Exposure to topiramate may not increase the risk of urolithiasis: A retrospective nationwide cohort study
Abstract number :
1.501
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2025
Submission ID :
1255
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Hyunkyum Cho, MD – Yonsei University College of Medicine
Woo-Seok Ha, MD – Yonsei University College of Medicine
Rationale: Topiramate has been known to be associated with an increased risk of urolithiasis (kidney stones) due to its action as a carbonic anhydrase inhibitor, which leads to metabolic acidosis and reduced urinary citrate levels. However, a recent Taiwanese population-based cohort study suggests that topiramate may not in real-world practice. This study aims to evaluate the influence of topiramate on the risk of experiencing a first lifetime episode of urolithiasis in Korea.
Methods: Using the Korean National Health Insurance Service-National Sample Cohort database, we enrolled participants from the national health screening program in 2015. We analyzed the days prescribed topiramate from 2002 to the day before the 2015 screening and excluded those previously diagnosed with urolithiasis. Propensity score 1:4 matching was performed between patients with and without topiramate exposure based on age, sex, body mass index, waist circumference, pre-existing comorbidities (hypertension, diabetes, heart failure, chronic kidney disease), and history of gout arthritis. Participants were followed longitudinally until diagnosed with urolithiasis. The Kaplan-Meier method and multivariable Cox proportional hazard regression were employed to determine the effect of topiramate on urolithiasis development.
Results: In total, 1,560 patients exposed to topiramate, including 168 currently using the medication, and 6,420 propensity score-matched controls without exposure were followed for five years. The risk of developing new urolithiasis was not significantly different between the two groups (HR 1.11 [95% CI 0.80-1.53], p-value = 0.545), with no significant findings in the log-rank tests, even when stratified by current use or total duration of topiramate exposure (p-values = 0.527, 0.678, and 0.111, respectively).
Conclusions: Our findings suggest that topiramate exposure may not increase the risk of urolithiasis, with neither the duration nor current use of the drug associated with an elevated risk.
Funding: Nothing to report.
Anti-seizure Medications