TOPIRAMATE ACCORD 200 MG FILM-COATED TABLETS - patient leaflet, side effects, dosage

Patient leaflet - TOPIRAMATE ACCORD 200 MG FILM-COATED TABLETS

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Package leaflet: Information for the patient Topiramate Accord 25 mg film-coated tablets

Topiramate Accord 50 mg film-coated tablets

Topiramate Accord 100 mg film-coated tablets

Topiramate Accord 200 mg film-coated tablets topiramate

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
If you get any side effects, talk to your doctor or pharmacist.This includes any possible side effects not listed in this leaflet. See section 4
1. What topiramate tablets are and what they are used for
2. What you need to know before you take topiramate tablets
3. How to take topiramate tablets
4. Possible side effects
5. How to store topiramate tablets
6. Contents of the pack and other information

1. What topiramate tablets are and what they are used for
Topiramate belongs to a group of medicines called “antiepileptic medicines.” It is used: alone to treat seizures in adults and children over age 6
with other medicines to treat seizures in adults and children aged 2 years and above
to prevent migraine headaches in adults

2. what you need to know before you take topiramate tablets

Do not take topiramate tablets:

■ if you are allergic to topiramate or any of the other ingredients of this medicine (listed in section 6).

■ for migraine prevention if you are pregnant or if you are a woman of childbearing potential unless you are using effective contraception(see “Pregnancy and breast-feeding” section for further information). You should talk to your doctor about the best kind of contraception to use while you are taking topiramate tablets.

If you are not sure if the above applies to you, talk to your doctor or pharmacist before taking topiramate tablets.

Warnings and precautions

Talk to your doctor or pharmacist before taking topiramate tablets if you:

have kidney problems, especially kidney stones, or are getting kidney dialysis
have a history of blood and body fluid abnormality (metabolic acidosis)
have liver problems
have eye problems, especially glaucoma
have a growth problem
are on a high fat diet (ketogenic diet)
are taking topiramate tablets to treat epilepsy and you are pregnant or a woman of childbearing potential (see “pregnancy, and breast-feeding”-section for further information)

If you are not sure if any of the above applies to you, talk to your doctor or pharmacist before taking topiramate tablets.

It is important that you do not stop taking your medicine without first consulting your doctor. You should also to talk to your doctor before taking any medicine containing topiramate that is given to you as an alternative to this medicine. You may lose weight if you use topiramate so your weight should be checked regularly when using this medicine. If you are losing too much weight or a child using this medicine is not gaining enough weight, you should consult your doctor.

A small number of people being treated with anti-epileptic medicines such as topiramate have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor.

Topiramate tablets can cause serious skin reactions, tell your doctor immediately if you develop a skin rash and/or blisters (see also section 4 ‘Possible side effects’).

Topiramate tablets may in rare cases cause high levels of ammonia in the blood (seen in blood tests) which can lead to a change in brain function, especially if you are also taking a medicine called valproic acid or sodium valproate. Since this may be a severe condition, tell your doctor immediately if the following symptoms occur (see also section 4 ‘Possible side effects’):

– difficulty thinking, remembering information, or solving problems
– being less alert or aware
– feeling very sleepy with low energy

At higher doses of topiramate tablets, the risk of developing these symptoms may increase.

Other medicines and topiramate tablets Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, Topiramate tablets and certain other medicines can affect each other. Sometimes the dose of some of your other medicines or this medicine will have to be adjusted.

Especially, tell your doctor or pharmacist if you are taking:

other medicines that impair or decrease your thinking, concentration, or muscle coordination (e.g. central nervous system depressant medicines such as muscle relaxants and sedatives).
birth control pills. This medicine may make your birth control pills less effective. You should talk to your doctor about the best kind of contraception to use while you are taking topiramate tablets.

Tell your doctor if your menstrual bleeding changes while you are taking birth control pills and topiramate.

Keep a list of all the medicines you take. Show this list to your doctor and pharmacist before you start a new medicine.

Other medicines you should discuss with your doctor or pharmacist include other anti-epileptic medicines, risperidone, lithium, hydrochlorothiazide, metformin, pioglitazone, glibenclamide, amitriptyline, propranolol, diltiazem, venlafaxine, flunarazine, St. John’s Wort (Hypericum perforatum ; a herbal preparation used to treat depression), warfarin used to thin the blood.

If you are not sure if any of the above applies to you, talk to your doctor or pharmacist before using topiramate.

