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To the Editor: Although Drs LaRoche and Helmers¹ discussed many of the important safety issues for new antiepileptic drugs in their Scientific Review article, additional safety issues have arisen with topiramate and zonisamide since their initial approval. Some of these safety issues may be related to the ability of these drugs to inhibit the enzyme carbonic anhydrase.

For topiramate, a warning describing a syndrome of acute myopia with secondary angle-closure glaucoma associated with treatment was added to the product labeling in 2001.² It is important to note that although this adverse event is uncommon, prompt discontinuation of topiramate is imperative and appears to reverse the process. In 2003, a further warning was added for oligohydrosis, which is characterized by deficient formation and secretion of sweat that can lead to life-threatening fevers and heat stroke. This adverse effect may be more significant in children than in adults treated with topiramate³ and . . . [Full Text of this Article]

Judith A. Racoosin, MD, MPH
racoosinj@cder.fda.gov

James F. Knudsen, PhD, MD
Division of Neuropharmacological Drug Products
Center for Drug Evaluation and Research
US Food and Drug Administration
Rockville, Md

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