topiramate ER (Trokendi XR)

Some people taking Trokendi XR (topiramate) have had eye problems. They can be related to nearsightedness and greater pressure in the eye(s). Symptoms can include eye redness, blurry vision, and eye pain. These symptoms usually happen within the first month of treatment, but they can also happen later. Symptoms can come on suddenly.

Tell your care team or eye specialist right away if you notice any changes in your vision while taking Trokendi XR (topiramate). They can check what's going on because eye problems can become serious if left untreated. If needed, your prescriber can stop the medication to keep your vision from getting worse. To do this safely, they'll help lower your dose slowly over time. Usually, these vision problems will go away after you stop taking it.

• Risk factor: Children | Hot weather | Taking anticholinergic medications | Taking other medications that make you sweat less

Some people might sweat less while taking Trokendi XR (topiramate). This can make it harder to control your body temperature. It can lead to overheating and high body temperature, which is dangerous. The risk might be higher for children. The risk is also higher if you take other medications that make you sweat less, such as anticholinergic medications.

Pay attention to how much you sweat or how hot you feel while you're exercising or in hot weather. Stay hydrated, use mist fans, and take breaks in the shade on hot days. If you can, try to stay indoors where there's air conditioning when the weather is hot. Call 911 if you or your child has signs of heat stroke or heat exhaustion, like dizziness, hot skin, headache, muscle cramps, or confusion.

• Risk factors: Kidney problems | Severe breathing problems | Diarrhea | Keto diet | Serious seizure condition called status epilepticus

Although rare, Trokendi XR (topiramate) can raise the acid levels in your blood. This condition is called metabolic acidosis. It can happen at any time during treatment. If left untreated, high acid levels can raise your risk of kidney stones and bone fractures. In children, this condition can lead to poor bone growth.

To monitor this risk, your prescriber will ask you to do a blood test before you start Trokendi XR (topiramate). You'll also need periodic blood tests during treatment. This helps make sure the acid levels in your blood aren't too high.

Call your care team right away if you have signs of metabolic acidosis while taking Trokendi XR (topiramate). Signs can include fast breathing, tiredness, loss of appetite, or irregular heartbeat. If your acid levels are too high, your prescriber might lower your dose or stop the medication. If needed, they can give you treatment for metabolic acidosis.

• Risk factors: History of depression | Taking other seizure medications or medications that affect mood

Trokendi XR (topiramate) can cause changes in mood. It can also raise the risk of suicidal thoughts or behavior. The risk can appear as early as 1 week after starting the medication.

Make sure your friends and family know to watch for signs of depression or changes in your mood or behavior while you're taking Trokendi XR (topiramate). This is especially important during the first few months and when your dose goes up. If you start thinking about hurting yourself, call 911 right away.

• Risk factors: Starting Trokendi XR (topiramate) at a higher dose | Raising the dose too fast

Trokendi XR (topiramate) can make it harder for you to remember things. It can also cause problems with speech and coordination. Tell your care team if you notice you're forgetting things more often, having problems with speech, or having a hard time moving around. They can check what's going on and see how they can help you.

• Risk factors: Starting Trokendi XR (topiramate) at a higher dose | Raising the dose too fast

Trokendi XR (topiramate) can make you sleepy or tired. It can also make it harder for you to concentrate. To be safe, don't drive or use machinery until you know how this medication affects you. Also don't drink alcohol with Trokendi XR (topiramate) because it make these side effects worse.

• Risk factors: History of metabolic disorders | Taking divalproex (Depakote) or valproic acid | Higher dose of Trokendi XR (topiramate)

Trokendi XR (topiramate) can cause ammonia to build up in your body. The risk is higher if you take it with valproic acid or divalproex (Depakote). Some people might not have symptoms, but others can.

Signs of high ammonia levels include feeling more tired or confused, having trouble concentrating, or vomiting. In serious cases, high ammonia levels can affect the brain. Get medical help right away if you notice any of these symptoms.

Trokendi XR (topiramate) has a risk of causing serious skin reactions. This includes Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN). If you have a rash, blisters, skin peeling, other unusual changes in your skin, or high fever, get medical help right away. Your care team will help lower your dose slowly over time to stop the medication. They'll talk to you about safer options to treat your condition.

• Risk factors: Men | Keto diet | Taking medications called carbonic anhydrase inhibitors

Trokendi XR (topiramate) can raise your risk of kidney stones. The risk might be higher if you follow a ketogenic (keto) diet. You can also be at risk if you take medications called carbonic anhydrase inhibitors, like acetazolamide. Be sure to drink plenty of fluids to help prevent kidney stones.

Talk to your prescriber before stopping Trokendi XR (topiramate). Stopping suddenly can raise your risk of seizures. If you take it to control seizures, stopping too quickly can make them come back or happen more often. Your prescriber can help you slowly lower your dose to stop safely.

In studies, some children taking immediate-release topiramate had signs of having weaker bones. It's unclear if this directly raises the risk of fractures. Get medical help right away if your child breaks a bone while taking Trokendi XR (topiramate). Let their prescriber know afterwards.

Studies also suggest that Trokendi XR (topiramate) might slow growth in children (in height and weight). The care team will keep track of your child's growth during follow-up visits. Talk to your prescriber if you're worried about your child's growth progress.

Trokendi XR (topiramate) can interact with many medications. Some interactions can make medications work less well. Others can put you at risk of side effects. It's important to tell your care team about all the medications you take and plan to take. They can check for interactions and make adjustments to your medications to keep you safe, if needed.

In particular, Trokendi XR (topiramate) can interact with medications called carbonic anhydrase inhibitors. These include acetazolamide and zonisamide (Zonegran). This can raise the risk of metabolic acidosis and kidney stones.

Another example is taking Trokendi XR (topiramate) with valproic acid or divalproex (Depakote). This interaction can make your body temperature drop. This can lead to symptoms like shivering, tiredness, trouble moving at your typical speed, confusion, or more seriously, coma. If this happens, get medical help right away.

Trokendi XR (topiramate) can harm an unborn baby if taken during pregnancy. It's caused birth defects like cleft lip or cleft palate. Some newborns might also be smaller than expected.

Tell your prescriber if you're pregnant or planning to become pregnant. They can explain the risks and benefits of taking Trokendi XR (topiramate) during pregnancy. If you're not planning a pregnancy, it's recommended that you use birth control while taking this medication to lower your risk.

If you take Trokendi XR (topiramate) while pregnant, you can join the North American Antiepileptic Drug (NAAED) Pregnancy Registry. This program helps researchers learn more about how safe the medication is for you and your baby.