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Topamax vs Keppra
Introduction
For patients with epilepsy or other seizure disorders, certain drugs that alter the activity of nerve pathways in the brain can help control seizure frequency and intensity. Topamax and Keppra are two such medications often prescribed for these conditions. They each affect different aspects of neuronal functioning but both have effects on reducing seizures in patients with epilepsy or other related neurological disorders. Topamax, also known as topiramate, is classified as a sulfamate-substituted monosaccharide anticonvulsant; it works by enhancing the activity of GABA (a neurotransmitter which slows down brain signals) and inhibiting certain types of voltage-dependent sodium channels. On the contrary, Keppra (levetiracetam) belongs to a class of drugs termed as synaptic vesicle protein modulators - it is presumed to work by affecting calcium channels and sensitizing neurons to inhibition during an abnormal discharge.
Topamax vs Keppra Side By Side
| Attribute | Topamax | Keppra |
|---|---|---|
| Brand Name | Topamax | Keppra |
| Contraindications | Should not be taken with medications that interact without consulting a physician. Abrupt discontinuation should be avoided. | Should not be taken with medications that interact without consulting a physician. Abrupt discontinuation should be avoided. |
| Cost | For brand-name, around $570 for 60 tablets of 100 mg. Generic versions cost between $0.40 and ~$1 per day. | For brand-name, approximately $320 for a month's supply of 500 mg, or 60 tablets. Generic versions cost between $0.25 to ~$0.50 per day. |
| Generic Name | Topiramate | Levetiracetam |
| Most Serious Side Effect | Increased suicidal thoughts or self-harm, vision changes, rapid heart rate, signs of kidney stones. | Suicidal thoughts/actions, severe allergic reactions, changes in mood or behavior, dizziness and loss of coordination. |
| Severe Drug Interactions | Interactions with over-the-counter medicines, vitamins, herbal products, and alcohol intake can heighten certain side effects such as drowsiness or cognitive impairment. | Interactions with other medications can affect how Keppra works and vice versa; this includes over-the-counter medicines, vitamins, herbal products along with alcohol intake which can heighten certain side effects such as drowsiness. |
| Typical Dose | Oral dosages begin at 25–50 mg/day, gradually increasing to an effective dose which can range from 200-400 mg/day divided into two doses. | Treatment usually begins with a dosage of 500 mg twice per day, which can be increased to a maximum of 1500 mg taken twice daily if necessary. |
What is Topamax?
Topiramate (the generic name for Topamax) is a type of anticonvulsant medication, which was a significant advancement over earlier classes of antiepileptic drugs. It was first approved by the FDA in 1996. Topamax works by calming the nerves in the brain that cause seizures and migraines, effectively reducing their frequency and severity. It is prescribed for various conditions including epilepsy, migraines, and sometimes off-label uses such as weight loss or bipolar disorder.
On the other hand, Levetiracetam (the generic name for Keppra) also falls under the class of anticonvulsants but has a different mechanism of action; it binds to SV2A synaptic vesicle protein, moderating nerve conduction across synapses. This results in it having fewer side effects than other anticonvulsants like Topamax which may have broader effects on neurotransmitters within the central nervous system.
What conditions is Topamax approved to treat?
Topamax and Keppra are both approved for the treatment of various types of seizures:
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With Topamax, it is used primarily to treat epilepsy in people two years of age and older. It can be used for monotherapy or adjunctive therapy for partial onset or primary generalized tonic-clonic seizures. It's also approved for use in prevention of migraine headaches.
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On the other hand, Keppra is approved as adjunctive therapy in the treatment of partial onset seizures in adults and children one month of age and older with epilepsy. It's also used as adjunctive therapy for myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy, as well as primary generalized tonic-clonic seizures in adults and children six years of age and older with idiopathic generalized epilepsy.
How does Topamax help with these illnesses?
Topamax, also known as topiramate, works to manage seizures by reducing abnormal electrical activity in the brain. It does this by increasing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that decreases nerve cell excitability throughout the nervous system, which can help prevent seizure activities. In addition to enhancing GABA's effects, Topamax also blocks certain types of channels that allow sodium and calcium into cells. By doing this, it helps slow down the rapid firing of neurons that leads to seizures.
