topiramate / Generic mfg. - LARVOL DELTA

African American Patients With Cyclic Vomiting Syndrome Have Higher Healthcare Utilization and Lower Guideline-Directed Therapy: A Propensity-Score-Matched Analysis of the TriNetX US Collaborative Network (ACG 2026) - "Outcomes assessed over 365 days included ambulatory visits, ED visits, inpatient admissions (IP), CT abdomen utilization, esophagogastroduodenoscopy (EGD), colonoscopy and CVS-directed medications (amitriptyline, nortriptyline, topiramate, aprepitant). After 1:1 PSM, 7,504 matched pairs were analyzed. African American patients had lower ambulatory care utilization (76.6% vs 81.5%; RR 0.941) but higher ED visits (41.2% vs 31.0%; RR 1.327), IP admissions (23.7% vs 18.4%; RR 1.286), and CT utilization (15.3% vs 12.3%; RR 1.239). EGD and colonoscopy utilization were similar."

Clinical • HEOR • CNS Disorders • Gastrointestinal Disorder • Rare Diseases

An Unusual Cause of Isolated Alkaline Phosphatase Elevation (ACG 2026) - "Two years ago, elevated transaminases were attributed to valproate-induced DILI, which resolved after switching to topiramate...Awareness of this entity is essential to prevent unnecessary interventions such as liver biopsy. Figure: Figure 1: Macro-ALP Formation pathway"

Cerebral Palsy • CNS Disorders • Epilepsy • Gastroenterology • Gastrointestinal Disorder • Genito-urinary Cancer • Heart Failure • Hematological Malignancies • Hepatology • Immunology • Infectious Disease • Inflammatory Bowel Disease • Monoclonal Gammopathy • Pneumonia • Prostate Cancer • Respiratory Diseases • Sarcoidosis • Solid Tumor • Ulcerative Colitis

Prescribing Patterns of Obesity Medications Among Overweight Patients With Psychotropic Medication Exposure (ACG 2026) - "Similarly, use of semaglutide rose from 0.19% to 2.54% , while topiramate use increased from 0.6% to 2.95% within 5 years... Overtime, patients with an overweight BMI (n=113, 918) who started psychotropic medications had a significant progression to obesity with 15.39% of patients transitioning to BMI â¥30 kg/m² during total follow-up of 5 years. Following psychotropic initiation, there was a progressive increase in the use of obesity pharmacotherapy. Patients prescribed metformin increased from 0.33% within 3 months to 2.07% within 5 years of initiation ."

Clinical • Diabetes • Genetic Disorders • Metabolic Disorders • Obesity

Burden of Alcoholic Liver Disease and Underutilization of FDA-Approved Medication for Alcohol Use Disorder: A Real-World Analysis (ACG 2026) - "Among patients with ALD, we assessed the incidence and prevalence of patient treated with MAUD, including naltrexone, acamprosate, and disulfiram...Off-label agents such as baclofen (7.2%) and topiramate (3.2%) were prescribed at rates exceeding disulfiram (1.2%)... We identified 2.639.758 patients with AUD. ALD incidence rose from 779 to 2,911 per 100,000 in females and 1,320 to 3,702 in males, while prevalence reached 7,484 in females and 9,288 in males by 2025. MAUD incidence among ALD patients was higher in females than males."

Clinical • Real-world • Real-world evidence • Addiction (Opioid and Alcohol) • Hepatology • Substance Abuse

More Than Meets the Eye: Topiramate-Induced Bilateral Secondary Angle Closure Unmasking Secondary Antiphospholipid Syndrome. (PubMed, Ocul Immunol Inflamm) - "The case illustrates that posterior segment findings that are disproportionate to the expected manifestations of topiramate-induced angle closure should prompt urgent evaluation for an underlying systemic autoimmune or hypercoagulable disorder. Careful posterior segment evaluation following normalization of intraocular pressure may reveal vision-threatening pathology and facilitate early multidisciplinary management."

Journal • Cardiovascular • CNS Disorders • Genetic Disorders • Hematological Disorders • Immunology • Inflammatory Arthritis • Lupus • Migraine • Pain • Systemic Lupus Erythematosus • Vasculitis

Functional and pharmacological characterization of the SCN2A variant p.C258R with mixed gain and loss of function causing developmental and epileptic encephalopathy type 11. (PubMed, Epilepsy Behav Rep) - "We aimed to electrophysiologically analyze the functional consequences of this mutation and to examine the in vitro properties of phenytoin, lamotrigine, and topiramate, which resulted in clinical improvement. The C258R mutation impairs NaV1.2 function through both LoF and GoF mechanisms. Sodium channel blockers with a strong use-dependence, such as phenytoin, may be preferential for seizure control in such cases."

