Management of topiramate toxicity is largely supportive. Initial steps include ensuring airway protection, breathing, and circulation. Activated charcoal may be administered if the patient presents early after ingestion. Intravenous fluids are important for renal perfusion and to correct electrolyte imbalances. Sodium bicarbonate can be used to address metabolic acidosis. In severe cases, especially those involving coma or significant neurological impairment, hemodialysis may be considered to enhance elimination of the drug.
