Specific Clarifications for Taking Epitomax

Topiramate (Epitomax) was discovered in 1979 by Bruce E. Marianow and Joseph F. Gardocki during their research work at McNeil Pharmaceuticals. Commercial use of Topiramate began in 1996. Mylan Pharmaceuticals received final FDA approval to sell generic topiramate in the United States, and a generic version was released in September 2006.

The indications for use are

  • Partial or generalized tonic-clonic seizures in adults and children over 2 years of age, including patients with newly diagnosed epilepsy (as monotherapy or in combination with other anticonvulsants);
  • seizures associated with Lennox-Gastaud syndrome in adults and children over 2 years of age (as part of complex therapy);
  • Prevention of migraine attacks in adults.
Specific Clarifications for Taking Epitomax

The drug is approved for use in children over 2 years of age. Influence on driving and operating machinery The drug should be administered with caution in patients engaged in potentially hazardous activities that require increased attention and rapid psychomotor reactions, because the drug may cause drowsiness and dizziness.

Adequate and strictly controlled clinical safety studies of Epitomax in pregnancy have not been conducted. Nevertheless, the use of the drug in pregnancy is possible only when the expected benefits to the mother exceed the potential risk to the fetus.

Excretion of Epitomax with the breast milk has not been studied in controlled studies. The limited number of observations suggests that Epitomax is excreted with breast milk. If use of Epitomax during lactation is necessary, discontinuation of breastfeeding should be considered.


  • Children under 2 years of age;
  • Childhood under 6 years of age for monotherapy, under 3 years for combined therapy of epilepsy;
  • Children under 18 years of age when used for migraine prophylaxis;
  • prophylaxis of migraine in pregnant women or women of childbearing age who do not use effective contraception;
  • Hypersensitivity to the drug components.

Caution: renal failure, hepatic failure, hypercalciuria, nephrourolithiasis (including anamnesis or family history).

Drug absorption

After oral administration, Epitomax is rapidly and effectively absorbed from the gastrointestinal tract. The bioavailability calculated based on the radioactive label yield after administration of 100 mg of 14C-Epitomax was 81%. Food intake has no clinically significant effect on the bioavailability of the drug.

Distribution of the drug

Specific Clarifications for Taking Epitomax

Binding to plasma proteins is 13-17%. After a single oral dose up to 1200 mg, mean Vd is 0.55-0.8 l/kg. The Vd value depends on gender. In women, the values are about 50% of those observed in men, which is associated with a higher content of adipose tissue in women. After a single oral administration, Epitomax pharmacokinetics is linear, plasma clearance remains constant at 20-30 ml/min, and AUC in dose range from 100 mg to 400 mg increases in proportion to the dose. In patients with normal renal function, it may take 4 to 8 days to reach equilibrium.

Metabolism of the drug. About 20% of Epitomax is biotransformed to form 6 metabolites, 2 of which mostly retain the structure of Epitomax and either have no or minimal anticonvulsant activity.

Excretion of the drug. Epitomax and its metabolites are excreted primarily with the urine. After multiple doses of 50 and 100 mg twice daily, the average T1/2 was 21 hours.

Watch out for the first signs of a stroke

In civilized countries, hundreds of thousands of strokes are reported annually. Unfortunately, if you “skip” the first minutes and hours of this formidable disease, the process becomes irreversible … That is why it is so important to know the rules of first aid for stroke

What causes a stroke

Watch out for the first signs of a stroke

There is no single cause of stroke, so it is customary to talk about a set of risk factors that can lead to stroke. First of all, it is, of course, heredity. If a person has “weak” vessels (that is, there is a genetically determined weakness of the connective tissue), he may develop an aneurysm (expansion or stratification of the wall of the vessel that feeds the brain), which, having reached a certain size, may “break” and a hemorrhagic stroke will occur. If a person has a tendency to accumulate “bad” cholesterol, then atherosclerotic plaques will form in his vessels, narrowing the lumen and promoting the formation of blood clots. Risk factors such as smoking, hypertension, arrhythmia, overweight and diabetes mellitus also “work”. Therefore, no one can feel insured against a stroke.

Learning the rules of stroke

“Why do I need them,” you will say, “I’m a completely healthy person, and young people full of vitality are included in the circle of my relatives and friends”. Unfortunately, a stroke is rarely interested in the age of the person to whom it comes. Of course, men over 45 and women over 55 are at risk, but today there are frequent cases of stroke in both 30-year-olds and those who have just turned 25. Moreover, the younger the person, the less expected symptoms he may have. , characteristic of a stroke, and therefore – the longer it will remain without help, and the more sad the consequences of a brain catastrophe may be.

Smile – speak up – raise your hands

Watch out for the first signs of a stroke

Stroke symptoms tend to develop very quickly. The scenario is approximately the same, only the sequence of their occurrence can change. Usually a person starts an attack of a sharp, unbearable headache, he complains that his head is literally “tearing”. The gait may change, it becomes unstable, the person falls, or paresis (numbness) of the muscles of the limbs or face begins. Stroke is characterized by unilateral paresis, when muscle weakness manifests itself only on the left or right side of the body. Because of this, the patient’s mouth seems to “twist” and even his facial features change. Speech becomes less clear – or slows down, or, conversely, the person starts to speak very quickly, but it is not clear. Fog before the eyes, defocusing of the gaze are also possible, it becomes difficult for the patient to formulate his thoughts and choose words.

