Topiramate Use in Perioperative Period for Deep Plane Face Lift

Perioperative Considerations

The American Society of Anesthesiologists recommends that patients using topiramate for epilepsy should not discontinue it abruptly due to the risk of precipitating seizures, and a proper tapering protocol is required, taking one capsule every other day for at least one week before stopping completely to avoid seizure risk 1
The primary concern with abrupt topiramate discontinuation is the risk of precipitating seizures, particularly in patients using it for epilepsy, though this patient is using it for weight control 1
A two-week cessation period followed by resumption would be inappropriate given the gradual titration requirements for topiramate 1

The American College of Gastroenterology notes that topiramate is not associated with coagulopathy or increased surgical bleeding 2
The American Gastroenterological Association recommends that carbonic anhydrase inhibition effects of topiramate do not create perioperative complications for facial surgery 2, 3
Blood pressure and heart rate monitoring is important given the potential effects of topiramate, but this patient appears to be on topiramate monotherapy at 50 mg twice daily 1

The American Society of Plastic Surgeons recommends continuing topiramate 50 mg twice daily through the perioperative period without interruption, and the patient should inform the anesthesiologist about topiramate use during preoperative assessment 1
The patient should maintain adequate hydration perioperatively, as topiramate can be associated with metabolic acidosis in rare cases 3
The patient should resume normal dosing schedule immediately postoperatively 1