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Elavil vs Topamax
Introduction
For individuals with migraines or seizures, certain medications that manipulate the activity of neurons in the brain can help control and prevent these conditions. Elavil (amitriptyline) and Topamax (topiramate) are two such drugs commonly prescribed for these purposes. They each influence different neuronal processes, but both have demonstrated effectiveness in managing symptoms. Elavil is a tricyclic antidepressant (TCA), primarily working by inhibiting serotonin and norepinephrine reuptake, which increases their levels within the synaptic gap to prolong their action on nerve cells. On the other hand, Topamax is classified as an anticonvulsant drug; it operates via multiple mechanisms including enhancing GABA-activated chloride channels, inhibiting carbonic anhydrase enzyme activities among others leading to decreased excitation of neurons.
Elavil vs Topamax Side By Side
| Attribute | Elavil | Topamax |
|---|---|---|
| Brand Name | Elavil | Topamax |
| Contraindications | Should not be taken with or recently after MAO inhibitors. | Should not be taken with or recently after MAO inhibitors. |
| Cost | Generic form costs range from $0.07/day to about $1/day depending on dosage and pack size. | Generic Topiramate costs start at around $0.16/per day and can go up based on dosage and quantity. |
| Generic Name | Amitriptyline | Topiramate |
| Most Serious Side Effect | Thoughts of suicide or self-harm, severe allergic reactions. | Thoughts of suicide or self-harm, sudden vision problems, severe allergic reactions. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | 25–150 mg/day, with a starting dose often at 75 mg per day for adults. | 100–200 mg/day, split into two doses, with a slow increase from an initial 25 mg/day. |
What is Elavil?
Amitriptyline (the generic name for Elavil) is a drug from the class of tricyclic antidepressants (TCAs), which were the first group of antidepressant drugs to be developed. Amitriptyline was approved by the FDA in 1961. Elavil increases free levels of serotonin and norepinephrine by blocking their reuptake, effectively “trapping” them in the brain for longer than usual. It's prescribed for various types of depression, migraine prevention, and certain types of pain.
On the other hand, Topiramate (generic name for Topamax) is an anticonvulsant that was initially created to treat seizure disorders but later found effective as a mood stabilizer in bipolar disorder and as a preventive treatment for migraines. Approved by FDA in 1996, it works differently from TCAs like Elavil; it inhibits neuronal voltage-dependent sodium channels and enhances GABA activity at some subtypes — this means its mechanism isn't entirely dependent on neurotransmitters like serotonin or norepinephrine.
Both medications come with side effects; however, due to its broader effect on multiple neurotransmitters including histamine receptors causing sedation among others , Amitriptyline may cause more numerous side effects compared to Topiramate.
What conditions is Elavil approved to treat?
Elavil is approved for the treatment of various conditions, including:
- Major depressive disorder
- Neuropathic pain associated with postherpetic neuralgia or peripheral neuropathy
- Migraine prevention
Topamax, on the other hand, is approved for different conditions such as:
- Epilepsy (as monotherapy or adjunctive therapy)
- Prevention of migraine headaches in adults and pediatric patients 12 years of age and older
How does Elavil help with these illnesses?
Elavil, also known as Amitriptyline, is a tricyclic antidepressant that works by increasing the amount of serotonin and norepinephrine available in the synapses of the brain. It does this by preventing these neurotransmitters from being reabsorbed back into the nerve cells in the brain. Both serotonin and norepinephrine are important chemicals that act as messengers between nerve cells and influence mood, emotion, sleep patterns and many other functions within both the body and mind. By boosting their levels in the brain's synaptic clefts (the spaces between neurons), Elavil can help alleviate depressive symptoms.
Topamax or Topiramate, on the other hand, primarily used to treat seizures but it has been found useful for managing migraines too. It works differently than Elavil; it enhances activity at receptors for gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter responsible for reducing neuronal excitability throughout your nervous system while also blocking sodium channels which further prevents repetitive firing of action potentials i.e., excessive neuron signaling. This dual-action helps control seizures and reduce frequency of migraine attacks but doesn't directly affect mood like Elavil would do.
What is Topamax?
