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Topamax Vs. Zonegram?


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#1 Jennydotz

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Posted 06 July 2011 - 07:14 PM

Hello all, Long time lurker, new member. Very new to migraine with aura (first one to 3/2011) and/or possible partial seizure Dx. Was on Topomax starter Dose of 25mg 2X/day for about 3 days, visual disturbances went away immediately, promising enough to tolerate the mixed bag of side effects EXCEPT the lack of sweating. The one thing that keeps me halfway sane is physical activity and it is freaking me out completely to not sweat normally. I left a message for my neurologist and backed down to 25mg 1X/day. I did sweat some at the lower dose, but still not normally. Anyway, neuro left me a message, said he could call me in a script for zonegram. Do I want this?

I perused the potential side effects, and they look the same as the topamax, including the sweating problem. Am I likely to have the same problem, in which case, shouldn't I try a different type of drug?

Does anyone know if the sweating thing is one of those side effects that would go away over time? Or is it something you're stuck with?

Thanks in advance for any advice or experience.
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#2 dymphna

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Posted 06 July 2011 - 11:26 PM

Hello all, Long time lurker, new member. Very new to migraine with aura (first one to 3/2011) and/or possible partial seizure Dx. Was on Topomax starter Dose of 25mg 2X/day for about 3 days, visual disturbances went away immediately, promising enough to tolerate the mixed bag of side effects EXCEPT the lack of sweating. The one thing that keeps me halfway sane is physical activity and it is freaking me out completely to not sweat normally. I left a message for my neurologist and backed down to 25mg 1X/day. I did sweat some at the lower dose, but still not normally. Anyway, neuro left me a message, said he could call me in a script for zonegram. Do I want this?

I perused the potential side effects, and they look the same as the topamax, including the sweating problem. Am I likely to have the same problem, in which case, shouldn't I try a different type of drug?

Does anyone know if the sweating thing is one of those side effects that would go away over time? Or is it something you're stuck with?

Thanks in advance for any advice or experience.


It doesn't go away. If you get it to that degree, you are stuck with it; it is part of the mechanism of the drug. You either drink more water to compensate (which you have to anyway because of the kidney stone issue), or you leave the drug.

It won't necessarily happen with Zonegran, as it is a completely different drug and may effect you differently. Or the same. You won't know until you try it.


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#3 Tryn

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Posted 07 July 2011 - 01:21 AM

I'm on Topamax and I barely sweat which sounds great but isn't really. If you get the not-able-to-sweat-anymore thing you're probably going to be stuck with it like Dymphna said. I've had it for about 3ish years now. It sucks.

If you do decide to switch over to the Zonegran please post and let me know how the sweating issue turns out.
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#4 Jerod Poore

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Posted 09 July 2011 - 04:52 PM

I perused the potential side effects, and they look the same as the topamax, including the sweating problem. Am I likely to have the same problem, in which case, shouldn't I try a different type of drug?


Lack of sweating (oligohidrosis) is a side effect of carbonic anhydrase inhibitors (CAIs). Topamax and Zonegran are both CAIs, although that's not their main mechanism of action. It's dueling studies as to which is the more potent, although most have Topamax as the more potent CAI.

As far as this side effect goes, my money is on your having it with Zonegran too.

Your diagnosis has Topamax written all over it, and Zonegran might still be worth trying. At least the only thing that doesn't work as well when you stop taking Topamax and go back to it is the weight loss, but since Topamax and Zonegran are so similar, your brain and body may not even notice the difference.
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#5 seamonkey

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Posted 09 July 2011 - 07:12 PM

I remember not sweating much on topamax. I was on 100mgs for a mood stabalizer back in 05-06ish and would go through 6 hour dance classes barely breaking a sweat.

I'm currently on 200mgs on zonegran at night for migraines. I DO sweat on the zonegran. I live in the south and the air conditioner in my car is broken. My car is all black with a black leather interior and most of the places I go have 0 places with shade to park, so it's like sitting in a sauna. I'm usually dripping by the time I get anywhere I need to be
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#6 Jennydotz

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Posted 10 July 2011 - 06:09 AM

Thanks everyone for the replies. I wish it were easier to actually talk to my doctor to ask questions. I've only seen the guy once and that was before the EEG. Then he just called and said "bla bla bla maybe seizure activity (WHAM, WHAT? very unexpected to me and scary), I'll call you in a script for topamax have a nice day." I am still waiting to hear back about the zonegran.

