Question for RJ

[Quiescent]

Hi Roberta,

I don't want to scare you but I have been wondering for awhile, has anyone ever gone above 300mgs of Topamax?

Also, I have been wondering about combining topamax with baclofen or campral.

Do you know of any reading I can do on these subjects?

:thanks:

[Guest]

Question for RJ

I'd like to add to Rachele's post. One of the new member's ( I won't name names for privacy's sake..) was just denied topa from the doc because the doc said it was too hard on your liver!! GREEAAAT. I know I'm supposed to be moderating better, but I have cut my drinking in half with the help of the topa. HOWEVER, I'm still drinking over what I know what is considered "moderate" by the medical community. I know this. That is why I'm still here.
So I'm a bit concerned about my liver. I did have my liver function tested at my doctor's insistence when he prescribed my Topamax. All results were normal (thank God.) Is Dr. Garcia in for comment? Perhaps our livers should be tested every year for good measure?
I'm just wrestling with whether drinking 2x as much as I was or taking the topa is worse.... ugh. I know for my sanity, my marriage, my waistline!!, my children now, the topamax has changed my life. I would be devastated if I had to stop taking it. Wondering if that doc maybe meant if you ALREADY HAD compromised liver function you should not take it, because the directions do clearly state that.
OK, I don't mean to scare anyone. Remember, everyone does what they have to do to make this work! I see my doc next wk (he keeps his thumb on me still! he's awesome, and part of the reason I don't fall too far off... I don't want to fail and have to report it to him--amongst MANY others!) and I'll ask him about this.
Thanks, RJ.
Oh, excuse my avatar. (it's not REALLY me. click on it. that's REALLY me. hee hee!)

[lushy]

Question for RJ

I am no expert but I believe you are not to be on Topa if you already have liver disease. I do not think it causes it, but RJ could better answer......

[Guest]

Question for RJ

Right, Lush,
I knew if you already HAD liver disease. I was just wondering about the chances of making things worse. ya know? just being paranoid, maybe.

[Joe32751]

Question for RJ

i haven't gone to my doctor or know my liver condition but based on how i feel since going topa and cutting back to back on the sauce....i'll stick to the topa vs 1 quart of rum per day. it has to be better i think or am i wrong?

[Roberta Jewell]

Question for RJ

Topa dosing and liver

Hi and sorry for the delay. I've forwarded this question and the follow ups to Dr. Garcia, who had just returned from travels but has left again for two weeks. She assures me she'll respond as soon as she gets back.

Yes, some of the meds you mentioned can be mixed; we'll go over that, as well.

Regarding higher doses of Topamax: we'll follow up in more detail, but for now, Topamax has been prescribed at 400 and 600 mg. levels to treat epileptic seizures and bulimia, but I am unaware of such high dosing for alcohol treatment. Side effects are often dose dependent and unfortunately, this drug has a number of potential side effects. That's why Dr. Garcia recommends using the lowest effective dose possible and augmenting with other therapies, such as dietary supplements, exercise, deep relaxation, etc.

Again, she can speak to the questions and concerns about liver issues and how she counsels her patients. In fact I wrote an entry in the blog about what to expect at your first doctor's visit, and a liver enzyme profile is one of them. You'll find it here.

Physicians obviously need to know their patients' history and health status regarding any serious condition before they prescribe a powerful medication. However, I think it's fair to say the literature reports a much higher degree of kidney stone problems than liver failure due to Topamax.

Or, once again quoting Dr. Bankole Johnson, MD, PhD, from this University of Texas Health Science Center publication:

"...Alcohol-dependent patients frequently have liver disease, one indicator of which is a rise in the plasma level of the enzyme gamma glutamyl transferase (GGT).

'It is of considerable clinical importance that topiramate was superior to placebo at significantly reducing the plasma GGT levels during the trial," Professor Johnson said. "Further, topiramate was shown to be effective treatment for all types of alcohol-dependent patients."'

Hope that helps. More on this later.

RJ