Sober Sky

New Pain Medication with No Addictive Properties

The addiction treatment community has wrestled for years fighting addictions and pain. Programs have developed different approaches to treating those with chronic pain issues. It is a difficult and a delicate issue that concerns many in the medical and addiction treatment industry. How to properly detoxify a patient and treat the underline pain that the individual is suffering from can be very tricky. The patient will present for drug treatment with the desire to be removed from pain medications, however the fear from the patient of the pain that will present as soon as medications are removed from the body becomes a barrier for the individual seeking treatment. It is a double edge sword and if not properly done, can create unnecessary pain for the patient.

 

A powerful new painkiller, which was developed on the basis of the research conducted at Stony Brook University and with no apparent side effects or addictive qualities, may now be only a year or two from the consumer market.

 

"This offers a major paradigm shift in the control of pain," declares Dr. Simon Halegoua, Professor of Neurobiology & Behavior at Stony Brook who in the 1990s, teamed up with fellow Stony Brook professors Dr. Gail Mandel and Dr. Paul Brehm to identify a novel sodium ion channel involved in the transmission of pain. They predicted that a drug aimed at blocking this channel, PN1/Nav 1.7, would control pain. PN1 (Peripheral Neuron 1), is uniquely expressed in peripheral nerves such as those involved in pain transduction.

 

When a patient is given an opiate like morphine, pain signals are still transmitted from sensory nerves to the central nervous system. Morphine action throughout the brain reduces and alters pain perception, but it also impairs judgment and results in drug dependence," explains Halegoua, also director of the Center for Nervous System Disorders at Stony Brook University. "With drugs targeting the PN1/Nav1.7 sodium ion channel, the pain signals would not be transmitted, even by the sensory nerves. And since the central nervous system is taken out of the equation, there would be no side effects and no addictive qualities."

 

The potential for such drugs is enormous -- the reduction or elimination of pain for patients with cancer, arthritis, migraine headaches, muscle pain, pain from burns, and pain from other debilitating diseases.

 

He notes that drugs in both oral and topical ointment forms, based on the research he conducted in a basement laboratory at Stony Brook with Mandel, a molecular biologist, and Brehm, an electro physiologist, are currently in Phase II clinical trials in England and Canada.

The Research Foundation of the State University of New York is the holder of the various patents originating from the work of the Stony Brook researchers. Icagen Inc., now in partnership with Pfizer, holds the exclusive license to these patents and has announced their own drug has now entered Phase I clinical trials in the U.S.

 

Story Source:

The above story is reprinted (with editorial adaptations by Sober Sky) from materials provided by Stony Brook University.

 

 

Related articles

• How to Prevent a Painkiller Addiction (everydayhealth.com)
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• Pain Relief: Love Just as Potent as Morphine, Study Shows (aolhealth.com)
• Bret Michaels feared addiction to painkillers (hollywoodnews.com)
• Study shows people in love feel less pain (seattletimes.nwsource.com)
• High dose narcotic painkillers prescribed: study (cbc.ca)
• Study shows people in love feel less pain - San Jose Mercury News (mercurynews.com)
• Anguish Of Romantic Rejection May Be Linked To Stimulation Of Areas Of Brain Related To Motivation, Reward And Addiction (yubanet.com)
• "Falling in love can act as a potent painkiller, and now scientists have figured out why:" and related posts (laughing1wolf.blogspot.com)

Study: Newer Antipsychotic Drugs Are Overused

Researchers Say Many Doctors Prescribe Drugs Despite Lack of Evidence of Effectiveness

By Brenda Goodman
WebMD Health News

Reviewed by Laura J. Martin, MD

Jan. 7, 2011 -- Many people taking powerful psychiatric medicationsthat increase their risk of weight gain and diabetes are prescribed those drugs when there’s little evidence that they will get any benefit from them, a new study shows.

