Prevalence of epilepsy in the US is estimated to affect around 1.2% of the population, accounting for more than 3 million of the population. Various medications and treatment regimens are presently in use and evaluated for controlling, for treatment and for prophylaxis. One among the commonly used anti-epileptic medications is Trokendi XR, which is also used for treating migraines, apart from seizures. The following subsections offer detailed information about the medication, its uses, mechanism of action and possible Trokendi XR side effects. This will help users prevent, identify and mitigate any possible undesirable outcomes from the drug.

Overview of Trokendi XR and mechanism of action

Trokendi XR belongs to the category of anticonvulsants, and is a brand name of the drug Topiramate. The drug was stumbled upon, when research efforts were focused on the creating anti-diabetic medication. The medication has been in use as an anti-epileptic, since approval in 1996, while it was additionally approved as an option for preventing migraines in 2004. The medication is also available as an extended-release version and this has been used as a part of combination treatment for weight loss.

To understand the mechanism of action of the medication it is essential to know a little about how seizures occur. Unusual or uncontrolled electrical discharge in the brain causes a seizure, and during this period, certain functions of the brain are interrupted. For instance, during a seizure, the individual may be less alert, may experience unusual sensations, and could trigger certain involuntary movements, that are commonly known as convulsions.

While the actual mechanism of action of Trokendi XR has not been fully established, the outcomes are attributed to the properties of the medication. For instance, the drug is known to exercise certain actions on the sodium channels and receptors. By stimulating activity at specific receptors, inhibiting activity at certain specific receptors, the medication prevents seizures, migraines and stops neuronal excitability. This refers to the generation or change in cell membrane voltage, that is known to trigger seizure activity.

Dosage for prescribed uses of Trokendi XR

With the basic overview of the drug behind us, it is time to look at the dosage for prescribed uses of the medication. As outlined above, it is used for treating epilepsy, preventing migraine, and by virtue of the possible outcomes, it is used in combination with other medication for weight management. The anticonvulsant is typically prescribed to be taken on a long-term basis. It is therefore necessary to get the dosage information right, as this will prevent any undesirable outcomes from wrong dosage or schedule. It is a well-known fact that incorrect dosage and scheduling is one of the reasons for a large number of individuals experiencing side effects from drugs.

The actual dosage of the anti-epileptic may depend on various factors such as the condition being treated, the age of the patient, the weight of the patient, and presence of other medical conditions.  Smaller dosages are initially prescribed and later modified to the desired levels necessary for the outcomes. The anticonvulsant is available as a capsule in strengths of 25/50/100/200 mg, that is typically taken once a day. As mentioned, the dosage differs for various conditions, as listed below. It is necessary to add here that the actual dosage will vary from person to person and the following information is intended to serve only as a broad reference of the strengths and are not claimed to be the actual dosages for specific conditions.

When prescribed for preventing migraines, Trokendi XR is typically recommended to be gradually increased from an initial dose of 25 mg daily to 50 mg daily after one week, which is then increased to 75 mg daily the following week, and finally stops at 100 mg daily one week later. The maintenance dose is usually 100 mg daily and the schedule or period will be as determined by the doctor.

When prescribed for epilepsy as the only medication, Trokendi XR is recommended to be increased from an initial dose of 50 mg to 100 mg daily after a week, which is then increased to 100 mg daily, and subsequent increases of 50 mg are recommended every week, till the medication reaches the maximum dosage of 400 mg daily. Maintenance doses for seizures, is 400 mg daily, when the medication is taken alone.

When prescribed for epilepsy along with only medications, the drug is recommended to be increased from an initial dose of 25 mg/50 mg depending on the actual type of seizures. Subsequent increases in dosage are around 25 mg/50 mg (depending on the condition) till the maximum dosage is reached. The maximum dosage is either 200 mg or 400 mg daily, which will also be the maintenance dose for the condition.

The dosage for pediatric patients differs from that of adults (shown above). For the purpose of differentiation, the above-mentioned dosages are suitable for children above the age of twelve and adults, while children below the age of twelve are to be administered pediatric dosages that are different. This is usually determined by various factors including the age, and the weight of the patient.