Journal • CNS Disorders • Developmental Disorders • Epilepsy • Psychiatry • NAV1

Development and validation of a pharmacokinetic tool to convert random topiramate concentrations to standardized trough levels in bipolar disorder. (PubMed, Front Pharmacol) - "This preliminary PK conversion tool reliably estimates the standardized trough concentration of immediate-release topiramate from random TDM levels. It could potentially aid safety monitoring by improving the interpretation of non-standard samples, though its clinical utility requires prospective external validation and linkage to patient outcomes."

Journal • PK/PD data • Bipolar Disorder • CNS Disorders • Mood Disorders • Psychiatry

Positive Allosteric GABAA Receptor Modulators Reduce Ethanol Consumption and Acute Functional Tolerance. (PubMed, Alcohol) - "We tested four such modulators (loreclezole, etifoxine, topiramate, and compound 2-261) on voluntary ethanol drinking and related behaviors in mice. Like apremilast, all four compounds dose-dependently prolonged recovery from ethanol-induced ataxia, prevented the development of acute tolerance, and reduced two-bottle choice ethanol consumption without altering blood ethanol clearance. Thus, both indirect activation of β3-containing GABAA receptors by apremilast and direct activation by positive allosteric modulators with selectivity for β2/β3-containing receptors reduce ethanol drinking while preventing acute tolerance."

Journal • Ataxia • Movement Disorders

Management of Non-REM parasomnias: A systematic review of evidence-based treatment approaches. (PubMed, Sleep Med Rev) - "Interventions also included melatonin, antidepressants, Z-drugs, topiramate for sleep-related eating disorder, serotonergic precursors in children, and hypnosis...Certainty was very low for most outcomes. High-quality trials with standardized and ideally objective measurements are needed to guide clinical practice."

Journal • Review • CNS Disorders • Sleep Disorder

Stability Evaluation of Compounded Multidrug Oral Liquids in a Dual-Vehicle Suspending System. (PubMed, Int J Pharm Compd) - "This study evaluated the chemical, physical, and microbiological stability of formulations containing topiramate, omeprazole, gabapentin, ondansetron, and levofloxacin prepared in Flavor Sweet™ SF and Flavor Plus™, also known as Syra Sweet™ SF and Syra Plus™. All formulations showed consistent pH and acceptable microbiological quality, although precipitation in some samples led to discontinuation of analysis. These results support the suitability of the vehicle system and highlight the importance of formulation parameters in stability and beyond-use dating."

Journal

SOGC Clinical Practice Guideline No. 471: Alcohol and Pregnancy. (PubMed, J Obstet Gynaecol Can) - "RECOMMENDATIONS: (Recommendations IN BOLD are new to this guideline update; an overview of the updated supporting literature for all recommendations is provided in Appendix B)."

Clinical guideline • Journal • Addiction (Opioid and Alcohol) • Obstetrics

Drugs for prevention of migraine. (PubMed, Med Lett Drugs Ther) - No abstract available

Journal • CNS Disorders • Migraine • Pain

Comparison table: Some drugs for migraine prevention. (PubMed, Med Lett Drugs Ther) - No abstract available

Journal • CNS Disorders • Migraine • Pain

The efficacy and safety of Desvenlafaxine Succinate Sustained-release Tablets in the prophylactic treatment of migraine (ChiCTR) - P=N/A | N=290 | Not yet recruiting | Sponsor: the Second Affiliated Hospital of Soochow University; the Second Affiliated Hospital of Soochow University

New trial • CNS Disorders • Migraine

Metabolic-Protective Strategies for Antipsychotic-Associated Weight Gain in Children and Adolescents: A Systematic Review. (PubMed, Cureus) - "This study aimed to systematically review and meta-analyze randomized controlled trials of metformin and other metabolic-protective strategies, including topiramate, melatonin, and antipsychotic switching, for preventing or treating antipsychotic-associated weight gain in children and adolescents. Metformin has the largest randomized pediatric evidence base among metabolic-protective strategies and consistently attenuated weight gain compared with control; however, its pooled effect on the primary outcome did not reach statistical significance at any time window, and metabolic benefits could not be confirmed. Decisions regarding metabolic-protective strategies should be individualized rather than universally applied, and larger, longer, standardized pediatric trials are needed."