What’s more, experts say that even when these drugs, which are known as atypical antipsychotics, are prescribed as recommended, they may not be safer or more effective than the less expensive, older medications that they’ve apparently replaced.

“Atypical agents were once thought to be safer and possibly more effective,” says study researcher G. Caleb Alexander, MD, an assistant professor in the department of medicine at the University of Chicago Hospitals. “And what we’ve learned over time is that they are not safer, and in the settings where there’s the best scientific evidence, they are no more effective.”

How Drugs Developed for Schizophrenia Became Used as Antidepressants

The first generation of drugs to treat serious mental illnesses like schizophreniawere introduced in the late 1950s and 1960s, but those drugs often had disfiguring and painful neurologic side effects like muscle spasms and tremors and caused involuntary movements like facial grimacing.

In 1989, the first of a newer generation of atypical antipsychotic drugs, Clozaril, was introduced with the promise of being more effective than its predecessors, with fewer side effects. Other medications in the class soon followed, including Abilify, Geodon, Invega, Risperdal, Saphris, Seroquel, and Zyprexa.

“Since there were all these new drugs, and it costs 700 to 800 million to bring a drug to market, drug companies needed to make that money back,” says Jeffrey Lieberman, MD, chairman of the department of psychiatry at Columbia University, who was not involved in the study. “These drugs were marketed aggressively.”

The study, which was published online in the journal Pharmacoepidemiology and Drug Safety, documents what Lieberman and others believe were the effects of that marketing.

Researchers found that the number of office visits in which a doctor documented a patient’s use of atypical antipsychotics more than doubled since the mid-1990s -- climbing from 6.2 million in 1995 to 14.3 million by 2008, making them the top-selling pharmaceutical drug class.

Over time, the way doctors prescribed those drugs changed, too, with doctors becoming more likely to prescribe these powerful medications for conditions in which they had not been rigorously studied or FDA approved, such as anxiety,depression, attention deficit disorder, and for aggression and agitation in dementia patients.

In adults, for example, the use of any antipsychotic medication -- old or new -- remained relatively stable from 1995 to 2001. But from 2001 to 2006 use of the medications doubled, the study showed, indicating that doctors were becoming quicker to turn to these powerful drugs.

In children, the use of the drugs skyrocketed, increasing 800% from 1995 to 2005.

“Time and time again what we see is medications that are prematurely adopted in populations that have little or nothing to gain, and this study is yet another example of how both doctors and patients may overenthusiastically or prematurely adopt medicines beyond the evidence base,” Alexander says.

Atypical Antipsychotics Become a Target of Lawsuits

In many cases, government regulators felt that pharmaceutical companies promoting these drugs broke the law by encouraging doctors to prescribe them “off-label.” Off-label drugs are those prescribed by doctors for purposes not approved by the FDA.

According to a report released in December 2010 by the consumer watchdog Public Citizen, some of the largest drug company settlements with the federal government in the last two decades were for the unlawful promotion of atypical antipsychotic drugs.

In 2010, for example, the drug company AstraZeneca paid $520 million to settle allegations by the federal government that it engaged in unlawful promotion of its drug Seroquel, which is the top-selling atypical antipsychotic.

AstraZeneca Responds

AstraZeneca offered the following written response to the findings of the new study:

“AstraZeneca believes that Seroquel is a safe and effective medication when used as recommended in the prescribing information and offers clinicians, patients and their loved ones an important treatment option.

Doctors need a range of options as they seek an appropriate treatment for individual patients, because they recognize a one-size-fits-all approach to treating all people with mental illnesses like bipolar disorder and schizophrenia is not possible. Doctors consider the needs of individual patients and the array of treatments that are available, including prescription medicines. Doctors are trained to carefully make these choices.

The company has worked diligently with the FDA to ensure that the safety profile of Seroquel is reflected appropriately in the prescribing information so that health care professionals can weigh the risk and benefit of Seroquel when making treatment decisions.

