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Topamax is commonly dosed by safely tapering up the dose to a therapeutic level, which is 100mg or 200mg daily.
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It can take 6-8 weeks to titrate to the typical ceiling dose of 200-300 mg day, because tolerance to the side effects of topamax builds slowly.
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consideration should be given to stopping topamax or valproate in patients who develop hypothermia, which may be manifested by a variety of clinical abnormalities including lethargy, confusion, coma, and significant alterations in other major organ systems such as the cardiovascular and respiratory systems.