Pitomate Drug Interactions

1. Avoid concomitant use of Topiramate with ethyl alcohol, azelastine (nasal), carbonic anhydrase inhibitors, orphenadrine, paraldehyde, thalidomide, ulipristal.
2. Topiramate exhibits weak CYP2C9 inhibitors so that it has the pharmacokinetic interactions with drug metabolized by CYP2C19 including some anticonvulsants, CNS depressants and oral contraceptives.
3. Topiramate may increase the levels/effects of alpha-/beta-agonists, amitriptyline, amphetamines, blonanserin, buprenorphrine, CNS depressants, flecainide, fosphenytoin, hydrocodone, lithium, memantine, metformin, methotrimeprazine, metyrosine, mirtazapine, oxycodone, phenytoin, pramipexole, primidone, quinidine, ropinirole, rotigotine, selective serotonin reuptake inhibitors, suvorexant, valproate products, zolpidem.
4. Topiramate may decrease the levels/effects of contraceptives (estrogens, progestins), methenamine, primidone, glyburide, digoxin, diltiazem.
5. The levels/effects of Topiramate may be increased by anticholinergic agents, brimonidine (topical), cannabis, doxylamine, dronabinol, droperidol, hydroxyzine, kava kava, loop diuretics, magnesium sulfate, methotrimeprazine, minocycline, nabilone, perampanel, rufinamide, salicylates, sodium oxybate, tapentadol, tetrahydrocannabinol, thiazide and thiazide-like diuretics.
6. The levels/effects of Topiramate may be decreased by carbamazepine, fosphenytoin, mefloquine, mianserin, orlistat, phenytoin, valproic acid.
7. Ketogenic diet may increase the possibility of acidosis and/or kidney stones. Monitoring for symptoms of acidosis or kidney stones is needed.