Topamax for Migraine Raises Uric Acid Levels, Could Increase Heart RisksSep 10, 2008 | Parker Waichman LLP
Topamax (topiramate) to treat migraines can increase levels of uric acid in the blood, a new study says. Some research has shown that high uric acid levels can increase the risk for cardiac problems.
Topamax, made by Ortho-McNeil Neurologics, a division of Johnson & Johnson, was originally approved to treat epilepsy in adults and children. In 2004, the approved uses of Topamax were expanded to include the prevention of migraine headaches. Generic versions of Topamax were approved by the Food & Drug Administration (FDA) in 2006. Topamax is also used off-label to treat bipolar disorder.
Topamax use has been linked to decreases in body weight and kidney stones, but no studies have looked at its affect on uric acid levels until now. For this new Topamax study, researchers from Duzce University in Turkey measured blood uric acid, cholesterol, and triglyceride levels in 53 patients with migraine who were receiving Topamax, as well as in 44 matched control subjects not treated with the drug.
Among the patients, average uric acid levels were significantly higher in the migraine patients receiving Topamax. In the Topamax patients for whom pretreatment uric acid levels were known, average uric acid levels were significantly higher after initiation of treatment than in the pretreatment measurements. Average serum triglyceride and total cholesterol levels were also higher in the migraine group, but the differences were not statistically significant.
It is known that excess uric acid in the body can create oxidative stress, which damages body cells and contributes to diseases, including the buildup of artery-clogging plaques. Considering the potential link between abnormally high uric acid levels and cardiovascular complications, "more emphasis should be put on the topiramate-related complications" such as high uric acid levels, the study authors wrote.
In July, British researchers at the Royal Group of Hospitals in Belfast, Northern Ireland, published a study in the journal Neurology that linked Topamax to birth defects, including cleft palate. Of 178 live births that occurred, three babies whose mothers took Topamax alone and 13 whose mothers took Topamax along with other anti-epilepsy drugs had major birth defects.
Four of the babies had cleft palates or cleft lips, which was 11 times higher than would be expected among women not taking epilepsy medication. More birth defects occurred in women taking Topamax along with the drug valproate, or valproic acid, than in women taking other epilepsy drugs or other Topamax drug combinations.