On the other hand, Keppra or levetiracetam has a slightly different mechanism but with similar goals. It still aims at controlling seizure activities but it does so by binding to synaptic vesicle protein SV2A in the brain which thought to result in stabilization of presynaptic neuronal membranes. This helps modulate neurological transmission within neural networks and prevents excessive electrical signals thereby reducing seizure occurrences.
Therefore both medications work towards managing epilepsy but through different mechanisms and pathways within our body's complex nervous system.
What is Keppra?
Keppra, a brand name for levetiracetam, is an antiepileptic drug (AED) that works by reducing the frequency of nerve signals in the brain. This action helps to alleviate seizures by preventing excessive electrical activity. Keppra was first approved by the FDA in 1999 and has since been used as a common treatment option for different types of epilepsy.
Unlike Topamax, another AED which also affects neurotransmitters but can lead to cognitive side effects like memory problems and difficulty concentrating, Keppra does not have similar impacts on cognition. Furthermore, while both drugs can cause mood changes or depression as potential side effects, these are less commonly associated with Keppra than Topamax.
One other key difference between these two medications lies in their weight-related outcomes: whereas Topamax may result in weight loss - sometimes quite drastic - this is not typically seen with Keppra use. Thus patients who cannot afford any weight loss might fare better with Keppra.
What conditions is Keppra approved to treat?
Keppra is approved for the treatment of:
- Seizure disorders in people with epilepsy
- Myoclonic seizures in adults and adolescents 12 years and older
- Partial onset seizures in adults and children as young as one month old
- Tonic-clonic seizures in individuals aged six years and above.
How does Keppra help with these illnesses?
Levetiracetam, or Keppra, operates by binding to synaptic vesicle glycoprotein 2A (SV2A) found in the brain. This protein plays an important role in the release of neurotransmitters - chemicals that transmit signals between nerve cells. By affecting SV2A, Keppra can modulate the amount of these neurotransmitters being released and thereby reduce seizure activity within the central nervous system. It's often chosen for its broad-spectrum efficacy against various types of seizures compared to Topamax which is a sulfa drug working primarily as a neuronal stabilizer and may not be suitable for people with sulfa allergies. As such, Keppra might be prescribed when patients do not respond well to other typical antiepileptic drugs like Topamax or it could also be used in combination with them.
How effective are both Topamax and Keppra?
Both topiramate (Topamax) and levetiracetam (Keppra) have demonstrated effectiveness in treating epilepsy, with FDA approvals coming a few years apart. Since they act on different aspects of neuronal excitability, they may be prescribed for different types of seizures or patient profiles. The efficacy of Topamax and Keppra in managing epileptic seizures has been directly compared in several studies; both drugs exhibited similar potency in controlling seizure frequency as well as comparable safety profiles. In these studies, no significant differences were found between patients receiving Topamax and those receiving Keppra regarding reduction in seizure occurrence.
A 2003 review on topiramate indicated that it is effective at reducing the frequency of various types of seizures from the onset of treatment. Its side effect profile is generally favorable compared to older anti-epileptic drugs, although some adverse effects such as cognitive impairment and weight loss can occur. Despite this, because topiramate acts on multiple neurotransmitter systems involved in seizure generation, it has become a widely used drug for epilepsy management globally.
A 2011 meta-analysis showed that levetiracetam appears to be more effective than placebo at reducing seizure frequency, demonstrating similar efficacy to other common antiepileptic drugs. However, unlike many first-line treatments which are frequently enzyme-inducing anti-epileptics (EIAEDs), levetiracetam does not induce liver enzymes leading to fewer drug-drug interactions making it an appealing alternative for individuals requiring polytherapy or who have coexisting health conditions requiring medication treatment outside their epilepsy management.
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At what dose is Topamax typically prescribed?
