Key takeaways
- Topiramate can interact with several substances, including other antiseizure medications, birth control pills, and alcohol.
- Taking topiramate with certain drugs can make your treatment(s) less effective or increase your risk of side effects, including kidney stones.
- Always discuss with your doctor and pharmacist all medications and supplements you are taking to ensure your safety.
Topiramate is a generic prescription medication that is used to treat certain types of seizures in adults and some children. It is also commonly used to prevent migraine headaches in adults and adolescents.
The medication works by decreasing abnormal electrical activity in the brain to prevent these conditions.
Topiramate can interact with certain medications, hormonal birth control, and other substances, which can make your treatment(s) less effective or increase your risk of side effects. This article explores some of the more common interactions of topiramate and how to stay safe while taking this medication.
Note: Topiramate is also available as the brand-name medications Topamax, Trokendi XR, and Qudexy XR. This article contains information specifically about interactions with generic topiramate oral tablets.
Topiramate can interact with several types of drugs. Some interactions can speed up how quickly topiramate leaves your body, potentially making it less effective. Others can make the level of topiramate in your blood too high, which may increase your risk of side effects.
The table below lists some common drugs that may interact with topiramate:
| Drug class or drug name | Drug examples | Interaction result with topiramate |
|---|---|---|
| Certain antiseizure medications | phenytoin (Dilantin), carbamazepine (Tegretol) | Can lower the amount of topiramate in your body, making it less effective. |
| Valproic acid | Depakene, Depakote | Can cause high levels of ammonia in the blood or a drop in body temperature |
| Birth control pills | estrogen-containing contraceptives | Can make birth control less effective, increasing the risk of pregnancy |
| CNS depressants | sleep medications, opioid pain relievers | Can cause extreme sleepiness, dizziness, and trouble concentrating |
| Carbonic anhydrase inhibitors | acetazolamide, zonisamide | Can increase the risk of kidney stones and metabolic acidosis (too much acid in the blood) |
| Hydrochlorothiazide | Microzide | Can increase the amount of topiramate in your body, raising the risk of side effects |
| Pioglitazone | Actos | May lower the amount of pioglitazone in your body, affecting blood sugar regulation/management |
| Lithium | Lithobid | May change the levels of lithium in your blood, increasing the risk of mental health changes |
This table does not include all possible drug interactions of topiramate oral tablets. For more details, see the prescribing information for topiramate.
Topiramate and other antiseizure medications
If you have epilepsy, you might take more than one antiseizure medication. Some of these, like phenytoin or carbamazepine, can speed up how your body gets rid of topiramate. If this happens, you might need a higher dose of topiramate to make it work.
On the other hand, taking topiramate with valproic acid can have harmful effects. This combination can cause high levels of ammonia in your blood, which can make you feel very tired, confused, or even lead to more serious brain problems. It can also cause your body temperature to drop too low, causing hypothermia.
Interactions with “brain-slowing” drugs (CNS depressants)
Topiramate can make you feel sleepy or dizzy. Drugs called central nervous system (CNS) depressants do the same thing. If you take them together, these effects can become much stronger.
Common CNS depressants include:
- Alcohol
- Sleep medications
- Muscle relaxants
- Opioid pain medications (like oxycodone or hydrocodone)
- Certain allergy medications (antihistamines)
Taking these with topiramate can make it hard to think clearly, drive, or stay awake.
Risks of kidney stones and blood acid levels
Topiramate is a type of drug called a carbonic anhydrase inhibitor. Taking it with other drugs in this same class — like acetazolamide — can be dangerous.
This combination increases the risk of:
- Kidney Stones: These are hard deposits that can be very painful to pass.
- Metabolic Acidosis: This is when your blood becomes too acidic. It can cause long-term health problems, such as weak bones or kidney issues.
Topiramate can have significant birth control implications. The medication can speed up how your body breaks down the hormones in birth control pills.
If you take more than 200 milligrams (mg) of topiramate per day, your birth control pills might not work as well. This means you could get pregnant even if you are taking your birth control pills every day.
You should avoid drinking alcohol while taking topiramate. Alcohol is a CNS depressant. When mixed with topiramate, it can cause severe drowsiness and confusion.
In some cases, alcohol can cause certain types of topiramate (especially extended-release versions) to be released into your body too quickly. This is called “dose dumping,” and it can lead to a dangerous overdose.
Your health history also matters. Some conditions can make interactions more likely or more dangerous:
- Kidney Problems: Since the kidneys clear topiramate from your body, having kidney disease can cause the drug to build up in your system.
- Liver Problems: Liver issues can affect how your body handles medications like valproic acid (another antiseizure medication) when taken with topiramate.
- Ketogenic Diet: Eating a very high fat, low carb diet (often used for epilepsy) while taking topiramate can increase your risk of kidney stones.
There is no major known interaction between topiramate and ibuprofen (Advil). However, always check with your doctor, as ibuprofen can affect your kidneys.
Most vitamins are safe, but some supplements can affect how your body handles medication. Always show your doctor a full list of your vitamins.
If you feel unusually sleepy or confused, or if you have back pain (which could be caused by a kidney stone), call your doctor right away. Do not stop taking topiramate without talking with them first, as stopping seizure medication suddenly can cause more seizures.
The best way to stay safe when taking topiramate is to be open with your healthcare team. Here are some helpful tips:
- Keep a list: Write down every medication and supplement you take.
- Use one pharmacy: This helps the pharmacist check for drug-drug interactions across all your prescriptions.
- Read the label: The paperwork that comes with your prescription includes a Medication Guide that contains important safety information.
Taking topiramate can be a very helpful treatment for many people. By understanding how it interacts with other substances, you can help make sure your treatment is both safe and effective.
Topiramate oral tablet is a generic prescription medication used to treat seizures and prevent migraine headaches. It can interact with various drugs, potentially reducing its effectiveness or increasing the risk of serious side effects. Additionally, topiramate can decrease the effectiveness of birth control pills, and when taken with central nervous system (CNS) depressants or alcohol, it may cause extreme drowsiness and cognitive impairment. People taking topiramate are also at an increased risk for kidney stones and metabolic acidosis if they take it with other carbonic anhydrase inhibitors. To stay safe while taking topiramate, it is essential to tell your doctor about your current medications, supplements, and alcohol consumption.
Disclaimer: While Medical News Today strives for factual, comprehensive, and current information, this article is not a substitute for a licensed healthcare professional’s expertise. Always consult a doctor before taking or discontinuing any medication. Drug information is subject to change and may not cover all uses, directions, precautions, warnings, interactions, reactions, or adverse effects. The lack of a warning does not guarantee a drug’s safety, effectiveness, or appropriateness for all patients or specific uses. Learn more about our approach to content integrity.