10 Things You Don’t Know About Topamax (Topiramate)

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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1.  Topamax (topiramate) works for the prevention of migraine and for seizures. What is awesome is the exact mechanism of its effects are unknown. So we don’t really know why it works to prevent migraines. We do know that topiramate may block the spread of seizures rather than raise the seizure threshold like other anti-seizure medications.

2.  Topamax is available as generic topiramate now, making it a ton cheaper than it was a couple years ago.

3.  It does not matter whether you take Topamax (or the generic topiramate) with or without food, the bioavailability is the same.

4.  In patients with liver or kidney abnormalities, the clearance of topiramate is slower.

5.  The dose of topiramate used for prevention of migraines is lower than used for seizure prevention. The goal dose for migraine prophylaxis is 100 mg per day (divided in two doses).

6.  Topamax is FDA approved for migraine prevention, epilepsy treatment and weight loss in combination with phentermine as Qsymia.
7.  Topiramate is one of the drugs in the new weight loss medication called Qsymia, which is a mixture of topiramate and phentermine. This is because topiramate suppresses appetite.

8.  There is a risk of cleft lip and cleft palate in babies born to mothers who have used Topiramate, making it a pregnancy risk category D drug.

9.  Feeling sleepy or drowsy is the main adverse reaction to Topamax/topiramate and about 10 – 20% of patients prescribed this medication discontinue it due to side effects. This side effect lead to the nickname Dopamax.

10.  It’s used in kids too. Topamax, at a dose of 100 mg a day, has been studied and was found to be effective in kids aged 12 – 17 for prevention of migraine headaches.

Dr O.

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