Q:  Drug Interaction w/Topamax & Glucophage?  Topamax as a Mood Stabilizer?

My doctor recently prescribed Topamax along with Lamictal to help with stabilizing my moods (I'm bipolar II). Why is Topamax not on your website as a mood stabilizer? Also, I have PCOS and therefore take glucophage, but have heard that this and the Topamax might not go well together. Do you know what the drug interaction may be?

Thanks,
Amanda 
 

Dear Amanda
Topamax is not on my website as a mood stabilizer because so far it has not been shown in "randomized trials" (those with a placebo "control" group) to work better than a placebo. It also has very significant side effects, although of course most of the medications we use as mood stabilizers do. In my view one of the only reasons it gets as much attention as it does, it's because of its frequent potential for causing weight loss. There are, however, some significant reports of improvement in patients with bipolar disorder taking Topamax, which are not to be ignored. If it did not so often cause cognitive impairment, I would probably use it quite a bit more.

As for an interaction between Topamax and Glucophage, I just ran those in a standard drug interaction checklist (this one). It indicated no known interactions. I am not aware of any recognized interactions either. Someone might have been worried that the Topamax could inhibit appetite while the Glucophage was lowering blood sugar. However, Glucophage is well known not to lower blood sugar below normal levels. On the other hand, perhaps this might not be the case if you're not eating anything. As far as I know, that is the limit of the "interaction".

Dr. Phelps