Metabolic acidosis

Patient

Q: I am a 32 yr old woman and I have been on 100 mg of Topamax for 18 months for severe migraines. 3 days ago my doctor told me that I have mild metabolic acidosis. I have been through many side effects because of this drug. But I will not stop this drug until my doctor makes me, it has given me my life back! He has prescribed me 40gr a day of sodium bicarb. I would like to know if their is something I can do at home to help this so I don't have to stop the topamax,by way of food or drink?

Symptoms:  Diarrhea, weakness
Doctor

A:   Thank you for your question. Let us first address why your migraine medication, Topiramate (Topomax) could have caused you to develop mild metabolic acidosis. Metabolic acidosis is a condition wherein the body produces increased levels of acid, or the kidneys are not excreting enough acid. This would cause the body's pH to decrease below 7.35. Preliminary symptoms of this condition are weakness, lethargy, joint/muscle pain, and confusion.
Topiramate is an anticonvulsant medication used to treat epilepsy but can also be used treat migraines. It causes metabolic acidosis by impairing both the normal reabsorption of filtered bicarbonate, and disruption of the excretion of acid by kidney.
Since your metabolic acidosis is described as mild, it is likely that it will be corrected by the sodium bicarbonate supplementation that you are taking. Your symptoms should improve once your pH raises to normal and with regular supplementation of sodium bicarbonate only, and no further treatment may be required. Should your symptoms not improve, please report these findings to your doctor to determine if your treatment needs to be altered.

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