Journal • Review • CNS Disorders • Genetic Disorders • Metabolic Disorders • Pediatrics • Psychiatry

Risks of neurodevelopmental disorders after prenatal exposure to antiepileptic drugs. (PubMed, J Child Psychol Psychiatry) - "Population-wide associations between prenatal AED exposure and neurodevelopmental disorders were largely attenuated in sibling comparison analyses, suggesting that shared familial factors may explain much of the observed risk. These findings support careful individualized prescribing during pregnancy while highlighting the need for further research on specific AEDs and exposure windows."

Journal • ADHD (Impulsive Aggression) • Attention Deficit Hyperactivity Disorder • Autism Spectrum Disorder • CNS Disorders • Developmental Disorders • Genetic Disorders • Mental Retardation • Psychiatry

Chronic Migraine Remission with Combination of Remote Electrical Neuromodulation (REN) and In-Clinic / Patient-Administered Sphenopalatine Ganglion (SPG) Block (PAINWeek 2026) - "Current acute treatments included rizatriptan, ubrogepant and acetaminophen with recent discontinued acute therapies including rimegepant and NSAIDS. Current preventative treatments include onabotulinumtoxinA, galcanezumab, amitriptyline, cyclobenzaprine, ondansetron and occipital nerve blocks with recent discontinued preventatives including topiramate... Patient was seen weekly for initial treatment sequence and noted near complete resolution of acute migraine symptoms after the first in-clinic SPG administration with smaller, although noticeable, levels of relief with self-administered SPG administration. Patient also noted significant, although not complete, reduction of acute pain and nausea within the first week of initiating REN. After one month of treatment, patient noted that migraine frequency reduced to one episode per week from the previous 4 to 6 episodes and was able to manage most acute episodes with acetaminophen, with rare need for other acute..."

Clinical • CNS Disorders • Depression • Migraine

Topiramate effects on ethanol and sucrose binge-like intake, anxiety- and compulsive-like behavior in non-dependent male and female C57BL/6J mice. (PubMed, Psychopharmacology (Berl)) - "These findings provide preliminary evidence that topiramate reduces EtOH binge-like intake, anxiety- and compulsive-like behavior in non-dependent mice with a non-significant attenuation of sucrose binge-like intake. Further research is warranted to establish the translational relevance and to evaluate the preventive potential of topiramate in binge-related disorders."

Journal • Preclinical • Binge Eating Disorder • CNS Disorders • Mood Disorders • Psychiatry

Potential Role of CYP3A4 in Determining In Vivo Exposure to Cannabidiol (CBD) and its Active Metabolite 7-OH-CBD: Evidence from an In Vitro Study. (PubMed, Eur J Drug Metab Pharmacokinet) - "ASMs with CYP3A4-inhibitory potential may alter systemic exposure to both CBD and its active metabolite, 7-OH-CBD, as demonstrated in vitro. However, co-administration of CBD with CYP3A4-substrate ASMs or CYP2C19 inhibitors is predicted to result in only modest increases in CBD exposure."

Journal • Preclinical • CNS Disorders • Epilepsy • CYP2C19 • CYP2C9 • CYP3A4

Systematic Review of Pharmacologic Treatment for Migraine Prevention in Adults: Report of the AAN Guidelines Subcommittee and the American Headache Society. (PubMed, Headache) - "This SR provides a comprehensive synthesis of evidence on pharmacologic migraine prevention in adults. High- and moderate-confidence findings confirm the efficacy of several established and newer preventive therapies and demonstrate improvements in patient-reported outcomes across multiple validated measures. These conclusions informed the development of evidence-based recommendations, presented in a companion publication, to guide clinicians in selecting preventive medications for adults with episodic and chronic migraine."

Journal • CNS Disorders • Migraine • Pain

Systematic Review of Pharmacologic Treatment for Migraine Prevention in Adults: Report of the AAN Guidelines Subcommittee and the American Headache Society. (PubMed, Neurology) - "This SR provides a comprehensive synthesis of evidence on pharmacologic migraine prevention in adults. High- and moderate-confidence findings confirm the efficacy of several established and newer preventive therapies and demonstrate improvements in patient-reported outcomes across multiple validated measures. These conclusions informed the development of evidence-based recommendations, presented in a companion publication, to guide clinicians in selecting preventive medications for adults with episodic and chronic migraine."

