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topiramate

topiramate

Brand names: Qudexy XR Sprinkle, Topamax, Trokendi XR

Form	Strength
TABLET, ORAL	25 mg;100 mg

Display Anticonvulsants, Miscellaneous, Antimigraine Agents, Miscellaneous Class: 281292, 283292

Medication comments:

Per policy, orders for these non-formulary agents will be changed to formulary equivalents.
Non-Formulary Agent	Formulary Equivalent
topiramate XR (Trokendi) 50 mg daily	topiramate (Topamax) 25 mg BID
topiramate XR (Trokendi) 100 mg daily	topiramate (Topamax) 50 mg BID
topiramate XR (Trokendi) 200 mg daily	topiramate (Topamax) 100 mg BID
topiramate XR (Trokendi) 400 mg daily	topiramate (Topamax) 200 mg BID

USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances. The following outlines must be followed.
generic (Brand) Route [Packaging: Manufacturer ⇒ Dispense]	Activities
topiramate (Topamax) PO [UD ⇒ UD]	100 mg tablet	Stock @ IDBH? Y NIOSH Table 2^B↑
Pharmacy: Receiving / Storage / Preparation Exposure Risk: minimal	• Handling/preparation PPE Requirements: n/a
	• Receiving from Distributor: Standard
	• Pharmacy Storage Area: Carousel
	• Packaging/Reconstitution Location: n/a
	• Compounding (Non-Sterile/Sterile) Location: n/a
	• Omnicell Load: Yes
Transport	• Transport (dose is placed inside a plastic sealable bag): Standard
Nursing: Storage / Administration Exposure Risk: low	• Handling/administration PPE Requirements: Single pair of CX approved gloves. Wash hands after handling
	• Storage of Finished dose in Nursing Area/Procedural Area: Omnicell
	• Signage on Patient Door Required: No
	• Manipulation of Dosage Form: Standard
	• Special Manipulation for Administration: Not recommended to crush, break or chew
Disposal / Spills	• Disposal of Drug Waste: Full- blue bin Trace/packaging- trash
	• Disposol of Used PPE: trash bin (inside plastic bag)
	• Spill management: n/a
Reason for exemption of USP<800> Containment Requirements: Purchased in final dosage form; packaged as unit dose. Does not require additional manipulation for dispensing.

2023 American Geriatrics Society Beers Criteria^® for potentially inappropriate medication use in older adults.
Medication:	topiramate (Qudexy XR, Topamax)
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome	antiepileptics ⇄ History of falls or fractures
Rationale	May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation	Avoid except for seizures and mood disorders.
Quality of evidence: High, Strength of Recommendation: Strong

Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es)	antiepileptics (including gabapentinoids) ⇄ CNS-active agents
Risk Rationale	Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation	Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
Quality of evidence: High, Strength of Recommendation: Strong

Last updated: Sep. 19, 2025

Therapeutic Interchange Policy toporamate XR -> topiramate
Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug / Assessment of Risk

UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

This site is intended for the staff of Iredell Health System. While others may view accessible pages, Iredell Health System makes no warranty, express or implied, as to the use of this information outside of Iredell Health System. The content of this policy and procedure document serves as guidance to the delivery of quality patient care. Care providers are expected to exercise critical thinking and situational awareness skills, and in specific situations to take such action as is necessary for the delivery of quality patient care.