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* Elevated and toxic lithium levels have been reported with higher (800 mg/d) doses of topiramate, but not with 500 mg/d. <ref> {{Pubmed|12006910|Pinninti at al, Does topiramate elevate serum lithium levels? J Clin Psychopharmacol. 2002 Jun;22(3):340.}}</ref> <ref> {{Pubmed|15349023|Abraham at al, Topiramate can cause lithium toxicity. J Clin Psychopharmacol. 2004 Oct;24(5):565-7}}</ref>
* Pharmacologic response and serum lithium levels should be monitored closely in particular after change of dosage or discontinuation of topiramate or discontinuation.
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