Minor
Probable
الوصف
Topiramate can cause metabolic acidosis through carbonic anhydrase inhibition, which may increase the risk of lactic acidosis in patients on metformin.
الآلية
Topiramate inhibits carbonic anhydrase, causing bicarbonate wasting and metabolic acidosis; systemic acidosis impairs mitochondrial function and lactate clearance, potentially unmasking metformin-associated lactic acidosis.
الأهمية السريرية
Case reports of lactic acidosis exist for this combination; the interaction is more relevant in patients with renal impairment, dehydration, or other metformin risk factors.
التدبير
Monitor serum bicarbonate and renal function; advise adequate hydration; consider withholding metformin if metabolic acidosis develops.