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Topiramate pregnancy prevention — GPhC CRA MCQ

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HardCNS TherapeuticsTopiramate pregnancy preventionGPhC CRA

A 31-year-old woman collects topiramate 50mg twice daily for migraine prevention. She says she and her partner are trying to conceive, and she has not heard of a pregnancy prevention programme. The prescription is from a private online clinic, and she has no epilepsy history. What is the most appropriate action?

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Correct answer: D — Do not supply until the prescriber confirms a safe pregnancy risk plan

Topiramate is contraindicated for migraine prophylaxis in pregnancy and should not be used in women of childbearing potential unless Pregnancy Prevention Programme conditions are fulfilled. Trying to conceive makes this an urgent safety concern. The pharmacist should not supply until the prescriber has reviewed the risk and documented an appropriate plan. Folic acid does not remove the teratogenic risk.

Reference: MHRA Drug Safety Update Topiramate 2024; BNF