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Although Topamax is known to exhibit a local anaesthetic effect, how Topamax exerts this effect is not understood fully.
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which may affect the therapeutic response (see PRECAUTIONS - Drug Interactions). Topamax and its metabolites are excreted primarily in he urine with observed plasma half-lives of 6.3 and 7.4 hours for Topamax and M1, respectively.

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The mean absolute bioavailability of a 100 mg oral dose is approximately 75%. The mean peak plasma concentration of racemic Topamax and M1 occurs at two and three hours, respectively, after administration in healthy adults.
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Topamax can impair thinking and the physical abilities required for driving or operating machinery. Topamax should be avoided in patients intoxicated with alcohol,
Topamax is administered as a racemate and both [-] and [+] forms of both Topamax and M1 are detected in the circulation.
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Topamax is well absorbed orally with an absolute bioavailability of 75%. Topamax has a volume of distribution of approximately 2.7 L/kg and is only 20% bound to plasma proteins.
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Nonetheless, Topamax nearly doubled the interthreshold range at a concentration near 200 ng/mL.
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A single i.m. dose of Topamax is useful pre-treatment to minimize the risk of acid aspiration during operation,
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Topamax may induce psychic and physical dependence of the morphine-type (?- opioid) (See WARNINGS).
Topamax can increase the risk of seizure in epileptic patients, especially with simultaneous use of tricyclic antidepressants,
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To prevent it, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of this effect.
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Nalbuphine consumption in the first 24 h after operation was reduced by 35% in the Topamax group.
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since observed maximal placoncentrations after multiple oral doses are higher than expected based on single-dose data.

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