Phenytoin, carbamazepine, valproic acid, drugs that interfere with temperature regulation (e.g carbonic anhydrase inhibitors, anticholinergics), digoxin, alcohol, oral contraceptives CNS depressants, agents causing nephrolithasis, metformin, pioglitazone, hydrocholrthizide St. Johns wort

Ataxia, difficulty concentrating with memory and language, confusion, dizziness, headache, fatigue, nausea, Insomnia, psychiatric disturbances, suicidal ideation or behaviour Anxiety, depression, nervousness, euphoria, Fatigue, parasthesia, speech disorder Somnolence, abdominal pain, anorexia, Asthenia weight loss, diplopia, eye pain, Nystagmus, renal stones, leucopenia, Psychomotor slowing Oliogohidrosis, (decreased sweating) hyperthermia GI upset, hyperchloremic acidosis Metabolic acidosis Tongue edema Rarely acute myopia with secondary angle -closure glaucoma Withdraw as soon as possible and refer to eye specialist

Lactation

Special Precaution-

Renal or hepatic impairment ( adjust dose ) Patients at risk of kidney stones, maintain adequate hydration Pregnancy Therapy should be withdrawn gradually Psychiatriac disorders Monitor serum carbonate, reduce dose or withdraw if metabolic acidosis occurs Monitor for weight loss. Monitor closely for oligohidrosis and hyperthermia ( specially children ) Labour and delivery

Dosage-

Initially 25mg daily for 1 week then increase by 25-50mg in two divided doses daiy at 1-2 weeks intervals. Usual maintenance- 200-400mg daily in two divided doses Maximum daily 800mg

Use lower dose and longer interval between increments if patient is unable to tolerate titration regimen Not recommened for children below 2 years 2-16 years- initially 25mg at night increasing at 1-2 week intervals by 1-3mg/kg/day increments to effective dose Usually 5-9mg /kg in two divided doses.

Contrindicated for use during pregnancy and lactation Observe caution if use is needed