Topiramate
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Topiramate Intractable cough: 3 case reports Two women aged 38 and 47 years and a 35-year-old man developed an intractable cough after starting topiramate [times to reaction onset not stated]. The older woman and the man were receiving the drug for migraine prophylaxis, while the younger woman was receiving the drug for both epilepsy and migraine prophylaxis. All three patients had migraine without aura and negative personal histories for asthma and respiratory diseases. The older woman experienced migraine attacks around 5–8 times per month; her migraines were responsive to triptans, but prophylaxis with amitriptyline, propranolol and flunarizine had been ineffective and topiramate was started. The dosage was titrated at 25mg each week. At a dosage of 100 mg/day, she developed paraesthesia and an episodic dry cough. Over the following months, her migraine attacks were well controlled and her paraesthesia resolved spontaneously; however, her cough worsened. Clinical and laboratory investigations were unremarkable. After approximately 6 months’ therapy, topiramate was discontinued leading to complete resolution of her cough within 1 week. At follow-up 1 year later, her cough had not recurred. The younger woman was receiving carbamazepine and had not had any seizures for 10 years; however, she did experience 6–7 migraine attacks per month. Topiramate was substituted for carbamazepine. After the topiramate dosage was titrated to 50mg twice daily, she developed a dry cough. The dosage was further increased to 200 mg/day with complete control of her migraine attacks and no seizure activity. However, her cough progressed from sporadic to persistent, and was still present after 8 months. Clinical and laboratory investigations were unremarkable. Topiramate was discontinued and carbamazepine was restarted, resulting in complete resolution of her cough in a few days. However, her migraine attacks recurred. At 8 months’ follow-up, there was no recurrence of the cough. The man was experiencing around 20 migraine attacks per month when he started prophylaxis with valproic acid, with good results. However, he had a dramatic weight gain and topiramate was substituted for valproic acid after 3 months. The topiramate dosage was titrated at 25mg each week. At a dosage of 75 mg/day he developed a dry cough as well as anxiety, impaired concentration and nervousness. Topiramate was discontinued and his cough and other adverse effects resolved completely in 3 days. His cough had not recurred at follow-up 6 months later. Author comment: "In the 3 cases presented, prophylactic treatment of migraine with topiramate was discontinued for the onset of an intractable cough, without features suggesting a secondary cause." Maggioni F, et al. Topiramate-induced intractable cough during migraine prophylaxis: Brief communication. Headache 50: 301-304, No. 2, Feb 2010. Available from: URL: http://dx.doi.org/10.1111/j.1526-4610.2009.01515.x 803009671 Italy
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