Topamax is a brand name for topiramate, an anticonvulsant drug used primarily to control seizures and prevent migraines. It works by reducing the electrical activity in the brain, which helps to reduce the frequency of seizures and prevent migraines before they start. Topamax was first approved by the FDA in 1996. As it's not an antidepressant like Elavil (amitriptyline), it does not increase levels of serotonin or norepinephrine in the brain. Its differing mechanism means that its side-effect profile is also different from that of tricyclic antidepressants like Elavil - most notably, it does not typically cause weight gain or sexual dysfunction (common side effects with Elavil). In fact, weight loss can be a common side effect with Topamax use. The impact on neuronal hyperexcitability can be beneficial especially for patients who suffer from epilepsy or chronic migraine headaches.
What conditions is Topamax approved to treat?
Topamax is a medication that has been approved for a variety of treatments:
- Epilepsy, specifically partial onset seizures or primary generalized tonic-clonic seizures
- Prevention of migraine headaches in adults and adolescents 12 years of age and older
- Adjunctive therapy for adults and pediatric patients ages 2 - 16 years with partial onset seizures or primary generalized tonic-clonic seizures, and in patients 2 years of age and older with seizures associated with Lennox-Gastaut syndrome.
How does Topamax help with these illnesses?
Topiramate, like Elavil, works to manage and mitigate seizure activity for those afflicted with epilepsy. It also plays a role in preventing migraines by stabilizing the electrical activity in the brain and affecting various neurotransmitters within the nervous system. Topamax primarily acts on two neurotransmitters, GABA (gamma-aminobutyric acid) and glutamate, which are key players in maintaining balance in brain activity. By increasing GABA's inhibitory action while simultaneously reducing glutamate's excitatory effect, it helps calm overactive nerve circuits involved in seizures and migraines. Unlike Elavil that carries antidepressant properties as well due to its impact on serotonin levels, Topamax does not have this additional function. As such it may be prescribed when a patient needs focused treatment for their neurological conditions without needing intervention for mood disorders.
How effective are both Elavil and Topamax?
Both amitriptyline (Elavil) and topiramate (Topamax) have well-established histories of successful use in managing various conditions, such as chronic pain syndromes for the former and epilepsy or migraine prevention for the latter. They were initially approved by the FDA within a few decades of each other and operate on different neurotransmitters, leading to distinct prescribing circumstances. The effectiveness of Elavil at alleviating symptoms associated with migraines was directly studied against Topamax in a 2011 clinical trial; both drugs showed comparable efficacy in reducing frequency and severity of migraines while exhibiting different safety profiles.
A review from 2007 highlighted that amitriptyline has been effective not only at managing depression but also neuropathic pain from its first week of administration. Its side effect profile is reasonably favorable, although it can cause significant sedation which may be undesirable in some patients. It's particularly noted that despite being an older generation antidepressant drug developed back when tricyclics were commonly used, Elavil remains widely prescribed due to its broad-spectrum activity beyond just treating depression.
On the other hand, a review conducted in 2012 provided evidence that topiramate seems more effective than placebo at preventing migraines and seizures alike without causing much weight gain – indeed, it often causes weight loss instead. The same cannot be said for most antiepileptic drugs or migraine preventive medications available today. However, research regarding its standalone use still needs further clarification since it's usually considered after trying simpler treatments like beta-blockers or calcium channel blockers first before moving onto antiepileptics like Topamax among others for refractory cases.
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At what dose is Elavil typically prescribed?
Oral dosages of Elavil range from 25–150 mg/day, but studies have indicated that a starting dose of 75 mg per day is often enough for treating major depressive disorder in adults. Elderly patients may be started on lower doses like 10-50mg/day due to increased sensitivity to the drug. Dosage can be gradually increased over several weeks if there's no response, but under medical supervision. The maximum dosage that should not be exceeded in any case is 150 mg/day.
On the other hand, Topamax has a wider range of dosages and its use extends beyond just treatment for depression; it's also used for migraine prevention and management of seizures. For migraines, adults usually start with a dose of 25mg once nightly for one week before increasing to twice daily from second week with increase by increments every week until an optimal response is achieved or up to a maximum dosage of around 100 mg per day. When used as an anticonvulsant (for seizures), the dosage could go higher - up to approximately 200-400mg per day split into two doses.
