A friend of mine had asked me about this. I had looked it up on Epocrates, but didnt know if it was dose-dependent.....
She was prescribed 25mg amitryptiline for migraines. It hasn't completely controlled her migraines though. Before she goes back to talk to her doctor, she asked if taking 25 mg topamax would both help with the migraines and counter weight gain. Epocrates interaction showed that you should use caution with this combo because of the additive effects, but I didnt know if its more for the 150mg amitryptiline or higher doses of topamax that you have to really worry about that. Any suggestions? I know that she's worried about increasing the amitryptiline more because shes already gained weight that shes still trying to lose back from when they originally tried an SSRI as a prophylactic.
I type fast and don't care about my grammer here. Don't bother criticizing it.
We use them together all the time. With the higher doses of either, you can get additive drowsiness and cognitive blunting. We also do the combination for the said reason. For example, valproatic acid + topiramate to get the maxim migraine prevention without the weight gain of valproic acid and keep the topiramte dose low to avoid the cognitive side effects.Originally Posted by mednut83
JMJ
What would be the start/optimal dosing of valproic acid + topiramate? What about nortryptiline vs amitryptiline and side effect profile? Nort. is less correct?
I don't use valproic acid and topiramate together too often. I may have 3-4 on that combo. If they are on already on topiramate, I usually start valproate as 250 MG once a day and titrate every 2-3 weeks. The one patient I can think of I now have her on Depakote 500 MG and topiramate 200 MG per day. I do have a handful for which Depakote was what worked but they started having weight gain. They had been on Topamax but it failed, but helped them loose weight. So I will add topiramate back to help with the weight gain. I see nortriptyline and amitriptyline as equal in headache prophylaxis so I go by side effects. If they need additional help sleeping at night then I favor amitriptyline.
JMJ
just remember the nickname for topamax is dope-a-max gets you a little doppy - additive effects us make it worse
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