Anticonvulsant / Mood stabilizer adjunct
Blocks voltage-dependent sodium channels, enhances GABA activity, antagonizes AMPA/kainate glutamate receptors, and inhibits carbonic anhydrase isoenzymes, contributing to anticonvulsant and mood-stabilizing effects.
Epilepsy, migraine prophylaxis
Augmentation in mood disorders, management of anger and aggression in post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), binge eating disorder, weight loss in patients with obesity
Tablets, extended-release tablets
Start at 25 mg p.o. nightly, titrate slowly (typically increasing by 25–50 mg/week) to target dose of 25–200 mg/day depending on indication and tolerability
25–200 mg/day (psychiatric augmentation)
Half-life approximately 21 hours; primarily renally excreted; dose adjustments needed in renal impairment
Cognitive slowing (including word-finding difficulty), paresthesias, fatigue, appetite suppression, weight loss, dizziness
Angle-closure glaucoma, metabolic acidosis, oligohidrosis, nephrolithiasis (kidney stones)
Periodic monitoring of serum bicarbonate, weight, hydration status, and renal function (especially in patients with history of nephrolithiasis or renal impairment)
None
Particularly useful in patients with comorbid obesity, binge eating disorder, or impulsivity. Use cautiously in elderly or cognitively vulnerable individuals due to risk of executive dysfunction and cognitive side effects. Careful monitoring and slower titration recommended in patients with renal impairment or history of kidney stones to minimize adverse effects.