It is AstraZeneca’s policy to promote our medicines and to conduct interactions with healthcare professionals in compliance with the laws and regulations that govern the healthcare community in the United States. We train AstraZeneca employees to follow our compliance policies.”

Putting the Brakes on Inappropriate Use

Experts feel the overuse of these medications will need to be addressed on several fronts.

“There are several strategies that can be used to achieve more rational use of these and other psychotropic medicines, including patient and physician education, FDA empowerment, and denial of payments by public and private payers for uses that lack sufficient scientific evidence,” Alexander says.

Lieberman said more comparative effectiveness studies would help doctors better understand when drugs in the atypical antipsychotic class were superior to each other or to older drugs, and that would better inform prescribing practices.

“It’s a bit like going to the supermarket and trying to buy laundry detergent: This one has enzymes; this one has brighteners.” he says. “But we don’t really know how the drugs compare to each other.”

Many felt that the solution should not include preventing doctors from being able to prescribe drugs off-label.

“Off-label prescribing is an important component of practice,” Lieberman says. “The reason is that it really takes a lot of money for a drug company to jump through all the hoops to get an FDA indication. There may be good evidence that a drug is effective in a given condition, but the company doesn’t see enough of a market there to get it approved.”

But he admits that many doctors may be using too free a hand with the prescription pad.

“On the other hand, you don’t want to be promiscuous and abuse that privilege,” he says.

 

Alcoholics May Stop at One Drink With Lundbeck Pill but what about the second drink,third and so on?

Image via Wikipedia

Alcoholics may stop one drink with new pill. What about the second drink? In Europe a new medication is being used to help the fight of alcoholism. For many years the search for a pharmacological treatment answer in the fight against alcoholism has been sought. The drug, nalmefene from H. Lundbeck A/S in Valby, Denmark, blocks brain signals that make activities such as sex and drinking feel good. Should trials succeed, the medicine may win clearance in Europe as early as 2012, becoming the first new alcoholism treatment approved there in more than 15 years.

Most of the current medications are geared to fighting relapse once a person stops using alcohol. The focus of the new drug promises an attack of the problem from a different angle. The individual continues to drink while using this medication. Currently the method of abstinent is required for most people to become free from alcohol.

This new method of treatment raises many questions on it's effectiveness to stop alcoholism. The addiction treatment communities are champions for new tools, medications, tecniques and approaches to the treatment of alcoholism. However, much concern exist when you hear of the magic pill cure to fight alcoholism. It does not take long for the addiction professionals and the treatment and recovery community to get cynical about the idea of giving a pill and continued drinking.  

New ideas are always evaluated and researched in the addiction treatment industry. So while we watch this new approach to medication and alcoholics develop I hope more people will focus on the education of alcoholism.  

By Scott Kelley LCDC

More information on article found at business week.

via www.businessweek.com

Summer Sky Treatment Center Houston Texas!

Summer Sky Treatment Center attended the 2010 Spectrum Conference hosted by the Houston Chapter of the Texas Association of Addiction Professionals. This years conference was The Thirty Seventh Annual Conference on Addiction Studies. It is a honor to help support such a great organization and be apart of addiction professionals serving those with substance use disorders across the State of Texas. Summer Sky recently opened up the new Detox Now Program. The Detox now program is created for those who do not want a 30 day stay in treatment, but desire to have detox take place. It is really geared to those who have had previous treatment or have a history of relapse. Please take a look at there website at http://www.summersky.us or call them at 1-888-857-8857.    

FDA Mulls Removing Weight-Loss Drug From U.S. Market

By JENNIFER CORBETT DOOREN

WASHINGTON—A federal advisory panel is being asked to help decide whether Abbott Laboratories' weight-loss drug Meridia should stay on the market.

Meridia has been the subject of an ongoing safety review. Earlier this year, the European Medicines Agency ordered Abbott to remove Meridia from the European market and the FDA toughened warnings on the drugs' label saying it shouldn't be used in patients with a history of heart problems. At the time, the FDA also said the product should be discontinued in patients who don't lose at least 5% of their baseline body weight within the first three to six months of treatment.

