosis or a stone and the benefits of continuing the medication outweigh the risks . However, prospective trials of potassium citrate therapy for patients on topiramate are required to be able to provide more firm recommendations on this topic …”