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This protective layer does two things: It shields the glutathione from being destroyed by stomach acid

This turnover produces byproducts that must be excreted

Compounded and FDA-approved medications are not interchangeable

GSH is synthesized in the cytosol in two ATP-dependent steps

In the context of early brain injury following subarachnoid hemorrhage (SAH), topiramate significantly reduced the elevated levels of TNF-, IL-1, and IL-6 induced by SAH, suggesting that topiramate may exert neuroprotection via its anti-inflammatory effects ( In an experimental model of abdominal aortic aneurysm, topiramate markedly downregulated pro-inflammatory M1 macrophage activity, reduced the expression of TNF-, IL-1, and matrix metalloproteinase-9, and promoted a phenotypic shift of macrophages from M1 to M2, thereby mitigating pro-inflammatory activity and enhancing tissue repair processes ( These studies collectively suggest that topiramate exerts significant neuroprotective effects across various pathological models through its potent anti-inflammatory properties