Remember: these are general guidelines; always consult your healthcare provider for personalized advice.
At what dose is Topamax typically prescribed?
Topamax treatment typically begins at a low dosage of 25 mg/day, taken at night. This dose can then be slowly increased by 25-50mg per week over the following weeks. The therapeutic dosage usually ranges between 100–200 mg/day, split into two doses to enhance tolerance and effectiveness. These doses are generally taken 12 hours apart for better absorption and minimization of side effects. In some cases, if there is no significant response to this regimen after an adequate trial period, the dosage may be increased with medical supervision up to a maximum of 400 mg/day divided into two doses, spaced about twelve hours apart.
What are the most common side effects for Elavil?
Common side effects of Elavil (amitriptyline) can include:
- Drowsiness or sedation
- Dry mouth
- Constipation
- Blurred vision
- Weight gain
- Difficulty urinating
- Lowering of blood pressure on standing, which can cause dizziness and increase the risk of falls
On the other hand, Topamax (topiramate) may cause:
- Tingling sensation in hands, feet, lips and face.
- Loss of appetite and weight loss
- Altered taste perception leading to a dislike for carbonated drinks
- Nausea or upset stomach
-Diarrhea or constipation
-Slow thinking and forgetfulness -Fatigue/weakness/drowsiness
These are not all the possible side effects. Each individual may react differently to medications. If you experience any distressing symptoms while taking these drugs, contact your healthcare provider immediately.
Are there any potential serious side effects for Elavil?
While Topamax is generally well tolerated, it can occasionally lead to serious side effects such as:
- Thoughts of suicide or self-harm
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat. In rare cases, you might experience a severe skin reaction that causes peeling and blistering.
- Visual problems including blurred vision or sudden blindness. You may also notice pain around your eyes.
- Increased heart rate or palpitations which could make you feel dizzy and shortness of breath.
- Metabolic acidosis (an imbalance in the body's acid-base) - this can cause confusion, periodic breathing (respiratory pauses), lack of energy, loss of appetite or irregular heartbeat.
- Symptoms related to low blood sodium levels like headache, weakness followed by seizures and possibly coma due to brain swelling
- Like other anti-seizure drugs, Topamax may cause a small increase in suicidal thoughts/actions; if any new/worsening signs appear contact your healthcare provider immediately.
Remember these are potential side effects not everyone experiences them. However should you encounter any unusual symptoms when taking Topamax seek medical attention promptly.
What are the most common side effects for Topamax?
Topamax, an alternative to Elavil, may cause certain side effects which can include:
- Numbness or tingling in the hands and feet
- Changes in taste
- Weight loss
- Diarrhea, nausea or stomach pain
- Fatigue and drowsiness
- Difficulty with memory and concentration
- Dizziness or loss of balance
- Kidney stones (increased urination) In rare cases it can also lead to a sudden decrease in vision with accompanied eye pain and redness. It's important when considering Topamax that you discuss these potential side effects with your healthcare provider.
Are there any potential serious side effects for Topamax?
While Topamax is generally well-tolerated, it can cause some serious side effects. These may include:
- Signs of an allergic reaction such as hives, difficulty breathing and swelling in the face or throat
- Changes in behavior, including new or worsening depression and suicidal thoughts or actions
- Severe back pain, blood in your urine, painful urination or a decrease in urine output (indicative of kidney stones)
- Confusion coupled with lack of sweating leading to fever (which could be signs of metabolic acidosis)
- Sudden vision problems such as pain around the eyes and blurry sight
- An irregular heartbeat that feels too fast or too slow
- Symptoms resembling those of a manic episode: feelings of extreme happiness followed by irritability, unusually energetic behaviour coupled with racing thoughts and trouble sleeping.
If you experience any of these symptoms while taking Topamax, seek medical attention immediately.
Contraindications for Elavil and Topamax?
Both Elavil and Topamax, like many other medications for treating depression or seizures, may exacerbate symptoms in some individuals. If you notice your condition worsening, or if there is an increase in suicidal ideation, thoughts, or behavior while taking either medication, it is vital to seek immediate medical attention.
