Topiramate-Induced Chest Pain: A Case Report

• Published in: Journal of pharmacy practice 2019-04, Vol.32 (2), p.236-239
• Main Authors: Ostroff, Jared L., LeClair (Barnet), Jessica N., Ostroff, Marissa L., Laskey, Corey S.
• Format: Article
• Language: English
• Subjects: Adult; Anticonvulsants - adverse effects; Anticonvulsants - therapeutic use; Chest Pain - chemically induced; Drug-Related Side Effects and Adverse Reactions - etiology; Emergency Service, Hospital; Epilepsy - drug therapy; Female; Hospitalization; Humans; Topiramate - adverse effects; Topiramate - therapeutic use
• ISSN: 0897-1900; 1531-1937
• DOI: 10.1177/0897190017753922

Background: Topiramate, an anticonvulsant used for prophylaxis of migraines and epilepsy, is commonly associated with adverse effects of cognitive dulling and fatigue. Chest pain is a potential adverse effect that to our knowledge has not been reported with the use of topiramate. Case Presentation: We present the case of a 38-year-old female with a seizure disorder who experienced chest pain after the first dose of topiramate. On day 1, she presented to the emergency department, was admitted, and over the course of 3 days had a chest X-ray, electrocardiogram (ECG), and echocardiogram, and her vitals, basic metabolic panel, complete blood counts, troponin, and d-dimer levels were monitored. The chest pain improved when the topiramate was held. No identifiable causes of chest pain were apparent, other than the topiramate. Discussion: The Naranjo probability scale was utilized to determine the causality of topiramate. The resulting score of 3 indicates that it is possible that the chest pain was due to the topiramate. Conclusion: This report demonstrates an example of a patient who experienced chest pain possibly caused by the initiation of topiramate. The objective of this case report is to increase the awareness of chest pain as an adverse effect of topiramate.