Now the FDA is considering whether to remove the product from the U.S. market. Meridia will be discussed Wednesday by the agency's endocrinologic and metabolic drugs advisory committee, which is made up of non-FDA medical experts.

The panel is being asked to vote on what additional regulatory action it thinks the FDA should take, including whether the product should be withdrawn from the U.S. market. The FDA usually follows the advice of its advisory committee but isn't required to do so. The FDA posted background materials for Wednesday's meeting on its website Monday.

The panel will primarily discuss a clinical study known as Scout, which was conducted in patients with a history of heart disease or diabetes. It showed patients in the study had a higher rate of cardiovascular events compared to patients on a placebo medication.

An FDA clinical review of the study said, "in a population of middle-age and older overweight and obese subjects, treatment with [Meridia] for an average of 3.5 years increased the relative risk for major adverse cardiac events by 16%." However, the FDA said the data from the study haven't been fully analyzed.

According to another FDA memo, agency staff said there was evidence that while Meridia improved some cardiac-risk factors, it "may have a detrimental effect on others," such as an increase in blood pressure and heart rate. Still, the memo said, given the modest decrease in body weight seen with most patients taking Meridia, "even a small increase in cardiovascular risk seems unwarranted."

In a document also posted on the FDA's website, Abbott said use of Meridia in the target population currently described on the product's label is associated with a low rate of cardiovascular events.

The company said it supports placing a boxed warning on the product giving doctors "advice on monitoring and discontinuation of therapy based on blood pressure, pulse, and weight loss parameters." A boxed warning is FDA's toughest warning on a drug label.

Write to Jennifer Corbett Dooren at jennifer.corbett-dooren@dowjones.com

Brain Mechanism Linked To Relapse After Cocaine Withdrawal

Addictive drugs are known to induce changes in the brain's reward circuits that may underlie drug craving and relapse after long periods of abstinence. Now, new research, published by Cell Press in the September 9 issue of the journal Neuron, uncovers a specific neural mechanism that may be linked to persistent drug-seeking behavior and could help to guide strategies for development of new therapies for cocaine addiction.

Previous research has shown that the ventral tegmental area (VTA) is a brain region that is activated when cocaine users experience a craving for cocaine after being exposed to cocaine-associated cues. The medial prefrontal cortex (mPFC), which receives input from the VTA via circuits that use the "reward" neurotransmitter dopamine, has also been implicated in drug craving after cocaine withdrawal. Further, increases in the level of brain-derived neurotrophic factor (BDNF) have been observed in the VTA and mPFC in rats after withdrawal from repeated cocaine exposure.

"BDNF plays a key role in modulating the structure and function of synapses, the sites of communication between neurons. Therefore, increased BDNF after cocaine withdrawal may drive synaptic changes that contribute to compulsive drug seeking behavior," explains senior author, Dr. Mu-ming Poo from the University of California, Berkeley. "It has been shown that increased BDNF in the VTA after cocaine withdrawal in rats promotes the drug-dependent motivational state. However, nothing is known about the potential BDNF effect on synaptic function and plasticity in mPFC neurons after cocaine withdrawal."

Dr. Poo and colleagues designed a study to examine how BDNF and the mPFC might contribute to relapse after cocaine addiction. The researchers found that the gradual increase in BDNF expression in the rat mPFC after terminating repeated cocaine exposure significantly enhanced the activity-induced potentiation of specific synapses. Dr. Poo's group went on to uncover the specific cellular mechanism linking increased BDNF with enhanced synaptic plasticity and demonstrated that interference with the key molecule in the BDNF signaling process reduced behavioral sensitivity after cocaine withdrawal in rats.