How bad is it not to sweat? In this weather if I can't avoid exertion and being outside will I have a heatstroke or something? Do I NEED to switch meds? Is it just weird to not sweat or is it dangerous? Topamax is becoming the devil I know and I'm afraid to switch if I don't hate it. However, I don't think I can stay at 25 mg/day where I feel comfortable and get any clinical benefit re. seizures. Then again how will I know when it is helping or not since my symptoms are vague (well not vague to me, but apparently vague to every Dr who I've talked to) and maybe not even seizure related. My first choice would be to ask my doctor such questions, but I can never talk to him.

I am new to the whole doctors/meds thing too. Just dealing with Drs offices, half-competent receptionists, and insurance pre-auths has been very stressful.
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#7 Jennydotz

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Posted 10 July 2011 - 06:15 AM

I remember not sweating much on topamax. I was on 100mgs for a mood stabalizer back in 05-06ish and would go through 6 hour dance classes barely breaking a sweat.

I'm currently on 200mgs on zonegran at night for migraines. I DO sweat on the zonegran. I live in the south and the air conditioner in my car is broken. My car is all black with a black leather interior and most of the places I go have 0 places with shade to park, so it's like sitting in a sauna. I'm usually dripping by the time I get anywhere I need to be


Thanks Seamonkey, So you were pretty physically active and never had a heatstroke or passed out or anything? Good to know that the 2 drugs won't necessarily have the same side effects
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#8 Jennydotz

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Posted 10 July 2011 - 06:24 AM

It doesn't go away. If you get it to that degree, you are stuck with it; it is part of the mechanism of the drug. You either drink more water to compensate (which you have to anyway because of the kidney stone issue), or you leave the drug.

It won't necessarily happen with Zonegran, as it is a completely different drug and may effect you differently. Or the same. You won't know until you try it.


Dymphna


Thanks Dympha for the response. Sorry to sound stupid, but why do you have to drink more water to compensate? I've seen this recommendation several places and I don't get it. I get the water/kidney stones thing, but not the water/not sweating thing.
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#9 seamonkey

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Posted 10 July 2011 - 07:31 AM


I remember not sweating much on topamax. I was on 100mgs for a mood stabalizer back in 05-06ish and would go through 6 hour dance classes barely breaking a sweat.

I'm currently on 200mgs on zonegran at night for migraines. I DO sweat on the zonegran. I live in the south and the air conditioner in my car is broken. My car is all black with a black leather interior and most of the places I go have 0 places with shade to park, so it's like sitting in a sauna. I'm usually dripping by the time I get anywhere I need to be


Thanks Seamonkey, So you were pretty physically active and never had a heatstroke or passed out or anything? Good to know that the 2 drugs won't necessarily have the same side effects


Nope. I DO remember I was on topamax when I was in a local production of Cats and I sweat a LOT from all the dancing and singing, but our costume designer was also an asshole who bought us cotton unitards instead of the ones that breathed better, so between the dancing, singing, cotton unitards, and the lights, we were basically baking ourselves on stage :mad:
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#10 dymphna

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Posted 11 July 2011 - 12:36 AM




It doesn't go away. If you get it to that degree, you are stuck with it; it is part of the mechanism of the drug. You either drink more water to compensate (which you have to anyway because of the kidney stone issue), or you leave the drug.

It won't necessarily happen with Zonegran, as it is a completely different drug and may effect you differently. Or the same. You won't know until you try it.


Dymphna


Thanks Dympha for the response. Sorry to sound stupid, but why do you have to drink more water to compensate? I've seen this recommendation several places and I don't get it. I get the water/kidney stones thing, but not the water/not sweating thing.


Zonisamide and associated oligohidrosis and hyperthermia

Ensuring that children remain cool and well hydrated during hot weather can minimize the potential for hyperthermia resulting from oligohidrosis.


