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Most commonly, topamax is started in low doses, 25 or 50 mg per day, and then increased slowly, under a doctor's orders, by 25 to 50 mg per week until an effective daily dose is reached. This slow approach to treatment reduces side effects. In children, the starting dose is up to 25 mg (1 to 3 mg|kg|day), taken nightly for the first week. The dose is then increased at 1 or 2 week intervals by 1 to 3 mg|kg|day. Although the usual adult dose is 200 mg twice daily, some adult patients may begin to see a clinical response at 200 mg per day. Some patients need doses higher than 200 mg daily. In children, the usual dose is 2.5 to 4.5 mg|kg twice daily. Patients should maintain an adequate fluid intake in order to minimize the risk of kidney stones.

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