Dealing with missed dosages

As the drug is intended to be taken on a long-term basis, there are chances of individuals missing out on doses. There is also the possibility of patients taking a double dose to make up for the missed dose, and this is to be avoided to prevent any possible Trokendi XR side effects. The ideal way to deal with a missed dose is as explained in detail here. In the event of a missed dose being noticed within a few hours of the scheduled time, the individual may take the dose immediately. However, if the missed dose has been noticed close to the scheduled time for the next dose, it is to be skipped, and the usual dose is to be taken as per schedule. The cut-off time for taking a missed dose should be 6 to 8 hours before the next dose. This is because of the extended-release nature of the medication. In other words, a dose taken close to the next dose may result in accumulating a heavier dosage and this could trigger side effects.

Commonly reported Trokendi XR side effects

All medications come with the possibility of undesirable effects and Trokendi XR is no exception. The exact nature of effects may differ from person to person and depends on various factors such as the condition being treated, the dosage, the schedule, the duration of intake of the medication, the overall health of the patient, existing health conditions, and medications in use. Side effects of drugs are broadly classified into mild or moderate effects and serious or adverse effects. The mild effects are generally commonly or frequently occurring in nature and may not require medical intervention. These effects tend to resolve naturally over a short period of time. The serious or adverse effects are typically rarely occurring in nature and may require some form of medical attention, depending on the nature of effects.

It is necessary to add here that all users of a medication may not necessarily experience undesirable effects. Some users are known to be free from all unwanted outcomes whatsoever. The following is a compilation of undesirable effects of Trokendi XR, and is neither exhaustive nor complete in nature. This is intended to serve as a broad reference of the type of side effects, and users are advised to seek additional information or complete information from the healthcare provider. Certain effects may actually require urgent medical intervention to prevent the condition from turning dangerous or life threatening in nature.

Effects that are frequently experienced, and not a cause for concern

As outlined above, some of the effects are not a reason to be apprehensive or alarmed and are relatively common in nature. This includes a sudden loss of appetite and this could also result in possible weight loss. This is essentially a possible undesirable outcome, that has turned into an off-label use of the medication. As listed in the introduction, the medication is used in combination with other medications for weight management. Other common effects include a distinct tingling sensation it the arms or the legs. Patients are known to experience difficulty in speaking, with some ending up with slurring of speech.

The patient is also likely to feel drowsy or tired as a result of the medication, apart from dizzy feelings. Additionally, there is also the probability of the patient experiencing anxiety or nervousness as a result of the medication. Other effects that have been reported commonly include low grade fever in patients, while some have reported feelings of nausea. There could be possible changes in vision, where the patient experiences blurred vision. Reflexes may be impacted, and the patient may react or respond slowly to situations. The patient may experience infections in the upper respiratory tract, and this may require some kind of symptomatic treatment.

The medication is also known to cause other symptoms such as difficulty in remembering, and a distinct or unusual pain in the abdomen. Similar or related effects include diarrhea in patients that may also resolve naturally. On a contrary note, some patients may experience constipation, which is also known to resolve naturally. The patient may also lose sensation in the skin, where touch perception is reduced. Additionally, there is also the possibility of the individual experiencing changes in taste, apart from loss of hair and an overall weak feeling.

Effects that re classified as serious in nature, warranting attention

Apart from the above mild effects, there is also the possibility of the patient experiencing certain serious or adverse effects that require medical intervention. For instance, effects such as serious impact on the eye are considered as adverse reactions. This includes loss of vision, glaucoma and near-sightedness, that are typically indicated with tell tale symptoms such as pressure in the eyes, or abnormal pain in the eyes.  The medication is also known to cause an increase in acid levels in the blood; medically known as metabolic acidosis. Symptoms that are indicative of this condition include confusion, loss of appetite, abnormal changes in heart beat rate and breathing. Other serious side effects include rise ammonia levels, formation of kidney stones, skin infections, and suicidal tendencies.

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