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Since topiramate exhibits carbonic anhydrase inhibitor activity, use with other carbonic anhydrase inhibitors is not recommended

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TMA and TMAO enterohepatic metabolite: carnitine can be converted by the intestinal microbiota to trimethylamine (TMA), and then in the liver to trimethylamine-N-oxide (TMAO) a metabolite associated with cardiovascular risk in the literature (Karlic and Lohninger 2004

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