Topiramate tablets with food and drink

You can take topiramate with or without food. Drink plenty of fluids during the day to prevent kidney stones while taking Topiramate tablets. You should avoid drinking alcohol when taking Topiramate tablets.

Pregnancy and breast-feeding

Migraine prevention:

Topiramate tablets can harm an unborn baby. You must not use topiramate tablets if you are pregnant. You must not use topiramate tablets for migraine prevention if you are a woman of childbearing potential unless you are using effective contraception. Talk to your doctor about the best kind of contraception and whether topiramate tablets is suitable for you. Before the start of treatment with topiramate tablets a pregnancy test should be performed.

Treatment of epilepsy:

If you are a woman of childbearing potential you should talk to your doctor about other possible treatments instead of topiramate tablets. If the decision is made to use topiramate tablets, you should use effective contraception. Talk to your doctor about the best kind of contraception to use while you are taking topiramate tablets. Before the start of treatment with topiramate tablets a pregnancy test should be performed.

If you are planning to become pregnant you should discuss your epilepsy treatment with your doctor as early as possible before you become pregnant.

If you are pregnant, or think you may be pregnant, you must tell your doctor straight away and discuss possible risks the epilepsy medicine you are taking might pose to your unborn baby. You and your doctor should decide if you will continue to take topiramate tablets while you are pregnant.

You should not stop your treatment without discussing this with your doctor. Suddenly stopping may lead to breakthrough seizures which may harm you and your unborn baby. It is important that your epilepsy remains well controlled.

As with other anti-epileptic medicines, there is a risk of harm to the unborn child if topiramate is used during pregnancy.

– If you take topiramate tablets during pregnancy, your baby has a higher risk for physical birth abnormalities, particularly, cleft lip (split in the top lip) and cleft palate (split in the roof of the mouth). Newborn boys may also have a malformation of the penis (hypospadia). These defects can develop early in pregnancy, even before you know you are pregnant.
– Studies with women treated with topiramate for epilepsy have shown that on average 4–5 babies in every 100 will have serious physical birth abnormalities. This compares to 2 to 3 babies in every 100 born to women who do not have epilepsy.
– The higher the dose of topiramate, the higher the risk of physical birth abnormalities but all doses carry a risk. It is important that where possible you are prescribed the lowest dose to control your epilepsy.
– Taking more than one epilepsy medicine at the same time may also increase the risk of physical birth abnormalities. This means that where possible, your doctor should consider using one epilepsy medicine to control your epilepsy.
– If you take topiramate tablets during pregnancy, your baby may be smaller than expected at birth. Talk to your doctor if you have questions about this risk during pregnancy.
– There may be other medicines to treat your condition that have a lower risk of birth defects.

Breast-feeding

The active substance in topiramate tablets (topiramate) passes into human milk. Effects have been seen in breastfed babies of treated mothers, including diarrhea, feeling sleepy, feeling irritable, and poor weight gain. Therefore, your doctor will discuss with you whether you abstain from breast-feeding or whether to abstain from treatment with topiramate tablets. Your doctor will take into account the importance of the medicine to the mother and the risk for the baby.

Mothers who breast-feed while taking topiramate must tell the doctor as soon as possible if the baby experiences anything unusual.

Driving and using machines

Dizziness, tiredness, and vision problems may occur during treatment with topiramate. Do not drive or use any tools or machines without talking to your doctor first.

Topiramate tablets contain lactose.

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. Warning! Each bottle contains a desiccant capsule. This a small canister on which “Do not eat” is written. Do not eat this.

Topiramate tablets contain sodium

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

3. how to take topiramate tablets

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Your doctor will usually start you on a low dose of topiramate and slowly increase your dose until the best dose is found for you.
Topiramate tablets are to be swallowed whole. Avoid chewing the tablets as they may leave a bitter taste.
Topiramate can be taken before, during, or after a meal. Drink plenty of fluids during the day to prevent kidney stones while taking topiramate.
See a doctor right away. Take the medicine pack with you.
You may feel sleepy, tired, or less alert; lack coordination; have difficulty speaking or concentrating; have double or blurred vision, feel dizzy due to low blood pressure, feel depressed or agitated, or have abdominal pain, or seizures (fits).

Overdose can happen if you are taking other medicines together with topiramate.

If you forget to take topiramate tablets

If you forget to take a dose, take it as soon as you remember it. However if it is almost time for your next dose, skip the missed dose and continue as usual. If you miss two or more doses, contact your doctor.

