ํ ํผ๋ผ๋ฉ์ดํธ
**ํ ํผ๋ผ๋ฉ์ดํธ(Topiramate)**๋ ์ฃผ๋ก ๊ฐ์ ๊ณ ์์ด์ ๋์น์ฑ ๋ฐ์ ์ฅ์ ์ ๋ํ ์ถ๊ฐ(๋ณด์กฐ) ์๋ฒ์ผ๋ก ์ฌ์ฉ๋๋ ์๋ก์ด 2์ธ๋ **ํญ๊ฒฝ๋ จ์ **์ ๋๋ค. * **์์์ ์ ์ฉ์ฑ**: **๋ถ๋ถ(์ด์ ์ฑ) ๋ฐ์** ๋ฐ ์๋์ฆ(์: ๊ณ ์์ด์ "๋ฌ๋ฆฌ๊ธฐ ๋ฐ์")์ ๊ด๋ฆฌํ๋ ๋ฐ ํนํ ์ ์ฉํฉ๋๋ค. * **์ฝ๋ํ์ ํน์ง**: ๊ฐ์์ ๋ฐ๊ฐ๊ธฐ๊ฐ ๋งค์ฐ ์งง์ง๋ง(2-4์๊ฐ), ๋ ์์ฉ์ฒด์ ๋ํ ์นํ๋ ฅ์ด ๋์ ๋น ๋ฅด๊ฒ ๋ฐฐ์ถ๋จ์๋ ๋ถ๊ตฌํ๊ณ ์ง์์ ์ธ ์น๋ฃ ํ์ฑ์ ๋ํ๋ ๋๋ค. * **์น๋ฃ์์์ ์ญํ **: ํ๋ ธ๋ฐ๋ฅด๋นํ, ๋ธ๋กฌํ์นผ๋ฅจ ๋๋ ๋ ๋ฒ ํฐ๋ผ์ธํ๊ณผ ๊ฐ์ ์ ํต์ ์ธ 1์ฐจ ์น๋ฃ๋ฒ์ผ๋ก ๋ฐ์ ์กฐ์ ์ด ๋ถ์ถฉ๋ถํ ๋ ์ข ์ข ๊ณ ๋ ค๋ฉ๋๋ค. * **์ค์ ์ ๊ณ ๋ ค์ฌํญ**: ์ ๋ค๋ฆญ ์ฝ๋ฌผ์ ์ฌ์ฉํ ์ ์์ด ๋น์ฉ ๋ถ๋ด์ ์ค์ด๋ ๋ฐ ๋์์ด ๋์ง๋ง, ์ฆ์ ํฌ์ฌ ์ผ์ (๊ฐ์์๋ ์ข ์ข ํ๋ฃจ 3ํ)์ผ๋ก ์ธํด ๋ณดํธ์์ ์๋นํ ํ์ ์ด ํ์ํฉ๋๋ค.
์์ฉ ๊ธฐ์ : Topiramate has a multimodal mechanism of action that dampens excitatory pathways and enhances inhibitory neurotransmission in the central nervous system: * **Voltage-gated Sodium Channels** โ Blocks repetitive action potentials in a time-dependent manner, preventing the spread of seizure activity. * **GABA Receptors** โ Increases the frequency of **GABA** activation at **GABA_A receptors**, enhancing inhibitory signals in the brain. * **AMPA/Kainate Receptors** โ Antagonizes these specific glutamate receptors, directly blocking excitatory neurotransmission (without affecting NMDA receptors). * **Carbonic Anhydrase** โ Weakly inhibits isoenzymes **CA-II** and **CA-IV**, though this is believed to play only a minor role in its overall antiepileptic efficacy.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Automatisms (running fits) and focal seizure activity ยท 12.5-25 mg PO (total dose) q8-12h ยท PO ยท q8-12h ยท Gradual adaptation in dosing is recommended. Inappetence is a major adverse effect with higher doses.
- Alternative second line anticonvulsant ยท 5-10 mg/kg PO q12h ยท PO ยท q12h
- Alternative treatment for refractory generalized and focal seizures ยท 5-10 mg/kg PO twice daily ยท PO ยท twice daily
- Seizures (Initial dose) ยท 2-10 mg/kg PO q12h ยท PO ยท q12h
- Seizures ยท 5-10 mg/kg PO twice daily ยท PO ยท twice daily ยท Start at the lower dosage to reduce adverse effects.
- Refractory epilepsy ยท 2.5-5 mg/kg PO three times daily ยท PO ยท three times daily ยท Presently, the author is using this drug at this dose, but at this stage there is not enough data to know how effective this treatment will be.
์ฉ๋์ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์ฐธ๊ณ ์๋ฃ์ ๋๋ค. ํญ์ ์ต์ ๋ผ๋ฒจ๊ณผ ๊ฐ๋ณ ํ์์ ๋ํด ํ์ธํ์ญ์์ค.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Hypersensitivity to topiramate
- Known hypersensitivity to topiramate
์ด์๋ฐ์
- GI distress (dogs)
- Inappetence (dogs, cats)
- Irritability (dogs)
- Sedation/Lethargy (cats, dogs)
- Ataxia (dogs)
- Somnolence (humans)
- Dizziness (humans)
- Acute myopia with secondary angle closure glaucoma (rare, humans)
- Calcium phosphate renal calculi (humans)
- Sedation
- Ataxia
- Anorexia
- Weight loss
- Gastrointestinal upset
์ฝ๋ฌผ ์ํธ์์ฉ
- Amitriptyline ยท Topiramate may increase amitriptyline levels
- Carbonic Anhydrase Inhibitors (acetazolamide, dichlorphenamide) ยท Concomitant use may increase the risk of renal stone formation
- CNS Depressants ยท May exacerbate the adverse effects of topiramate ยท moderate
- Lamotrigine ยท May increase topiramate levels
- Phenytoin ยท May decrease topiramate levels; phenytoin levels may increase ยท moderate
- Valproic Acid ยท May decrease topiramate and VPA levels
- Phenobarbital ยท May increase clearance and decrease plasma concentrations of topiramate ยท moderate
๋ชจ๋ํฐ๋ง
- Seizure frequency and severity (Efficacy)
- Adverse effects (GI distress, sedation, inappetence)
- Seizure frequency and severity
- Body weight and appetite
- Renal function in compromised patients
๊ณผ์ฉ๋
Overdoses in humans have caused convulsions, drowsiness/lethargy, slurred speech, blurred and double vision, impaired mentation/stupor, ataxia, metabolic acidosis, hypotension, agitation, and abdominal pain. In dogs, common findings reported to the ASPCA APCC include ataxia and lethargy. **Treatment**: * Gut emptying protocols if the ingestion was recent. * Supportive therapy. * Hemodialysis is effective in enhancing the elimination of topiramate from the body.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.