Topiramate Dosing Regimens

Clinical Indications and Dosing

The American Gastroenterological Association recommends topiramate 100-150 mg daily in divided doses for moderate-severe Cyclic Vomiting Syndrome, starting at 25 mg daily and titrating up by 25 mg each week 1
For PTSD-Associated Nightmares, studies have used various dosing schedules, with some starting at 50 mg/day and titrating to 200 mg/day over 10-14 days, with a median effective dose of 150 mg/day 2
When combined with phentermine for obesity, the topiramate component is given as a single daily dose, with maximum doses of 92 mg topiramate daily 3

Titration is critical, starting at 25-50 mg/day and increasing by 25-50 mg increments every 3-7 days to minimize adverse effects, although this specific guideline is also available from other sources, a similar recommendation is made by the American Academy of Neurology 5