Severe Weight Loss and Emaciation Following Topiramate Administration

Topiramate is an antiepileptic drug, used also for prevention of an episodic migraine. Its effects include sodium-channel-blocking activity, enhancement of cerebral GABA concentrations and antagonism of AMPA/kainate receptors, which leads to a decreased glutamate-mediated excitation. It is documented to possess weight reducing properties. It attenuates appetite through mechanisms that remain to be elucidated. Severe weight loss is not reported in the literature. We investigated one patient with severe weight loss (40.2% loss) resulted in emaciation and found that the implicated drug was topiramate. This notion was confirmed when we discontinued the implicated drug (Topiramate) as the patient regained his weight again to the previously recorded levels. Conclusion: Severe weight loss up to emaciation may occur after topiramate administration, Topiramate can be used to counteract the weight gain effect of antipsychotics, long acting topiramate preparation alone or in combination with long acting phentermine can be used to treat morbid obesity.