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Neurologia. 2009 Nov;24(9):808-10.

[Low versus high doses of topiramate in the preventive treatment of migraine].

[Article in Spanish]

Author information

  • 1Servicio de Neurologia, Hospital Universitario, Salamanca, Spain.

Abstract

INTRODUCTION:

The efficacy of topiramate in the preventive treatment of migraine is well demonstrated. Clinical trials indicate that the dose of 100 mg/daily is the ideal in terms of efficacy, but doses as low as 50 mg/ daily show some efficacy, which could improve its tolerability in some patients.

OBJECTIVE:

To analyse the behaviour of the different doses of topiramate in daily clinical practice.

PATIENTS AND METHODS:

Patients with frequent migraine with or without aura episodes who received topiramate in our clinic were treated in a homogeneous way. Initially they were given 50 mg/daily (usually as a nocturnal dose), after increasing the dose in 2-3 weeks. The efficacy was evaluated after 6-8 weeks. If no response (decrease in frequency by at least 50%) was observed the dose of topiramate was increased (25 mg/week) up to 100 mg/daily, The patients were seen at least once every 3 months.

RESULTS:

This series includes 182 patients. Globally, 75% of the patients responded, 14% did not respond and 11% did not tolerate the drug. One-quarter of patients (44 cases) responded to low doses, while 92 patients (51%) responded to the 100 mg/dose. Tolerability slightly decreased on increasing the dose.

CONCLUSIONS:

These data indicate that one-quarter of the patients respond to low doses in daily clinical practice, though about half of these patients will need doses of 100 mg/day. Given the higher tolerability of low doses, we recommend trying first low doses before giving higher doses, which will be necessary in half of the patients.

PMID:
20099154
[PubMed - indexed for MEDLINE]
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