Brief Answer:

Ok, but let the dr. who prescribes your heart meds know about it.

Detailed Answer:

Hello,

I did a search on Lexicomp Drug Interactions and put all of your current medications and Topamax in the search.

Topamax can interact with 2 of your current medications, and here is what the literature states about these:

1. Topamax can increase the concentration of Flecainide in the blood stream.

The research on this is not actually based on Topamax but on a medication that is similar to it (same class). So caution should be used if combining Topamax and Flecainide.

The recommendations are "Monitor for toxic effects of flecainide if a carbonic anhydrase inhibitor (i.e. Topamax) is started or the dose of it is increased; or decreased effects of Flecainide if Topamax is discontinued or dose decreased."

So, while Topamax is not absolutely contraindicated with Flecainide, your doctor should check you to make sure that you need as much Flecainide as you have been on.

2. Topamax can also interact with Digoxin possibly causing a lower amount of digoxin in your blood stream, but the risk rating on this interaction is that no action is needed.

This is what Lexicomp states regarding Topamax and Digoxin:
"Digoxin / Topiramate
Risk Rating B: No action needed
Topiramate may decrease the serum concentration of Digoxin.
No routine monitoring is recommended.

However, if any signs of reduced digoxin efficacy become evident (eg, increased heart rate, worsening atrial fibrillation, shortness of breath, etc), digoxin levels should be obtained."

So, in summary, it is Ok to take Topamax with your current medications, but the doctor who prescribes your heart medications should be aware you are starting Topamax and may need to reevaluate the dose you take of Flecainide.

Also, if you have an increase in heart rate or other heart symptoms, then your doctor should check a digoxin level.

Lexicomp will indicate that 2 meds should not be used if there is an absolute contraindication, and no such warning was given here.

Hope I have answered your query.

Take care

Regards,
Dr Bonnie Berger-Durnbaugh, General & Family Physician

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