Macromate Dosage/Direction for Use

Recommended Dose: Dosage of topiramate must be adjusted carefully and individualized according to patient response and tolerance and the condition being treated. Small increments or longer intervals between increments may be necessary if patients cannot tolerate the previously mentioned regimens.
It is not necessary to monitor plasma topiramate concentrations to achieve optimal clinical effect with the drug when it is added to an existing anticonvulsant regimen. However, the addition of topiramate to phenytoin may require an adjustment of the phenytoin dose to achieve optimal clinical outcome. Addition or withdrawal of phenytoin and/or carbamazepine during adjunctive therapy with topiramate may require adjustment of the topiramate dose.
Epilepsy: Monotherapy: Adults: The initial oral dose of topiramate is 25 to 50 mg at night for 1 week increased thereafter by increments of 25 or 50 mg at intervals of 1 to 2 weeks until the effective dose is reached. Daily doses of more than 25 mg should be taken in 2 divided doses. When used as monotherapy, usual doses range from 100 mg daily to a maximum of 500 mg daily.
Children ≥ 6 years: The initial daily oral dose is 0.5 to 1.0 mg/kg at night for the first week, increased thereafter by 0.5 to 1 mg/kg every 1 or 2 weeks, daily in 2 divided doses.
Adjunctive therapy: Adults: The initial oral dose of topiramate is 25 to 50 mg at night for 1 week increased thereafter by increments of 25 or 50 mg at intervals of 1 to 2 weeks until the effective dose is reached. Daily doses of more than 25 mg should be taken in 2 divided doses. The usual daily dose is 200-400 mg.
Children ≥ 2 years: The initial for oral dose is 25 mg. This is given as a single dose at night for 1 week, then increased by 1 to 3 mg/kg every 1 or 2 weeks until the effective dose is reached; these higher daily doses are divided and given twice daily. About 5 to 9 mg/kg daily is usually required.
Migraine: Adults: Topiramate is given orally in initial doses of 25 mg at night for 1 week, increased by 25 mg increments every week, to a usual dose of 50 mg twice daily.
Special Population: Renal impairment: In patients with moderate to severe renal impairment (CrCl < 70 ml/min/1.73 m²), one-half of the usual adult dose of topiramate is recommended. For patients undergoing hemodialysis a supplemental dose equal to about one-half of the daily dose should be given in divided doses (at the start and finish of the procedure).
Hepatic impairment: Topiramate should be used with caution in patients with hepatic impairment.
Method of Administration: Topiramate tablets can be taken without regard to meals. Because of the bitter taste, immediate-release tablets or topiramate preferably should be swallowed intact and not broken or chewed.