A 26-year-old woman started on an antiepileptic for focal seizures reports 4 kg weight loss over three months, difficulty finding words while speaking, and passage of a small renal stone. Which drug best fits this profile?
- A Levetiracetam
- B Topiramate ✓
- C Lamotrigine
- D Gabapentin
Correct answer: B. Topiramate
Explanation
Topiramate characteristically causes weight loss, cognitive slowing with prominent word-finding difficulty, paresthesias, nephrolithiasis and metabolic acidosis, the latter two reflecting its carbonic anhydrase inhibition. Levetiracetam causes irritability but not weight loss or stones, and gabapentin tends toward weight gain. Lamotrigine lacks cognitive and renal adverse effects at typical doses. Recognising this cluster prevents unnecessary workup and guides counselling about hydration and slow titration.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.