Neither Elavil nor Topamax should be taken if you are currently using MAO inhibitors (MAOIs) or have used them recently. Always inform your healthcare provider about any medications that you're currently on; this includes MAOIs which require a period of about two weeks to clear from the system before starting treatment with Elavil or Topamax to prevent dangerous interactions.
How much do Elavil and Topamax cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Elavil (25 mg) averages around $140, which works out to about $4.67/day.
- The price for 60 capsules of Topamax (50 mg) is approximately $320, working out to roughly $5.30/day.
Thus, if you are on a higher dosage range for Elavil (i.e., 100 mg/day or more), then brand-name Topamax may be less expensive on a per-day treatment basis. Please note that cost should not be the primary factor in determining which medication is right for you.
Now looking at generic versions:
- Amitriptyline (the generic form of Elavil) comes in packs starting from 10 up to several hundred tablets with an approximate cost ranging from as low as $0.07/day to no more than about $1/day depending on your dosage and pack size.
- Generic Topiramate (the active ingredient in Topamax) costs start at around $.16/per day and can go up based upon dosages and quantity purchased at once.
In general, both medications have affordable options when choosing their generic forms over their branded counterparts.
Popularity of Elavil and Topamax
Amitriptyline, known by its brand name Elavil, was prescribed to about 3.5 million people in the US in 2020. This tricyclic antidepressant accounted for nearly 7% of prescriptions within its class. Amitriptyline has been on the market since the early 1960s and is used not only for depression but also as an effective treatment for nerve-related pain and prevention of migraines.
Topiramate or Topamax had around six million prescriptions issued in the USA during that same year. While it's primarily utilized as a seizure medication (accounting for roughly 15% of antiepileptic drug prescriptions), it's also endorsed off-label use includes migraine prevention, weight loss and bipolar disorder management. The prevalence of topiramate has seen a moderate increase over the past decade due to these expanded uses.
Conclusion
Both Elavil (amitriptyline) and Topamax (topiramate) have established histories of usage in patients with various conditions, including depression, migraines, and neuropathic pain for Elavil, and epilepsy as well as migraine prevention for Topamax. Multiple clinical studies indicate that both drugs are more effective than placebo treatments. In some situations, the two drugs may be used together but this requires careful consideration by a physician due to potential drug interactions.
Elavil primarily acts by increasing the levels of serotonin and norepinephrine in the brain which helps elevate mood while Topamax works primarily through modulating certain neurotransmitters like glutamate and GABA as well as inhibiting certain sodium channels. Thus they tend to be prescribed under different circumstances depending on individuals' specific needs.
Both medications are available in generic form which can provide significant cost savings especially for those who must pay out-of-pocket. It's important to note that both medications might require an adjustment period where effects may not become noticeable immediately.
The side effect profile is somewhat similar between these two medications; however there could be differences based on individual response. Common side effects include dizziness or lightheadedness when standing up suddenly after sitting or lying down (orthostatic hypotension), dry mouth, constipation with Elavil; whereas tingling sensations or numbness (paresthesias), loss of appetite leading to weight loss could occur with Topamax. Patients should closely monitor their symptoms especially upon starting therapy or when dosage changes are made. They should seek medical help promptly if serious side effects such as thoughts about self-harm develop.
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Refrences
- McClure, E. W., & Daniels, R. N. (2021, January 13). Classics in Chemical Neuroscience: Amitriptyline. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/acschemneuro.0c00467
- Shank, R. P., & Maryanoff, B. E. (2008, May 14). Molecular Pharmacodynamics, Clinical Therapeutics, and Pharmacokinetics of Topiramate. CNS Neuroscience & Therapeutics. Wiley.http://doi.org/10.1111/j.1527-3458.2008.00041.x
- Fantasia, H. C. (2014, October). Migraine Headache Prophylaxis in Adolescents. Nursing for Women's Health. Elsevier BV.http://doi.org/10.1111/1751-486x.12150
- Dodick, D. W., Freitag, F., Banks, J., Saper, J., Xiang, J., Rupnow, M., … Hulihan, J. (2009, March). Topiramate versus amitriptyline in migraine prevention: A 26-week, multicenter, randomized, double-blind, double-dummy, parallel-group noninferiority trial in adult migraineurs. Clinical Therapeutics. Elsevier BV.http://doi.org/10.1016/j.clinthera.2009.03.020