Topiramate and valproic acid

What does the topiramate label say about valproic acid?

Topiramate label, drug interactions

Concomitant administration of valproic acid and topiramate has been associated with hypothermia and hyperammonemia with and without encephalopathy.

Topiramate label, warnings and precautions

Discontinue topiramate if an alternative etiology cannot be established (5.11, 5.12, 5.13) Hyperammonemia/encephalopathy: measure ammonia if encephalopathic symptoms occur (5.14) Kidney stones: avoid use with other carbonic anhydrase inhibitors, drugs causing metabolic acidosis, or in patients on a ketogenic diet (5.15) Hypothermia has been reported with and without hyperammonemia during topiramate treatment with concomitant valproic acid use

Qudexy Xr label (Upsher-Smith Laboratories, LLC, September 3, 2026), warnings and precautions

Discontinue QUDEXY XR if an alternative etiology cannot be established. ( 5.12, 5.13 , 5.14 ) Hyperammonemia/encephalopathy: measure ammonia if encephalopathic symptoms occur ( 5.15 ) Kidney stones: avoid use with other carbonic anhydrase inhibitors, drugs causing metabolic acidosis, or in patients on a ketogenic diet ( 5.16 ) Hypothermia has been reported with and without hyperammonemia during topiramate treatment with concomitant valproic acid use

Eprontia label (Azurity Pharmaceuticals, Inc., November 13, 2025), warnings and precautions

Encephalopathy (Without and With Concomitant Valproic Acid Use) EPRONTIA treatment can cause hyperammonemia with or without encephalopathy [see Adverse Reactions ( 6.2 )].

Source: FDA drug label (Qudexy Xr, NDA205122), Upsher-Smith Laboratories, LLC, effective September 3, 2026 (SPL set 46f54677-3a22-4c38-9b92-923020164e15), via openFDA

Source: FDA drug label (Eprontia, NDA214679), Azurity Pharmaceuticals, Inc., effective November 13, 2025 (SPL set e2a4df59-fead-4a01-9021-9eda02c48010), via openFDA

What does the valproic acid label say about topiramate?

Valproic acid label, drug interactions

Monitoring of valproate concentrations is recommended ( 7.1 ) Co-administration of valproate can affect the pharmacokinetics of other drugs (e.g., diazepam, ethosuximide, lamotrigine, phenytoin) by inhibiting their metabolism or protein binding displacement ( 7.2 ) Patients stabilized on rufinamide should begin valproate therapy at a low dose, and titrate to clinically effective dose ( 7.2 ) Dosage adjustment of amitriptyline/nortriptyline, propofol, warfarin, and zidovudine may be necessary if used concomitantly with Valproic acid ( 7.2 ) Topiramate: Hyperammonemia and encephalopathy

Valproic acid label, warnings and precautions

Antiepileptic drugs, including valproic acid, increase the risk of suicidal thoughts or behavior ( 5.7 ) Bleeding and other hematopoietic disorders; monitor platelet counts and coagulation tests ( 5.8 ) Hyperammonemia and hyperammonemic encephalopathy; measure ammonia level if unexplained lethargy and vomiting or changes in mental status, and also with concomitant topiramate use; consider discontinuation of valproate therapy ( 5.6 , 5.9 , 5.10 ) Hypothermia;

Both medicines on the record

What next?

Topiramate: the full record

Valproic acid: the full record

Check more medicines together

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