Table of ContentsView AllTable of ContentsHow Topamax WorksSide EffectsDosageOverdosePrecautionsDrug InteractionsSimilar MedicationsStaying Healthy on Topamax

Table of ContentsView All

View All

Table of Contents

How Topamax Works

Side Effects

Dosage

Overdose

Precautions

Drug Interactions

Similar Medications

Staying Healthy on Topamax

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What is the most important information I should know about Topamax?Before taking Topamax (topiramate), tell your doctor if you are:pregnant; orhave impaired kidney function; orare taking another anticonvulsant.

What is the most important information I should know about Topamax?

Before taking Topamax (topiramate), tell your doctor if you are:pregnant; orhave impaired kidney function; orare taking another anticonvulsant.

Before taking Topamax (topiramate), tell your doctor if you are:

Topamax (topiramate) is an anticonvulsant medication used to treat epilepsy and migraine headaches.It’s also used off-label to treat a wide range of mood and eating disorders and to aid in substance abuse therapy.

Topamax’s mechanism of action is unclear. We do know that the drug blocks sodium channels that deliver electrical impulses to nerve, muscle, brain, and other excitable cells. By doing so, Topamax appears to enhance the activity of a chemical messenger (neurotransmitter) known asgamma-aminobutyric acid (GABA).

Topamax is available in capsule and tablet formulations. The tablet is offered in 25-, 50-, 100-, and 200-milligram (mg) formulations. The capsule is available in 15 mg and 25mg. The dosage varies with the person’s condition and age.

Topamax has both approved and off-label uses. The U.S. Food and Drug Administration (FDA) has approved it for:

Topamax can also be combined with other drugs to treat partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome (a severe form of childhood epilepsy).

Off-Label Uses

Topiramate’s is sometimes used off-label as a treatment for:

While topiramate is sometimes prescribed off-label for bipolar disorder and depression, research does not support its use for such purposes. One review of randomized controlled trials found that topiramate was no more effective than placebo as a monotherapy or add-on therapy for bipolar episodes.

How to Take Topamax

At the beginning of treatment, your healthcare provider typically will increase your dosage gradually to reduce the risk of side effects. The medication takes approximately five days to build up and reach a steady state in your system.Your healthcare provider will tell you how to taper down your dosage gradually if you decide together to stop using it. Don’t stop taking it abruptly on your own; this can cause a rebound of disease symptoms (such as seizures in people with epilepsy or abnormal moods in people with bipolar disorder).

Don’t stop taking topiramate without consulting your healthcare provider.

Storage

Store Topamax at room temperature, out of direct light, and away from heat and moisture in a closed container.

What Are the Side Effects of Topamax?

Side effects of topiramate tend to be transient and resolve on their own as your body adapts. Common/mild side effects include:

Consult your healthcare provider if you notice any of the following:

Dosage: How Much Topamax Should I Take?

Your provider will determine the best dosage for you based on several factors, including your weight, condition, other medications, age, and contraindications. Generally, this will be the lowest dosage that’s likely to provide the desired results.

Usually, you’ll begin with a low dose, which your doctor will slowly raise until it reaches the optimum for your condition. This gives your body time to adapt and reduces the risk of side effects.

Modifications

When prescribed for young children, the Topamax capsule can be broken open and its contents sprinkled over food.

Missed Dose

If you forget to take Topamax, take it as soon as you remember, unless it’s close to your next dose time. In that case, skipped the missed dose and then resume your usual dosing schedule. Don’t ever take more than one dose at a time.

If you miss more than one dose, consult your healthcare provider. You’ll probably have to restart your treatment regimen.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Overdose: What Happens If I Take Too Much Topamax?

Symptoms of a topiramate overdose include:

Seek help immediately if you think you’ve taken too much Topamax.

When deciding on any medical treatment, healthcare providers weigh risks vs. benefits. If your doctor has prescribed Topamax, they’ve determined that the potential good it can do for you outweighs any possible negative issues. Still, some precautions are in order. Here are a few:

What Are Reasons I Should Not Take Topamax?

Although it’s not common, Topamax can cause serious complications that require you to stop or avoid treatment. Among them are:

What Other Medications Interact With Topamax?

Certain drugs reduce or increase the availability of Topamax. This is especially true when it’s used with other anticonvulsants such asTegretol(carbamazepine) andLamictal(lamotrigine).Your doctor might have to adjust your dosage to compensate.

Other co-administered drugs that can require dose adjustments include the diuretic Microzide (hydrochlorothiazide) and the diabetes medications Actos (pioglitazone) and metformin.

Avoid taking carbonic anhydrase inhibitors, which include:

Topamax also can reduce the efficacy of estrogen-based contraceptives, increasing the risk of pregnancy and breakthrough bleeding.

What Medications Are Similar?

A wide variety of Topamax alternatives is available, depending on the condition for which you take it. Consult your healthcare provider if you’d rather take a different medication.

How Can I Stay Healthy While Taking Topamax?

Just as you would with any other medications, follow the usual guidelines for healthful eating, exercise, sleep, etc. to help Topamax do its work.

Avoid ketogenic diets while you’re taking Topamax to minimize the risk of kidney stones. Drink lots of fluids.

Topamax can reduce the efficacy of oral contraceptives, so consider using additional methods as backup.

Frequently Asked Questions

Topamax takes approximately five days to build up and reach a steady state in your system. You probably won’t feel any change until then.

