Minor
Probable
Descripción
Topiramate can cause metabolic acidosis through carbonic anhydrase inhibition, which may increase the risk of lactic acidosis in patients on metformin.
Mecanismo
Topiramate inhibits carbonic anhydrase, causing bicarbonate wasting and metabolic acidosis; systemic acidosis impairs mitochondrial function and lactate clearance, potentially unmasking metformin-associated lactic acidosis.
Relevancia clínica
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.
Manejo clínico
Monitor serum bicarbonate and renal function; advise adequate hydration; consider withholding metformin if metabolic acidosis develops.