Do not take a double dose (two doses at the same time) to make up for a forgotten dose.

If you stop taking topiramate tablets

Do not stop taking this medicine unless told to do so by your doctor. Your symptoms may return. If your doctor decides to stop this medication, your dose may be decreased gradually over few days. If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Tell your doctor, or seek medical attention immediately if you have the following side effects: Very common (may affect more than 1 in 10 people) Depression (new or worse)
Seizures (fits)
Anxiety, irritability, changes in mood, confusion, disorientation
Problems with concentration, slowness of thinking, loss of memory, problems with memory (new onset, sudden change or increased severity)
Kidney stone, frequent or painful urination
Increased acid level in the blood (may cause troubled breathing including shortness of breath, loss of appetite, nausea, vomiting, excessive tiredness, and fast or uneven heart beats)
Decreased or loss of sweating (particularly in young children who are exposed to high temperatures)
Having thoughts of serious self-harm, trying to cause serious self-harm
Loss of part of the field of vision
Glaucoma – blockage of fluid in eye causing increased pressure in the eye, pain, or decreased vision.
Difficulty thinking, remembering information, or solving problems, being less alert or aware, feeling very sleepy with low energy – these symptoms may be a sign of a high level of ammonia in the blood (hyperammonemia), which can lead to a change in brain function (hyperammonemic encephalopathy).
Serious skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis – these may appear as rashes with or without blisters. Skin irritation, sores or swelling in the mouth, throat, nose, eyes and around the genitals. The skin rashes may develop into serious widespread skin damage (peeling of the epidermis and superficial mucous membranes) with life-threatening consequences.
Inflammation of the eye (uveitis) with symptoms such as eye redness, pain, sensitivity to light, runny eyes, seeing small dots or getting blurred vision

Other side effects include the following, if they get serious, please tell your doctor or pharmacist:

Very common (may affect more than 1 in 10 people):

Stuffy, runny nose or sore throat
Tingling, pain and/or numbness of various body parts
sleepiness,tiredness
Dizziness
Nausea, diarrhoea
Weight loss
Anaemia (low number of red blood cells)
Allergic reaction (such as skin rash, redness, itching, facial swelling, hives)
Loss of appetite, decreased appetite
Aggression, agitation, anger, abnormal behaviour
Difficulty falling or staying asleep
Problems with speech or speech disorder, slurred speech
Clumsiness, or lack of coordination, feeling of unsteadiness when walking
Decreased ability to complete routine tasks
Decreased, loss of, or no sense of taste
Involuntary trembling or shaking in the arms, hands or legs; rapid, uncontrollable movements of the eyes
Visual disturbance, such as blurred vision, double vision, decreased vision, difficulty focusing
Sensation of spinning (vertigo), ringing in the ears, ear pain
Shortness of breath
Cough
Nose bleeds
Fever, not feeling well, weakness
Vomiting, constipation, abdominal pain or discomfort, indigestion, stomach or intestinal infection
Dry mouth
Hair loss
Itching
Joint pain or swelling, muscle spasms or twitching, muscle aches or weakness, chest pain
Weight gain
Decrease in platelets (blood cells that help stop bleeding), decrease in white blood cells that help to protect you against infection, decrease in potassium level in the blood
Increase in liver enzymes, increase in eosinophils (a type of white blood cell) in the blood
Swollen glands in the neck, armpit, or groin
Increased appetite
Elevated mood
Hearing, seeing, or feeling things that are not there, severe mental disorder (psychosis)
Showing and/or feeling no emotion, unusual suspiciousness, panic attack
Problems with reading, speech disorder, problems with handwriting
Restlessness, hyperactivity
Slowed thinking, decreased wakefulness or alertness
Reduced or slow body movements, involuntary abnormal or repetitive muscle movements
Fainting
Abnormal sense of touch; impaired sense of touch
Impaired, distorted, or no sense of smell
Unusual feeling or sensation that may precede a migraine or a certain type of seizure
Dry eye, sensitivity of the eyes to light, eyelid twitching, watery eyes
Decreased or loss of hearing, loss of hearing in one ear
Slow or irregular heartbeat, feeling your heart beating in your chest
Low blood pressure, low blood pressure upon standing (consequently, some people taking topiramate tablets may feel faint, dizzy, or may pass out when they stand up or sit up suddenly)
Flushing, feeling warm
Pancreatitis (inflammation of the pancreas)
Excessive passing of gas or wind, heartburn, abdominal fullness or bloating
Bleeding gums, increased saliva, drooling,