"In short, our results demonstrate that elevated BDNF expression after cocaine withdrawal sensitizes the excitatory synapses in the mPFC to undergo activity-induced persistent potentiation that may contribute to cue-induced drug cravings and drug-seeking behavior," concludes Dr. Poo. Although a clear correlation between rat and human behaviors of cocaine craving and relapse remains to be established, the cellular mechanism uncovered in this study does appear to have behavioral relevance and may represent a direct brain sensitization that is involved in triggering relapse.

The researchers include Hui Lu, Pei-lin Cheng, Byung Kook Lim, Nina Khoshnevisrad, and Mu-ming Poo, University of California, Berkeley, Berkeley, CA.

Source:
Cathleen Genova
Cell Press

via www.medicalnewstoday.com

Study Contends Pot Isn't a Major 'Gateway Drug

Researchers say ethnicity, stress, unemployment are stronger predictors of hard drug use

 Randy Dotinga

FRIDAY, Sept. 3 (HealthDay News) -- A new report casts doubt on the argument that marijuana is a "gateway drug" that plays a major role in leading people to try other illegal drugs.

Researchers found that other factors, such as ethnicity and stress levels, are more likely to predict whether young adults will use other illegal drugs.

Even unemployment appears to be more closely linked to harder illicit drug use than marijuana use, the study authors noted.

"Employment in young adulthood can protect people by 'closing' the marijuana gateway, so over-criminalizing youth marijuana use might create more serious problems if it interferes with later employment opportunities," study co-author Karen Van Gundy, an associate professor of sociology at the University of New Hampshire, said in a university news release.

The researchers based their findings on surveys of 1,286 young adults who attended Miami-area public schools in the 1990s.

Ethnicity was the best predictor of future illegal drug use, the study findings indicated, with whites the most likely to use the drugs, followed by Hispanics and then blacks.

The study findings are published in the September issue of the Journal of Health and Social Behavior.

So does early use of marijuana play a role in boosting the likelihood of later drug use? It's unclear.

"This study really doesn't answer the question," said Dr. Richard D. Blondell, director of addictions research at the University at Buffalo (UB), who was not involved in the new study. "As the authors point out, there are a lot of factors at play here. There is no one single answer to why somebody develops addiction."

In a study published recently in the Journal of Addiction Medicine, Blondell and colleagues at UB reported that new research suggests that many people first get addicted to drugs while using prescription painkillers.

More information

The U.S. National Library of Medicine has details on drug abuse.

Addiction Points of View!

I have started this category of discussion so that others who have opposing views, opinions, ideas, or just something new and innovative can share and comment on points of view. While i am foremost all about the community and the consumer and the rights they have toward addiction treatment services, I am also not so closed minded to say that because i am an expert in the field of addiction, treatment and recovery that i am always right. Please feel free to comment!  

Topiramate helps with prevention of Migraines

Topiramate

(toe pyre' a mate)

Last revised: May 1, 2010.

U.S. National Library of Medicine
National Institutes of Health

Why is this medication prescribed?

Topiramate is used alone or with other medications to treat certain types of seizures in people who have epilepsy. Topiramate is also used with other medications to control seizures in people who have Lennox-Gastaut syndrome (a disorder that causes seizures and developmental delays). Topiramate is used to treat patients who continue to have seizures even when they take other anti-seizure medications. Topiramate is also used to prevent migraine headaches, but not to relieve the pain of migraine headaches when they occur. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.

How should this medicine be used?

Topiramate comes as a tablet and a sprinkle capsule (capsule that contains small beads of medication that can be sprinkled on food) to take by mouth. It is usually taken with or without food twice a day in the morning and evening. Take topiramate at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take topiramate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

There is another medication with a name similar to the brand name for topiramate. You should be sure that you receive topiramate and not the similar medication each time you fill your prescription. Be sure that the prescription your doctor gives you is clear and easy to read. Talk to your pharmacist to be sure that you are given topiramate. After you receive your medication, compare the tablets to the pictures in the manufacturer's patient information sheet. If you think you were given the wrong medication, talk to your pharmacist. Do not take any medication unless you are certain it is the medication that your doctor prescribed.

Topiramate tablets have a bitter taste so you should swallow them whole. Do not split, chew, or crush them. It is especially important that you not take topiramate tablets that have been broken for any length of time because tablets that are broken may lose their effectiveness over time.

Your doctor will probably start you on a low dose of topiramate and gradually increase your dose, not more than once every week.

Topiramate may control your seizures or migraines, but will not cure your condition. Continue to take topiramate even if you feel well. Do not stop taking topiramate without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking topiramate, you may have severe seizures, even if you have not had seizures in the past. Your doctor will probably decrease your dose gradually.

The sprinkle capsules may be swallowed whole or opened and poured over food. To take the sprinkle capsule with food, follow these steps:

• Prepare a teaspoonful of soft food such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt.

• Hold the capsule upright over the food. You should be able to read the word 'TOP' on the capsule.

• Twist off the clear part of the capsule and pour the entire contents onto the spoonful of food.

• Swallow the entire mixture immediately without chewing.

• Drink fluids right after swallowing to wash down the mixture and to be sure that you swallow all of it.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with topiramate and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer's website to obtain the Medication Guide.

Other uses for this medicine

Topiramate is also used for the management of alcohol dependence. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking topiramate,

• tell your doctor and pharmacist if you are allergic to topiramate or any other medications.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acetazolamide (Diamox); amitriptyline; antidepressants; antihistamines; dichlorphenamide (Daranide); digoxin (Lanoxin, Digitek); hydrochlorothiazide (Microzide, Oretic); ipratropium (Atrovent); iron; isoniazid (INH, Nydrazid); lithium (Eskalith, Lithobid); medications for anxiety, irritable bowel disease, mental illness, motion sickness, Parkinson's disease, ulcers, or urinary problems; metformin (Glucophage); methazolamide; oral contraceptives (birth control pills); other medications for seizures such as carbamazepine (Tegretol) and phenytoin (Dilantin, Phenytek); pioglitazone (Actos); risperidone (Risperdal); salicylate pain relievers such as aspirin, choline magnesium trisalicylate (Trisalate), choline salicylate (Arthropan), diflunisal (Dolobid), magnesium salicylate (Doan's, others), and salsalate (Argesic, Disalcid, Salgesic); sedatives; sleeping pills; tranquilizers; valproic acid (Depakene, Depakote); and zonisamide (Zonegran). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you or any family members have or have ever had kidney stones, if you drink or have ever drunk large amounts of alcohol, and if you have ever thought about killing yourself or tried to do so. Also tell your doctor if you have or have ever had metabolic acidosis (a disturbance in the body's acid-base balance that results in excessive acidity of the blood); osteopenia, osteomalacia, or osteoporosis (conditions in which the bones are soft or brittle and may break easily); diabetes; glaucoma (a type of eye disease); any disease that affects your breathing such as asthma or chronic obstructive pulmonary disease (COPD); depression or abnormal moods; a growth problem; or liver or kidney disease. Also tell your doctor if you have diarrhea or if you develop diarrhea during your treatment.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking topiramate, call your doctor.

• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking topiramate.

• you should know that topiramate may make you drowsy, dizzy, confused, or unable to concentrate. Do not drive a car or operate machinery until you know how this medication affects you.

• if you are taking topiramate to control seizures, you should know that you may continue to have seizures during your treatment. You may need to avoid activities such as swimming, driving, and climbing so that you will not harm yourself or others if you lose consciousness during a seizure.

• ask your doctor about the safe use of alcoholic beverages while you are taking topiramate.

• if you are taking oral contraceptives (birth control pills), tell your doctor if unexpected bleeding or spotting occurs. Topiramate can decrease the effectiveness of oral contraceptives.