Doctors recommend memorizing three basic techniques for recognizing stroke symptoms: SMILE – SPELLS – RAISE HANDS (SPL)

  • Ask the person to SMILE. With a stroke, the smile is “crooked” because the muscles on one side of the face are much less responsive.
  • TALK to him and ask him to answer a simple question, for example: “What is your name?” Usually, at the time of a brain catastrophe, a person cannot even pronounce his name coherently.
  • Invite him to RAISE BOTH HANDS at the same time. As a rule, the patient cannot cope with this task, the hands cannot rise one level, since one side of the body obeys worse.

Stroke treatment

The main task of doctors is to restore blood circulation in the brain of a person with a stroke. Since some of the brain cells have already died, time plays against – the sooner treatment is started, the more a person has a chance to survive and have less destructive consequences.

One of the main treatments for ischemic stroke is thrombolytic therapy. A person is injected with drugs that dissolve the blood clot. It makes sense to carry out such treatment only in the first hours after a stroke.

Treatment for hemorrhagic stroke is reduced to controlling bleeding and reducing pressure on the brain. Methods depend on the cause of the stroke – high blood pressure, head trauma, taking anticoagulants – blood thinners, a thin spot in the wall of a blood vessel – an aneurysm.

How to reduce your risk

Stroke treatment

Attention to your health and lifestyle, called prevention, can prevent up to 80% of strokes. The main catch is that it’s difficult to do prophylaxis when nothing hurts. So, at least, it was in the situation with my dad.

What can you do to reduce your risk of stroke? Change your lifestyle and influence modifiable risk factors: eat right, do not smoke, do not drink a lot of alcohol, play sports, monitor your weight, control diabetes, blood pressure, atrial fibrillation and other conditions that increase the risk.

The diet should be high in fruits and vegetables, whole grains, legumes, nuts, and poultry. The consumption of red meat and other foods rich in saturated fat should be reduced. An excess amount of salt in the diet raises blood pressure, so a relatively safe dose of salt per day is about 6 g, which is about the same as a teaspoon.

Moderate physical activity 150 minutes per week (brisk walking, dancing, active games with children or walking with pets) will be a great contribution to the prevention of heart disease.


Stroke treatment

According to statistics from the American Stroke Association, 10% of stroke survivors recover completely, 25% with minor disabilities, 40% with moderate or severe disabilities that require special care, 10% need to be transferred to a specialized long-term care facility. 15% die soon after a stroke.

Unfortunately, the catastrophe has already occurred, some of the brain cells have died. It is impossible to “cure” and bring them back to life. Therefore, rehabilitation after a stroke should be aimed at fully or partially restoring the lost skills – neighboring areas of the brain will take over the functions of dead cells – and, if possible, return to independent life. Ideally, rehabilitation should begin after stabilization of the condition – right in the intensive care unit or hospital ward.

Rehabilitation can include classes with different specialists, for example, a physical therapy instructor, a speech therapist. Abroad, the “rehabilitation” team that helps a person recover from a stroke is very large: it consists of a neurologist, a rehabilitation nurse, a nutritionist, a social worker and other specialists.

Stroke. How to avoid and what to do?

Cardiovascular diseases have long been the leading cause of death. The World Health Organization estimates that 17.9 million people died from heart disease in 2016. 85% of all these deaths are caused by heart attacks and strokes. According to the Stroke Foundation every minute and a half someone suffers a stroke.

In the spring of 2019, these statistics ceased to be abstract figures for the journalist Sasha Vasilyeva – her dad had a stroke. She talks about what my dad went through, understands the types, signs and risk factors of stroke and explains what can be done for prevention.

What is a stroke

Stroke. How to avoid and what to do?

The human brain, like all other tissues and organs, needs oxygen and nutrients. They are carried by the bloodstream through the arteries.

It is vitally important that this constant process of blood circulation is not interrupted – brain cells (and not only them), left without oxygen, quickly die. A condition in which cerebral circulation is impaired is called a stroke.

The main types of developments are as follows.

Ischemic stroke

Blood may not flow to the brain because the artery supplying it is partially or completely blocked. This is an ischemic stroke. It occurs in more than 80% of cases. The artery is blocked by a blood clot – a thrombus. It can be the “master” of this artery – to arise there due to wall damage. Or a blood clot – an embolus – may be a “guest” rushing in from another place in the body. Such a “guest” travels through the blood vessels of the brain until it reaches the narrowest one in order to get stuck in it.

Hemorrhagic stroke

Stroke. How to avoid and what to do?

Another type of stroke, hemorrhagic, occurs, for example, when a weakened blood vessel that feeds the brain ruptures. In other words, a cerebral hemorrhage occurs: blood floods the nearest areas of the brain, damaging them. Those brain cells that are located behind the rupture site are deprived of blood supply and oxygen and also suffer. In another type of hemorrhagic stroke, blood enters the space between the brain and the bones of the skull.

Transient ischemic attack

A variant of short-term circulatory disorders in the brain, which is also caused by a blood clot, is also possible. For example, when washing his face in the morning, a person finds that half of his mouth does not obey well. He gets scared, but while he brushes his teeth, everything goes away. Or suddenly one hand goes numb – not for long, and the person decides that this is an accident, not a symptom.

Such a condition close to a stroke is called a transient ischemic attack. It usually goes away in a few minutes, does not destroy brain cells, but it can be a harbinger of an impending stroke, therefore, such symptoms cannot be attributed to accident.