breath odour

Excessive intake of fluids, thirst
Skin discolouration
Muscle stiffness, pain in side
Blood in urine, incontinence (lack of control) of urine, urgent desire to urinate, flank or kidney pain
Difficulty getting or keeping an erection, sexual dysfunction
Flu-like symptoms
Cold fingers and toes
Feeling drunk
Learning disability
Abnormally elevated mood
Loss of consciousness
Blindness in one eye, temporary blindness, night blindness
Lazy eye
Swelling in and around the eyes
Numbness, tingling and colour change (white, blue then red) in fingers and toes when exposed to the cold
Inflammation of the liver, liver failure
Abnormal skin odour
Discomfort in your arms or legs
Kidney disorder
Maculopathy is a disease of the macula, the small spot in the retina where vision is keenest. You should call your doctor if you notice a change or decrease in your vision.

Children

The side effects in children are generally similar to those seen in adults, but the following side effects may be more common in children than adults: – Problems with concentration

– Increased acid level in the blood
– Having thoughts of serious self-harm
– Tiredness
– Decreased or increased appetite
– Aggression, abnormal behaviour
– Difficulty falling or staying asleep
– Feeling of unsteadiness when walking
– Not feeling well
– Decrease in potassium level in the blood
– Showing and/or feeling no emotion
– Watery eyes
– Slow or irregular heartbeat

Other side effects that may occur in children are: Common (may affect up to 1 in 10 people) – Sensation of spinning (vertigo)

– Vomiting
– Fever

Uncommon (may affect up to 1 in 100 people)

– Increase in eosinophils (a type of white blood cell) in the blood
– Hyperactivity
– Feeling warm
– Learning disability

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

5. how to store topiramate tablets

Keep this medicine out of sight and reach of children.Do not use this medicine after the expiry date, which is stated on the carton and bottle or blister after EXP. The expiry date refers to the last day of that month.

Do not store above 25°C. Keep the container tightly closed in order to protect from moisture. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. contents of the pack and other information

What topiramate tablets contain

The active substance is topiramate.

Each film-coated tablet contains 25 mg topiramate.

Each film-coated tablet contains 50 mg topiramate.

Each film-coated tablet contains 100 mg topiramate.

Each film-coated tablet contains 200 mg topiramate.

The other ingredients are lactose monohydrate (see section 2: topiramate tablets contain lactose), cellulose microcrystalline, starch, pregelatinised (i.e. potato starch), croscarmellose sodium and magnesium stearate.

■ The 25 mg tablets are coated with hypromellose, titanium dioxide (E171) and macrogol 6000.
■ The 50 mg and 100 mg tablets are coated with hypromellose, titanium dioxide (E171), macrogol 6000 and iron oxide yellow (E172)
■ The 200 mg tablets are coated with hypromellose, titanium dioxide (E171), macrogol 6000 and iron oxide red (E172).

What topiramate tablets look like and contents of the pack

Film-coated tablet.

Topiramate Accord is available in four strengths containing either 25 mg, 50 mg, 100 mg and 200 mg topiramate.

The 25 mg film-coated tablets are white round and biconvex, with bevelled edges and embossed TP on one side and 25 on the other. The 50 mg film-coated tablets are light yellow round and biconvex with bevelled edges and embossed TP on one side and 50 on the other. The 100 mg film-coated tablets are dark yellow round and biconvex, with bevelled edges and embossed TP on one side and 100 on the other. The 200 mg film-coated tablets are red, round and biconvex, with bevelled edges and embossed TP on one side and 200 on the other. Topiramate film-coated tablets are available in aluminium/aluminium blisters in packs sizes of 10, 14, 20, 28, 30, 50, 56, 60, 100, 120 and 200 film-coated tablets or in high density polyethylene (HDPE) bottles fitted with a white opaque polypropylene child resistant closure with wad having induction sealing liner supplied in cardboard cartons in pack sizes of 14,30,60,100 and 200 film-coated tablets. In each container there is a desiccant canister, which should not be swallowed. Not all pack sizes may be marketed.

Marketing authorization holder

Accord Healthcare Limited,

Sage House,319 Pinner Road, North Harrow, Middlesex, HA1 4HF, United Kingdom

Manufacturer: