Topamax (topiramate): A complete guide to uses and side effects

What is Topamax used for?

The Food and Drug Administration (FDA) has approved Topamax for age groups and conditions described here.

Migraine prevention

Topamax is used to reduce the frequency of migraine attacks in adults and adolescents ages 12 years and older. It’s a preventive medication taken daily to stop migraines before they start.

Epilepsy and seizures

Topamax is approved for adults and children ages 2 years and older to treat:

• focal onset seizures (formerly called partial onset seizures)
• generalized tonic-clonic seizures
• seizures associated with Lennox-Gastaut syndrome (it’s taken with other medications for this use)

Off-label uses

Doctors may prescribe Topamax off label for conditions not currently approved by the FDA.

• Bipolar disorder: Topamax is occasionally used off label as a mood stabilizer, though clinical evidence regarding effectiveness is limited.
• Nerve pain: Topamax may be used off label for conditions like diabetic neuropathy.
• Weight loss: While not approved for weight loss alone, Topamax is an active ingredient in the weight-management medication Qsymia.

Common side effects of Topamax

Most of the common side effects of Topamax are mild and may diminish as your body adjusts to the medication.

Mild side effects include:

• paresthesia (a tingling or “pins and needles” sensation in the hands and feet)
• cognitive effects such as:
  • slowed thinking
  • difficulty concentrating or remembering things
  • speech problems, such as slurred speech
• fatigue
• sleepiness
• dizziness
• nausea
• weight loss, which is often due to a loss of appetite or changes in how things taste

These are just some of the mild side effects of Topamax. To learn more, see the drug’s prescribing information.

Experiencing side effects? After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews its side effects. If you develop a side effect while taking this medication and want to report it to the FDA, you can visit MedWatch or call 800-FDA-1088.

Serious risks and allergic reactions

Topamax may cause severe side effects. Seek medical attention immediately if you experience any of the following:

• Eye problems: These include sudden vision changes, eye pain, or redness (signs of secondary angle-closure glaucoma) or visual field defects (blind spots).
• Metabolic acidosis: This is caused by high acid levels in the blood with symptoms such as rapid breathing, fatigue, or heart rate changes. In children, chronic acidosis can slow growth and reduce bone density.
• Kidney stones: Symptoms include severe pain in the back or abdomen or blood in the urine. Drink plenty of fluids to reduce the risk of kidney stones.
• Serious hypersensitivity: Seek help for a fever with a skin rash, swollen glands, or facial swelling, which may indicate drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) or severe skin reactions like Stevens-Johnson Syndrome.
• High ammonia levels: Symptoms include unexplained lethargy, vomiting, or mental status changes, especially if taken with valproic acid.
• Mood changes: These include new or worsening depression, anxiety, or suicidal thoughts.

Topamax dosage guide

The ideal dose of Topamax is highly individualized, since the starting amount and maintenance levels vary significantly based on your age and the condition you’re taking the drug to treat.

To help your body adjust and minimize side effects, your healthcare professional will typically use a titration schedule. This involves starting you at a low dose and gradually increasing it over several weeks.

Typical dosage for adults and adolescents

• Migraine prevention: The usual target dosage is 100 milligrams (mg) per day (50 mg taken twice daily).
• Seizures: Dosages for adults range from 200 mg to 400 mg per day, split into two doses.

How to take topamax tablets vs. sprinkle capsules

• Oral tablets must be swallowed whole. Do not crush or chew them, as they have a very bitter taste.
• Sprinkle capsules can be swallowed whole or opened and sprinkled onto a teaspoon of soft food (like applesauce). The mixture should be swallowed immediately and not stored for later use.

Topamax interactions

There are several substances you should avoid during treatment with Topamax.

• Do not consume alcohol while taking Topamax, as it can lead to severe dizziness and confusion.
• Topamax can make hormonal birth control less effective, especially at doses greater than 200 mg per day.
• A ketogenic diet increases the risk of kidney stones and metabolic acidosis when combined with Topamax.

Frequently asked questions

Topamax cost and savings

Topamax is available in a generic form called topiramate. A generic drug contains the same active ingredient as its brand-name version but tends to cost less. Talk with your doctor if you’d rather be prescribed topiramate instead of Topamax. You’ll also need to check your insurance plan, as it may only cover one version of the drug.

The manufacturer of Topamax offers a savings card that may help lower the cost of the drug. For more information and to find out whether you’re eligible for support, visit the manufacturer’s website.

Summary

Topamax is a prescription anticonvulsant drug approved by the FDA for daily migraine prevention in adolescents and adults, as well as for treating seizures and epilepsy in people ages 2 years and older. Healthcare professionals usually use a gradual dose increase to help the body adjust to side effects such as a tingling sensations, slowed cognitive function, weight loss, and fatigue.

While effective, Topamax carries serious risks including kidney stones, metabolic acidosis, secondary angle-closure glaucoma, and suicidal thoughts. People taking this medication must avoid alcohol and ketogenic diets during treatment, keep in mind that the drug can decrease the effectiveness of hormonal birth control, and can consider asking their doctor about the lower-cost generic alternative, topiramate.