Doctors don’t prescribe topiramate specifically for weight loss, but the drug often causes it. In some studies, people lost up to 17% of their body weight while taking Topamax.

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration (FDA).Topamax (topiramate) tablets and Topamax (topiramate capsules) sprinkle capsules.Medline Plus.Topiramate.Nourredine M, Jurek L, Angerville B, et al.Use of topiramate in the spectrum of addictive and eating disorders: A systematic review comparing treatment schemes, efficacy, and safety features.CNS Drugs. 2021;35(2):177-213. doi:10.1007/s40263-020-00780-yNickel MK, Nickel C, Mitterlehner FO, et al.Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study.J Clin Psychiatry. 2004;65(11):1515-1519. doi:10.4088/jcp.v65n1112Kramer CK, Leitão CB, Pinto LC, Canani LH, Azevedo MJ, Gross JL.Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials: Topiramate and weight loss.Obesity Reviews. 2011;12(5):e338-e347. doi:10.1111/j.1467-789X.2010.00846.xPigott K, Galizia I, Vasudev K, Watson S, Geddes J, Young AH.Topiramate for acute affective episodes in bipolar disorder in adults. Cochrane Common Mental Disorders Group, ed.Cochrane Database of Systematic Reviews. 2016;2016(9). doi:10.1002/14651858.CD003384.pub3Additional ReadingEstemalik, E. and Tepper, S.Preventive treatment in migraine and the new US guidelines.Neuropsychiatr Dis Treat. 2013;9:709-20. doi: 10.2147/NDT.S33769

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration (FDA).Topamax (topiramate) tablets and Topamax (topiramate capsules) sprinkle capsules.Medline Plus.Topiramate.Nourredine M, Jurek L, Angerville B, et al.Use of topiramate in the spectrum of addictive and eating disorders: A systematic review comparing treatment schemes, efficacy, and safety features.CNS Drugs. 2021;35(2):177-213. doi:10.1007/s40263-020-00780-yNickel MK, Nickel C, Mitterlehner FO, et al.Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study.J Clin Psychiatry. 2004;65(11):1515-1519. doi:10.4088/jcp.v65n1112Kramer CK, Leitão CB, Pinto LC, Canani LH, Azevedo MJ, Gross JL.Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials: Topiramate and weight loss.Obesity Reviews. 2011;12(5):e338-e347. doi:10.1111/j.1467-789X.2010.00846.xPigott K, Galizia I, Vasudev K, Watson S, Geddes J, Young AH.Topiramate for acute affective episodes in bipolar disorder in adults. Cochrane Common Mental Disorders Group, ed.Cochrane Database of Systematic Reviews. 2016;2016(9). doi:10.1002/14651858.CD003384.pub3Additional ReadingEstemalik, E. and Tepper, S.Preventive treatment in migraine and the new US guidelines.Neuropsychiatr Dis Treat. 2013;9:709-20. doi: 10.2147/NDT.S33769

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Food and Drug Administration (FDA).Topamax (topiramate) tablets and Topamax (topiramate capsules) sprinkle capsules.Medline Plus.Topiramate.Nourredine M, Jurek L, Angerville B, et al.Use of topiramate in the spectrum of addictive and eating disorders: A systematic review comparing treatment schemes, efficacy, and safety features.CNS Drugs. 2021;35(2):177-213. doi:10.1007/s40263-020-00780-yNickel MK, Nickel C, Mitterlehner FO, et al.Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study.J Clin Psychiatry. 2004;65(11):1515-1519. doi:10.4088/jcp.v65n1112Kramer CK, Leitão CB, Pinto LC, Canani LH, Azevedo MJ, Gross JL.Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials: Topiramate and weight loss.Obesity Reviews. 2011;12(5):e338-e347. doi:10.1111/j.1467-789X.2010.00846.xPigott K, Galizia I, Vasudev K, Watson S, Geddes J, Young AH.Topiramate for acute affective episodes in bipolar disorder in adults. Cochrane Common Mental Disorders Group, ed.Cochrane Database of Systematic Reviews. 2016;2016(9). doi:10.1002/14651858.CD003384.pub3

Food and Drug Administration (FDA).Topamax (topiramate) tablets and Topamax (topiramate capsules) sprinkle capsules.

Medline Plus.Topiramate.

Nourredine M, Jurek L, Angerville B, et al.Use of topiramate in the spectrum of addictive and eating disorders: A systematic review comparing treatment schemes, efficacy, and safety features.CNS Drugs. 2021;35(2):177-213. doi:10.1007/s40263-020-00780-y

Nickel MK, Nickel C, Mitterlehner FO, et al.Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study.J Clin Psychiatry. 2004;65(11):1515-1519. doi:10.4088/jcp.v65n1112

Kramer CK, Leitão CB, Pinto LC, Canani LH, Azevedo MJ, Gross JL.Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials: Topiramate and weight loss.Obesity Reviews. 2011;12(5):e338-e347. doi:10.1111/j.1467-789X.2010.00846.x

Pigott K, Galizia I, Vasudev K, Watson S, Geddes J, Young AH.Topiramate for acute affective episodes in bipolar disorder in adults. Cochrane Common Mental Disorders Group, ed.Cochrane Database of Systematic Reviews. 2016;2016(9). doi:10.1002/14651858.CD003384.pub3

Estemalik, E. and Tepper, S.Preventive treatment in migraine and the new US guidelines.Neuropsychiatr Dis Treat. 2013;9:709-20. doi: 10.2147/NDT.S33769

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