Perioperative Management of Topiramate for Weight Control

Critical Safety Considerations

• Abrupt discontinuation of topiramate can precipitate seizures in patients, regardless of the indication, including weight management or appetite suppression, according to the American College of Clinical Pharmacology 1
• The risk of seizure precipitation applies universally, whether topiramate is prescribed for epilepsy, migraine prevention, or weight control, as stated by the National Institute of Neurological Disorders and Stroke 1

Perioperative Continuation Protocol

• The American College of Surgeons recommends continuing topiramate at the current dose throughout the entire perioperative period to prevent seizure risk 1

Proper Discontinuation Protocol

• If discontinuation becomes necessary, the American Academy of Neurology advises against stopping abruptly and recommends tapering by taking one capsule every other day for at least 1 week before complete cessation to minimize seizure precipitation risk 1

Special Considerations

• The American Gastroenterological Association notes that topiramate can impair thinking, motor skills, and cause somnolence, which may interact additively with anesthesia, and also has carbonic anhydrase inhibitor properties that may lead to metabolic acidosis, particularly at higher doses 2