Topiramate with Posaconazole Interaction Details
Brand Names Associated with Topiramate
- Eprontia ®
- Qudexy XR®
- Topamax®
- Topiramate
- Trokendi XR®
Brand Names Associated with Posaconazole
- Noxafil PowderMix®
- Noxafil®
- Posaconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Elevated topiramate plasma concentrations and topiramate toxicity
Interaction Summary
Use caution when posaconazole is coadministered with topiramate. A case report described probable posaconazole-induced topiramate in a 48-year-old male. Monitor the patient for increased topiramate adverse events (anorexia, somnolence, stupor).
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Use caution when posaconazole is coadministered with topiramate as this may result in increased topiramate plasma concentrations, leading to excessive toxicity. Monitor the patient for increased topiramate adverse events (anorexia, somnolence, stupor).
Mechanism Of Interaction
Unknown
Literature Reports
A) A case was reported of a 48-year-old male who experienced probable posaconazole-induced topiramate toxicity. Following pneumectomy for invasive aspergillosis, the patient had been initiated on posaconazole at hospital discharge. Two weeks after discharge, he presented with 10 days of progressive stupor, daytime somnolence, anorexia, decreased oral intake, weight loss, and a "catatonic state". Past medical history was significant for long-standing epilepsy, stabilized with valproic acid and topiramate, and hemiglossectomy for lingual squamous cell carcinoma. Medications on admission were topiramate (100 mg twice daily), valproate (700 mg twice daily); posaconazole (200 mg four times daily) was discontinued 2 days prior to admission based on clinical discussion. The topiramate plasma level on admission was 27.34 micromol/L, which was highly elevated for the patient's dose (pharmacokinetic modeling suggests a peak plasma concentration of 5 micromol/L may be expected for a 100-mg dose). Eleven days after discontinuing posaconazole, the topiramate level had decreased to 11.51 micromol/L, which coincided with symptom resolution. Valproate levels were normal throughout hospital stay. The patient's stupor and appetite improved slowly over 10 days, and he was discharged 3 weeks after admission. The patient received amphotericin B, followed by voriconazole, and completed antifungal treatment without further incident .
Topiramate Overview
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Topiramate is used alone or with other medications to treat certain types of seizures including primary generalized tonic-clonic seizures (formerly known as a grand mal seizure; seizure that involves the entire body) and partial onset seizures (seizures that involve only one part of the brain). Topiramate is also used with other medications to control seizures in people who have Lennox-Gastaut syndrome (a disorder that causes seizures and developmental delays). Topiramate is also used to prevent migraine headaches but not to relieve the pain of migraine headaches when they occur. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.
Posaconazole Overview
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Posaconazole is used to prevent serious fungal infections that can spread throughout the body in adults and children 2 years of age and older with a weakened ability to fight infection. Posaconazole delayed-release tablets are used to treat invasive aspergillosis (a serious fungal infection that begins in the lungs and spreads through the bloodstream to other organs) in adults and teenagers 13 years of age and older. Posaconazole oral suspension is also used to treat yeast infections of the mouth and throat including yeast infections in adults and teenagers 13 years of age and older that could not be treated successfully with other medications. Posaconazole is in a class of medications called azole antifungals. It works by slowing the growth of fungi that cause infection.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.