Q:  Reaction to Trileptal & Topamax

I have been prescribed Trileptal, which caused my throat to almost close off; my tougue and lips became swollan.  I was than told to obviously stop taking Trileptal and was prescribed Topamax.  Topamax is causing the same side effects as the Trileptal.  Are these drugs related?  What is causing these side effects?  Are there other drugs I can try?


Dear Jennifer -- 
Here's a way of thinking about this:  when we prescribe a medication that commonly causes an allergic reaction, like Trileptal, and a person has an allergic reaction, which you clearly did; we often avoid prescribing a medication known also to cause allergic reactions (an example in this case would be lamotrigine).  We don't want to run the risk of the second one getting a reaction from your already-alerted immune system, where if we'd just waited a month or two for things to quiet down, you'd have been able to tolerate that second one without a problem.  

However, Topomax is not famous for causing allergic reactions.  It can certainly happen -- just about any medication can cause an allergic response in some person.  And as a doc' friend of mine says, "medications are guilty until proven innocent" when it comes to a possible allergic reaction.  

So you see, we could wonder whether you had the reaction to Topomax where if it had come along a month or two later, you mightn't have had that reaction.  But, that's not particularly important now:  once you have an allergic reaction, as it certainly sounds like you did (unless the Topomax came along so quickly after the Trileptal that the original allergic reaction hadn't died down at all, and there was possibility that Topomax was just an "innocent bystander" that happened to be around while your body was still reacting to Trileptal), then if your body ever sees that medication again your reaction could be even bigger.  So if you ever were forced into trying Topomax again, for one reason or another, you'd have to start out really cautiously and looking very closely for a reaction like this one you've just had.  

The swollen tongue part, and the "throat closing off", are signs of a severe allergic reaction (known as "anaphylaxis") that as you could surely tell can be very dangerous.  So if Topomax was really causing that (remember, guilty until proven innocent; and proving innocent in this case would be potentially very risky) you'd have to be extremely careful if you ever tried it again, making sure your doctor knew and maybe even taking the first dose under direct medical supervision, including a team of providers who know how to put a tube down your windpipe if it's closing off... Yipes!. 

Now, what else can you try?  Well, obviously we don't want to turn around and try another drug known to cause allergic reactions.  So, one the list of mood stabilizers, lithium is not commonly associated with such reactions, and Depakote relatively rarely.  So, if you haven't been there yet, those would be among your options next, based on the information we have here.  

Dr. Phelps

Published November, 2002