Possible removal of topiramate by continuous renal replacement therapy

Browning, Linda; Parker, Dennis; Liu-DeRyke, Xi; Shah, Aashit; Coplin, William M.; Rhoney, Denise H.

doi:10.1016/j.jns.2009.10.001

« Previous Next »Journal of the Neurological Sciences
Volume 288, Issue 1 , Pages 186-189, 15 January 2010

Possible removal of topiramate by continuous renal replacement therapy

Linda Browning
- Detroit Receiving Hospital, Department of Pharmacy, Detroit, Michigan, USA
Dennis Parker Jr.
- Wayne State University, Eugene Applebaum College of Pharmacy & Health Sciences, Detroit, Michigan, USA
Xi Liu-DeRyke
- Orlando Regional Medical Center, Department of Pharmacy, Orlando, Florida, USA
Aashit Shah
- Wayne State University College of Medicine, Department of Neurology, Detroit Receiving Hospital, Detroit, Michigan, USA
William M. Coplin
- Wayne State University College of Medicine, Departments of Neurology and Neurological Surgery, Neuroscience Intensive Care Unit, Detroit Receiving Hospital, Detroit, Michigan, USA
Denise H. Rhoney
- Wayne State University, Eugene Applebaum College of Pharmacy & Health Sciences, 259 Mack Avenue, Detroit, MI 48201, USA
- Corresponding author. Tel.: +1 313 993 7742; fax: +1 313 577 5369.

Received 17 February 2009; received in revised form 18 August 2009; accepted 7 October 2009. published online 09 November 2009.

Abstract

Background

Topiramate is primarily renally eliminated and requires dosage adjustment based upon renal function. While there is data to suggest drug removal during intermittent hemodialysis (IHD), little is known regarding its clearance and dosing during continuous renal replacement therapy (CRRT).

Case description

We describe a 59-year-old man with refractory status epilepticus who was started on continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure while receiving topiramate with a series of serum concentrations to assess for removal during CVVHDF.

Conclusion

Our data suggest clinically important amounts of topiramate are removed by CRRT, and higher topiramate dosage may be needed for these patients instead of the current recommended 50% of normal dosage. Unfortunately, there is no antiepileptic drug dosing recommendation when used during CRRT due to the paucity of data. This case highlights a need for research evaluating the effect of CRRT on AED elimination in order to optimize therapy for seizure control.

Keywords: Topiramate, Antiepileptic drugs, Acute renal failure, Continuous renal replacement therapy, Status epilepticus