Practice Drug Point

Topiramate can induce hypoadrenalism in patients taking oral corticosteroid replacement

BMJ 2009; 338 doi: (Published 08 January 2009) Cite this as: BMJ 2009;338:a1788
  1. K Jacob, specialist registrar1,
  2. P J Trainer, professor of endocrinology1
  1. 1Department of Endocrinology, Christie Hospital NHS Trust, Manchester M20 4BX
  1. drkoshyjacob{at}

    Case history

    A 35 year old woman was taking life long glucocorticoid (dexamethasone) and mineralocorticoid (fludrocortisone, Florinef, Squibb) replacement for congenital adrenal hyperplasia caused by 21-hydroxylase deficiency. She started taking topiramate (Topamax, Janssen-Cilag) in March 2005, and the dose was titrated to 100 mg daily for atypical seizures secondary to mesial temporal sclerosis.

    Before starting topiramate she had been taking stable doses of dexamethasone (0.25 mg a day) and fludrocortisone (100 μg a day), with biochemical evidence of good control …

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