Oral dosages of Topamax for epilepsy treatment begin at 25–50 mg/day, gradually increasing to an effective dose which can range from 200-400 mg/day divided into two doses. Pediatric patients aged 2-16 years may start with a lower dosage of approximately 0.5-1 mg/kg/day, with the dosage increased over several weeks as required. For Keppra, adults and adolescents from 16 years old usually start on a daily dose of 500mg twice a day which could be increased up to a maximum of 1500mg twice per day based on individual patient response and tolerability. Children and infants older than one month should be given initial doses dependent upon their weight that can also be increased gradually if there is no adequate response.
At what dose is Keppra typically prescribed?
Keppra treatment usually begins with a dosage of 500 mg twice per day. The dose can then be increased to a maximum of 1500 mg taken twice daily if necessary, spaced approximately 12 hours apart. These adjustments could be made every two weeks depending on the patient's response and tolerability. It should also be noted that for people with kidney problems, doses may need to be adjusted lower based on their creatinine clearance rate - a measure of kidney function. As always, any changes in dosing should only be carried out under the guidance of your healthcare professional.
What are the most common side effects for Topamax?
Common side effects of Topamax may include:
- Memory problems or confusion
- Weight loss
- Nervousness, anxiety, and mood changes
- Drowsiness or fatigue (somnolence)
- Tremor
- Loss of appetite (anorexia)
- Nausea and diarrhea
- Tingling sensation in arms and legs (paresthesia)
- Change in taste
- Dry mouth
-Decreased sweating leading to increased body temperature
On the other hand, Keppra can have side effects such as:
-Drowsiness or fatigue (somnolence)
-Infection including flu-like symptoms
-Anxiety, depression, hostility or aggression
-Nervousness
-Loss of muscle coordination
-Dizziness
-Rash
Are there any potential serious side effects for Topamax?
While both Topamax and Keppra are used as anticonvulsants, they can have different side effects. For Topamax, watch for signs of:
- Increased suicidal thoughts or self-harm
- Allergic reactions such as hives, difficulty breathing, swelling in your face or throat
- Vision changes like blurred vision, sudden blindness or pain upon light exposure
- Rapid heart rate, palpitations or feeling faint
- Low blood bicarbonate levels - confusion, irregular heartbeat, shallow breathing
- Symptoms of a severe metabolic issue (metabolic acidosis) - tiredness/weakness/difficulty thinking
- Signs of kidney stones: severe back/side/abdominal/groin pain; pink/bloody/cloudy urine; painful urination
Keppra can also cause serious side effects including:
- Suicidal thoughts/actions
- Severe allergic reactions: rash/hives/swelling of the face/throat/tongue/trouble breathing
- Changes in mood (aggression/hostility/anxiety/depression) Unusual changes in behavior/patterns /thoughts about suicide/self-harm Loss-of-control movements (ataxia): clumsiness/unsteadiness/trouble speaking/shaking hands that you cannot control/difficulty swallowing/seizures
It's important to monitor any new symptoms and bring them to your doctor's attention immediately.
What are the most common side effects for Keppra?
Keppra, similar to other medications, also has its own set of potential side effects which users should be aware of. These may include:
- Drowsiness or fatigue
- Weakness or lack of energy
- Unsteady walking
- Mood swings and behavioral changes such as agitation and hostility
- Headache
- Pain in the muscles or joints
- Stomach upset including nausea and vomiting
- Infections involving the respiratory tract leading to stuffy or runny nose along with a sore throat. It's important to note that these symptoms might not occur in every individual taking Keppra, however if any of them persist it is crucial to inform your healthcare provider promptly.
Are there any potential serious side effects for Keppra?
Keppra, like any other medication, can cause a host of side effects. It is important to keep an eye out for the following symptoms:
- Signs of allergic reaction such as hives; difficulty breathing; swelling in your face or throat
- Changes in mood or behavior, anxiety, panic attacks, trouble sleeping
- Feelings of suicide or hurting yourself
- Hallucinations (seeing or hearing things that are not real), unusual thoughts or behavior
- Dizziness and loss of coordination (which might lead to falls)
- Extreme drowsiness
- Agitation and aggression towards others.
If you experience any of these concerning symptoms while taking Keppra, it's essential that you seek immediate medical attention.
