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Conditions or therapies that predispose patients to acidosis, such as kidney disease, severe pulmonary disease, status epilepticus, diarrhea, ketogenic diet, or certain drugs, may be additive to the bicarbonate lowering effects of topiramate

The lack of independent replication or detailed data means these findings, while encouraging, are not considered high-quality evidence by todays standards

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1%), worsening depression (1% to 2% vs