• you should know that topiramate can prevent you from sweating and make it harder for your body to cool down when it gets very hot. This happens most often in warm weather and to children who take topiramate. Avoid exposure to heat, drink plenty of fluids and tell your doctor if you have a fever, headache, muscle cramps, or an upset stomach, or if you are not sweating as usual.

• you should know that you may be more likely to develop a kidney stone while you are taking topiramate. Drink 6 to 8 glasses of water every day to prevent kidney stones from forming.

• you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking topiramate for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took antiepileptics such as topiramate to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an antiepileptic medication such as topiramate, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an antiepileptic medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

What special dietary instructions should I follow?

Talk to your doctor about increasing the amount of food you eat if you lose weight while you are taking topiramate.

Talk to your doctor before changing your diet or beginning any type of weight loss program. Do not follow a ketogenic diet (a high-fat, low-carbohydrate diet used to control seizures) or any other high-fat, low-carbohydrate diet, such as the Atkins diet, while you are taking this medication.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is less than 6 hours before you are scheduled to take your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Topiramate may cause other side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• numbness, burning, or tingling in the hands or feet

• slowed reactions

• difficulty concentrating

• speech problems, especially difficulty thinking of specific words

• memory problems

• lack of coordination

• confusion

• nervousness

• aggressive behavior

• irritability

• mood swings

• depression

• headache

• drowsiness

• weakness

• excessive movement

• uncontrollable shaking of a part of the body

• uncontrollable eye movements

• extreme thirst

• weight loss

• constipation

• diarrhea

• gas

• heartburn

• change in ability to taste food

• swelling of the tongue

• overgrowth of the gums

• dry mouth

• increased saliva

• trouble swallowing

• nosebleed

• teary or dry eyes

• back, muscle, or bone pain

• missed menstrual periods

• excessive menstrual bleeding

• skin problems or changes in skin color

• dandruff

• hair loss

• growth of hair in unusual places

• ringing in the ears

• difficulty falling or staying asleep

• swelling of the hands, arms, feet, ankles, or lower legs

• difficulty urinating or pain when urinating

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• blurred vision

• double vision

• eye pain

• worsening of seizures

• slow heart rate

• pounding or irregular heartbeat

• chest pain

• trouble breathing

• fast, shallow breathing

• inability to respond to things around you

• excessive tiredness

• nausea

• vomiting

• stomach pain

• loss of appetite

• intense back or side pain

• bloody, cloudy, or foul-smelling urine

• constant need to urinate

• fever

• chills

Topiramate may cause osteoporosis (a condition in which bones can break more easily) in adults and rickets (abnormal, curved bone growth) in children. Topiramate may also slow the growth of children and may decrease the final height that children reach. Talk to your doctor about the risks of taking topiramate.

Topiramate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [athttp://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Tablets should be stored at room temperature and away from excess heat and moisture (not in the bathroom). Sprinkle capsules should be stored at or below 77 °F (25 °C). Never store broken tablets or mixtures of sprinkles and soft food. These should be used right away or discarded. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• seizures

• drowsiness

• speech problems

• blurred vision

• double vision

• trouble thinking

• tiredness

• loss of coordination

• loss of consciousness

• dizziness

• stomach pain

• vomiting

• agitation

• depression

• loss of appetite

• pounding or irregular heartbeat

• fast, shallow breathing

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to topiramate.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

Topamax^®

TAAP 2010 State Conference on Addiction Studies

The 2010 TAAP State Conference on Addiction Studies was an amazing conference. It was held July 8th-10th, 2010 in San Antonio,Texas. The theme of the conference was Sail into Summer with Sizzling CEUs. This was the Thirty-Sixth Annual TAAP State Conference on Addiction Studies. This conference once again sold out on Exhibitor Space.This conference is becoming the place to be for getting your Continued Education hours completed in the drug and alcohol industry. The Speakers were amazing and the hotel staff were first class. I hope that you will join TAAP (TEXAS Association of Addiction Professionals) Next year.