Adults The recommended total daily dose of topiramate for prophylaxis of migraine headache is 100 mg/day administered in two divided doses.The dosage should then be increased in increments of 25 mg/day administered at 1-week intervals.The dosage should then be increased at 1- or 2-week intervals by increments of 1 to 3 mg/kg/day (administered in two divided doses), to achieve optimal clinical response.Daily doses up to 30 mg/kg/day have been studied and were generally well tolerated.Some patients may achieve efficacy with once-a-day dosing.In clinical trials as adjunctive therapy, 200 mg was the lowest effective dose.Adults Dose and titration should be guided by clinical response.
Subsequently, at weekly or bi-weekly intervals, the dose should be increased by 25-50 mg/day and taken in two divided doses.
Some patients with refractory forms of epilepsy have tolerated topiramate monotherapy at doses of 1,000 mg/day.
These dosing recommendations apply to all adults including the elderly in the absence of underlying renal disease.
Topiramate is indicated in adults for the prophylaxis of migraine headache after careful evaluation of possible alternative treatment options. It is recommended that therapy be initiated at a low dose followed by titration to an effective dose.
Dose and titration rate should be guided by clinical response.