Journal • Review • CNS Disorders • Migraine • Pain

New Migraine Guidelines Expand Treatment Options For Migraine Prevention (RTTNews) - "The guidelines discuss how preventive medicines are different from medicines used to treat a migraine attack after it starts...The new guidelines recommend atogepant, erenumab, fremanezumab, galcanezumab, and eptinezumab as first-choice medicines for preventing migraine. These medicines are given in different ways...For people with episodic migraine, meaning migraine occurring on fewer than 15 days a month, the treatments with the strongest evidence of effectiveness include atogepant, eptinezumab, erenumab, fremanezumab, galcanezumab, propranolol, topiramate, and valproate....Botox is also an option for chronic migraine."

Clinical guideline • Migraine

Therapeutic Potential of Anti-Obesity Drugs in Obesity-Associated Female Reproductive Dysfunction: Translating Mechanistic Evidence into Personalized Clinical Strategies. (PubMed, Medicina (Kaunas)) - "Evidence suggests that several FDA-approved and off-label anti-obesity agents, including orlistat, liraglutide, semaglutide, phentermine/topiramate, bupropion/naltrexone, metformin, exenatide, and tirzepatide, may improve reproductive outcomes primarily indirectly through weight reduction and metabolic improvement...However, evidence for several agents remains limited, and concerns persist regarding reproductive safety during pregnancy. Overall, anti-obesity pharmacotherapy may represent an important adjunctive strategy for improving reproductive and metabolic health in women with obesity, although larger randomized clinical trials are still required."

Clinical • Journal • Review • Diabetes • Genetic Disorders • Gestational Diabetes • Gynecology • Infertility • Inflammation • Metabolic Disorders • Obesity • Polyendocrine Metabolic Ovarian Syndrome • Sexual Disorders • Women's Health • LEP

Acute catatonia and psychosis in the context of seizure exacerbation in epilepsy: a case report. (PubMed, Front Psychiatry) - "We report a 44-year-old woman with a 27-year history of epilepsy, maintained on carbamazepine and topiramate, and a longstanding psychiatric history of major depressive disorder, obsessive-compulsive symptoms, and chronic nihilistic delusions and intermittent hallucinations documented at baseline. One week before admission, her antidepressant was switched from clomipramine to venlafaxine 150 mg/day...Management with escalating benzodiazepines and cautious antipsychotic uptitration (quetiapine XR, cariprazine) was associated with complete catatonic remission and psychotic symptom resolution over 29 days...Clinicians should resist anchoring on temporal associations between seizure activity and psychiatric symptoms. EEG findings must be interpreted in their pharmacological context; pharmacokinetic interactions should inform antipsychotic dose selection; and QTc prolongation warrants structured cardiac monitoring."

Journal • Anesthesia • CNS Disorders • Depression • Epilepsy • Major Depressive Disorder • Mental Retardation • Mood Disorders • Psychiatry • CYP3A4

Cognitive Side Effects of Antiseizure Medications in Adults with Epilepsy: An Update with a Focus on New Therapeutic Agents. (PubMed, CNS Drugs) - "Overall, newer-generation ASMs, including rufinamide, lacosamide, brivaracetam, cannabidiol, fenfluramine, and ganaxolone, demonstrate generally favourable cognitive profiles when used at recommended doses, particularly in monotherapy or rational polytherapy. Eslicarbazepine and cenobamate may be associated with mild, dose-dependent cognitive effects, occurring only at the upper end of the recommended dose range. In contrast, old ASMs and certain second-generation agents, notably topiramate and zonisamide, remain consistently associated with higher cognitive risks...Cognitive dysfunction in epilepsy is multifactorial, reflecting the interaction between disease-related neurobiological mechanisms and treatment effects. Optimal management requires balancing seizure control with cognitive preservation through individualised drug selection, cautious titration, and minimisation of polytherapy to achieve the best functional and quality-of-life outcomes."

Adverse events • Journal • Review • CNS Disorders • Cognitive Disorders • Developmental Disorders • Epilepsy • Mental Retardation