Topamax in Tails and a Top-Hat? New Long-Acting Trokendi XR Hits the Shelves

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Topamax (topiramate) is used for the treatment of epilepsy, migraine headaches and weight loss (as half of the new weight loss drug Qsymia). Now, there is a new long-acting Topamax called Trokendi XR.

What’s the scoop with this new Topamax that’s hitting the shelves and is it any better than topiramate?

  •  Trokendi XR is now available to patients in the United States. Trokendi XR is a once-daily extended release formulation of topiramate (Topamax) used for the treatment of epilepsy.

  •  Trokendi XR has been approved, for now, only as an anti-epileptic drug indicated for treatment in patients 10 years of age and older with partial onset or primary generalized tonic-clonic seizures.

  •  It’s available in 25mg, 50mg, 100mg, and 200mg extended-release capsules.

  •  We don’t know or think it’s any better than Topamax but it may have easier once daily dosing.

  •  When Trokendi XR is widely available it will be pricier than Topamax.

  •  Topamax (topiramate) is available as a cheaper generic so you and your doctor will decide if its worth the cost to switch.

Dr O.

Trokendi XR will start from around $180 for 30 capsules of the lowest dose, 25 mg, up to about $650 for 30 capsules of the highest 200 mg dose. Since there is a generic version of topiramate available, many insurance plans will consider Trokendi XR a Tier 2 or 3 medication if it’s covered, meaning you’ll pay a higher co-pay. In contrast, generic topiramate is available from many pharmacies at under or around $20 for 60 tablets, depending on the strength, and will be covered by most insurance plans under the lowest tier or co-pay level.

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