Contraindications for Topamax and Keppra?
Both Topamax and Keppra, like most other antiepileptic drugs (AEDs), may increase the risk of suicidal thoughts or behavior in some people. If you notice an increase in these symptoms or if your seizures worsen while taking either medication, please seek immediate medical attention.
Neither Topamax nor Keppra should be taken if you are using other medications that interact with them without consulting your physician first. Certain drugs can affect how these medications work and vice versa; this includes over-the-counter medicines, vitamins, herbal products along with alcohol intake which can heighten certain side effects such as drowsiness or cognitive impairment.
It's crucial to always inform your healthcare provider about any other medications you are currently taking before starting a regimen of Topamax or Keppra. Abrupt discontinuation should also be avoided as it may lead to increased seizure frequency or status epilepticus – a life threatening condition where seizures do not stop.
How much do Topamax and Keppra cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Topamax (100 mg) averages around $570, which works out to about $19–38/day, depending on your dose.
- The price for a month's supply of Keppra (500 mg), or 60 tablets, is approximately $320, working out to roughly $10.67/day.
Thus, if you are in the higher dosage range for Topamax (i.e., 200 mg/day or higher), then brand-name Keppra is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which drug is right for you.
For the generic versions of Topamax (topiramate) and Keppra (levetiracetam), costs are significantly lower:
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Levetiracetam can be found in packs starting from 30 capsules with approximate costs ranging from $0.25 to ~$0.50 per day at typical dosages between 500mg and 1500mg daily.
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Generic topiramate has similar pricing structures but may cost slightly more at doses above 200mg daily due to required pill amounts - typically between $0.40 and ~$1 per day based on various pack sizes available.
Prices may vary depending on factors like location and pharmacy choice; it's always best to discuss options with your healthcare provider or pharmacist.
Popularity of Topamax and Keppra
Topiramate, available as a generic drug and under the brand name Topamax, was used by approximately 4.2 million people in the United States in 2020. This anticonvulsant medication is commonly used to manage seizures and prevent migraines. It represents roughly 9% of all epilepsy prescriptions in the US. Over recent years, its prevalence has been relatively stable.
On the other hand, Levetiracetam, also known as Keppra, was prescribed to about 5.1 million people across America during that same year. Known for its broad-spectrum activity against various types of seizures, levetiracetam constitutes just over 11% of total antiepileptic drug prescriptions nationwide. The usage rate for this particular medication appears to be on an upward trend since around 2013.
Conclusion
Both Topamax (topiramate) and Keppra (levetiracetam) have a long-standing history of use in patients with epilepsy, with numerous clinical trials demonstrating their efficacy compared to placebo treatments. Sometimes, these medications may be used together under careful monitoring by a physician as they can interact with one another. They work via different mechanisms: topiramate slows down neuron firing rates and augments the activity of the neurotransmitter GABA while levetiracetam prevents seizures by binding to synaptic vesicle proteins thereby modulating neurotransmitter release.
Topamax is often considered a first-line treatment option for certain types of seizures, whereas Keppra can be used as an initial therapy or added on to other seizure medications if necessary. Both drugs are available in generic form, which represents significant cost savings especially for those who must pay out-of-pocket.
The side effect profiles between the two drugs show some similarities but also key differences. Both are generally well tolerated although topiramate has been linked more frequently with cognitive side effects such as confusion and difficulty concentrating than levetiracetam. Weight loss is common with topiramate while weight gain can occur with levetiracetam. Patients starting either medication should closely monitor any changes especially when initiating treatment or adjusting dosages; immediate medical help should be sought if worsening symptoms or unusual behavioral changes arise.
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Refrences
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- van Passel, L., Arif, H., & Hirsch, L. J. (2006, January). Topiramate for the treatment of epilepsy and other nervous system disorders. Expert Review of Neurotherapeutics. Informa UK Limited.http://doi.org/10.1586/14737175.6.1.19
- Faught Jr, E. (2008, January). Topiramate in the treatment of partial and generalized epilepsy. Neuropsychiatric Disease and Treatment. Informa UK Limited.http://doi.org/10.2147/ndt.s512
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