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However, estimates of the prevalence and magnitude of this effect are from small samples and do not address whether topiramate's effects on acid\u2013base balance differ in the presence of an AUD or by topiramate dosage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Veterans Health Administration electronic health record (EHR) data were used to identify patients with a minimum of 180\u2009days of topiramate prescription for any indication and a propensity score\u2010matched control group. We differentiated patients into two subgroups based on the presence of a diagnosis of AUD in the EHR. Baseline alcohol consumption was determined using Alcohol Use Disorders Identification Test\u2013Consumption (AUDIT\u2010C) scores in the EHR. Analysis also included a three\u2010level measure representing mean daily dosage. The topiramate\u2010associated changes in serum bicarbonate concentration were estimated in difference\u2010in\u2010differences linear regression models. A serum bicarbonate concentration &lt;17\u2009mEq\/L was considered to represent possible clinically significant metabolic acidosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort comprised 4287 topiramate\u2010treated patients and 5992 propensity score\u2010matched controls with a mean follow\u2010up period of 417\u2009days. The mean topiramate\u2010associated reductions in serum bicarbonate concentration were &lt;2\u00a0mEq\/L in the low (\u226488.75), medium (&gt;88.75 and \u2264141.70), and high (&gt;141.70) mg\/day dosage tertiles, irrespective of AUD history. Concentrations &lt;17\u2009mEq\/L occurred in 1.1% of topiramate\u2010treated patients and 0.3% of controls and were not associated with alcohol consumption or an AUD diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The excess prevalence of metabolic acidosis associated with topiramate treatment does not differ with dosage, alcohol consumption, or the presence of an AUD. Baseline and periodic serum bicarbonate concentration measurements are recommended during topiramate therapy. Patients prescribed topiramate should be educated about the symptoms of metabolic acidosis and urged to report their occurrence promptly to a healthcare provider.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.15011","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T01:50:20Z","timestamp":1677030620000},"page":"438-447","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of topiramate therapy on serum bicarbonate concentration in a sample of 10,279 veterans"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9632-0118","authenticated-orcid":false,"given":"Michelle S.","family":"Naps","sequence":"first","affiliation":[{"name":"Mental Illness Research, Education and Clinical Center Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"},{"name":"School of Engineering and Applied Sciences University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirley H.","family":"Leong","sequence":"additional","affiliation":[{"name":"Mental Illness Research, Education and Clinical Center Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5137-9714","authenticated-orcid":false,"given":"Emily E.","family":"Hartwell","sequence":"additional","affiliation":[{"name":"Mental Illness Research, Education and Clinical Center Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"},{"name":"Department of Psychiatry University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher T.","family":"Rentsch","sequence":"additional","affiliation":[{"name":"VA Connecticut Healthcare System US Department of Veterans Affairs  West Haven Connecticut USA"},{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"},{"name":"Faculty of Epidemiology and Population Health London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1018-0450","authenticated-orcid":false,"given":"Henry R.","family":"Kranzler","sequence":"additional","affiliation":[{"name":"Mental Illness Research, Education and Clinical Center Crescenz Veterans Affairs Medical Center  Philadelphia Pennsylvania USA"},{"name":"Department of Psychiatry University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2015.1041505"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526\u20104610.2011.01863.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2013.12.002"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2018.06.015"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061901"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2014.06.021"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.12496"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.06.004"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.12411"},{"issue":"10","key":"e_1_2_6_11_1","first-page":"597","article-title":"Implementation of evidence\u2010based alcohol screening in the veterans health administration","volume":"12","author":"Bradley K.A.","year":"2006","journal-title":"The American Journal of Managed Care"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.16.1789"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12263\u2010009\u20100159\u20109"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1940-0640-8-12"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1162\/rest.89.2.221"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MED.0000000000000366"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001659"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E437"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2015.0584"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2014.07.013"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263\u2010015\u20100244\u20100"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/155.2.176"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/0471722146"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(03)13370\u20103"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.14.1641"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3628"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028014534397"},{"key":"e_1_2_6_28_1","unstructured":"Kane S.P.Topiramate ClinCalc DrugStats Database Version 2021.10. 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