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We report our experience with topiramate rectal suspensions in a single center case series of three patients <1 year of age from 2017 to 2020 who received topiramate per rectum after being placed nil per os (NPO) status at a free standing children's hospital. The objective was to describe the compounding methods and clinical outcomes of three of the youngest patients to receive topiramate rectal suspensions. All three patients received topiramate per rectum for 2-4 days. No adverse effects or increase in seizure frequency were noted. For patients placed on NPO status, there is currently no alternative to oral topiramate. No studies describe per rectum topiramate use in pediatrics. Rectal administration of topiramate is not only useful in times when patients are NPO, but may also be useful when patients on topiramate experience status epilepticus. The formulation of topiramate suppositories should be explored in the future. Until further information is available, dose substitution should be done carefully with close supervision by a healthcare provider. Published by Elsevier Ltd.


Marry T Vuong, Aric McBride, Natanya Mishal, Gabriella Philipson. Topiramate rectal suspensions in pediatric patients. Seizure. 2021 Feb;85:45-47

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PMID: 33418165

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