This is one case where kids are like little adults. There are numerous studies on this. CAIs decrease sweating. If they do so enough, they can cause hyperthermia. The "work around" is to remain well hydrated. With water. Not Gatorade, not coffee, not tea, not soda.

Severe Topiramate-Associated Hyperthermia Resulting in Persistent Neurological Dysfunction

Oligohydrosis and fever in pediatric patients treated with zonisamide

Although the mechanism for zonisamide-associated oligohydrosis has not been fully elucidated, the drug may mediate its effect on eccrine sweat glands by inhibiting carbonic anhydrase, thereby influencing pH dynamics, hydrogen ion concentration, and available calcium transients.


And that is what it is doing in the brain that causes the problem (and, conversely, stops the seizures).

The problems come in when a person is not keeping themselves hydrated enough, because orthostatic hypotension can result, all of the above bolded stuff can "go out of whack", and one's heart rhythm can start flipping out. Oh, and you start feeling really, really flipping cold.

Just drink the water.


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#11 Jennydotz

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Posted 11 July 2011 - 03:55 AM

Just drink the water.


Dymphna


Roger that. Thanks. That all looks scary, gives me more doubts about the zonegran being any better than the topamax.

I notice Dymphna that you put a lot of effort into your posts. You are very generous with your time here. I appreciate that because I very much want information, but I am suggestible and distractable so Google searches in the wrong state of mind can send me into severe panic mode.

Edited by Jennydotz, 11 July 2011 - 04:05 AM.

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#12 dymphna

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Posted 11 July 2011 - 01:22 PM



Just drink the water.


Dymphna


Roger that. Thanks. That all looks scary, gives me more doubts about the zonegran being any better than the topamax.

I notice Dymphna that you put a lot of effort into your posts. You are very generous with your time here. I appreciate that because I very much want information, but I am suggestible and distractable so Google searches in the wrong state of mind can send me into severe panic mode.


Don't panic. And don't worry about Zonegran vs Topamax. They are two completely different medications and a person won't know how one or the other will work for them until they try.

We put a lot of time into our searches because we're Hon Code certified. It means we can back up what we say. We don't link everything, because we have a lot of "institutional knowledge" (read: miscellaneous crap) floating around in our heads, but if we find out we're wrong, we'll come back and say that, too.


D
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Yes, my name really is Dymphna.

 

I'm not a doctor, nurse, pharmacist, or therapist.

I can find you an answer and I won't blow smoke up your ass.

 

St. Dymphna is the Patron for brain maladies.

 

I'm the Enforcer.

 

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#13 Jennydotz

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Posted 14 July 2011 - 07:11 PM

I am on day 3 of Zonegran 50mg after about 10 days of Topamax. Mentally thus far the zonegran is much better, it's like a fog is lifting. But I think the not sweating may be the same. It's hard for me to tell because I'm one whose always cold and don't sweat much anyway. I'm keeping my fingers crossed that it's not happening cause I don't want to switch again.
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#14 dymphna

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Posted 14 July 2011 - 10:50 PM

I am on day 3 of Zonegran 50mg after about 10 days of Topamax. Mentally thus far the zonegran is much better, it's like a fog is lifting. But I think the not sweating may be the same. It's hard for me to tell because I'm one whose always cold and don't sweat much anyway. I'm keeping my fingers crossed that it's not happening cause I don't want to switch again.


I hope it works out for you. Whatever you do, really try and stick it out for a full 8 weeks to give it an honest trial; there may be some side effects that seem like deal breakers that will actually go away on their own if you just allow the drug to stabilize in your system.


D
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Yes, my name really is Dymphna.

 

I'm not a doctor, nurse, pharmacist, or therapist.

I can find you an answer and I won't blow smoke up your ass.

 

St. Dymphna is the Patron for brain maladies.

 

I'm the Enforcer.

 

eqnmrt.jpg

 


#15 Jennydotz

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Posted 15 July 2011 - 05:41 AM

THanks Dymphna,

Do you think brand name vs. generic would make a difference in not sweating? That is really the only side effect I'm experiencing and I am very uncomfortable with it, I would never make it 8 weeks.
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