Table 1

Main adverse effects and teratogenic risks of acetazolamide and topiramate

MedicationMain adverse effectsTeratogenicity
AcetazolamideDiarrhoea, paraesthesia, fatigue, renal stones, altered taste, nausea, tinnitus, vomiting and depression8 In animals at 200–1000 mg/kg79 80 but none identified in a study of 50 human pregnancies.18
TopiramateNausea, dizziness, depression, cognitive slowing and weight loss.8
Can reduce efficacy of hormonal contraceptives at higher doses23 especially >200 mg/day.22 		Major congenital malformations in women with epilepsy—RR 3.8 (95% CI 1.4 to 10.6).21 81
Increased risk of:

  • Oral clefts 1.4%–2.2%27–29 (OR 6.3 (95% CI 3.1 to 12.5)82

  • Hypospadias 1.1%–5.1%81 83 84 (OR 4.79 (95% CI 1.5 to 15.8)84

  • Cardiorespiratory malformations 1.4%85 but non-significant81 83 84

  • RR, relative risk.