Topiramate Dosages: Your GoodRx Guide
Key takeaways:
Topiramate is an antiseizure medication that’s also used to prevent migraines. You can take it by mouth as a tablet, capsule, or liquid solution. Immediate-release (IR) and extended-release (ER) forms are both available.
Your topiramate dosage depends on your age, body weight, and other medical conditions. How often you take topiramate depends on whether you’re taking an IR or ER form.
Topiramate is available as a lower-cost generic. But certain products are brand-name only. You can find generic topiramate for less than $25 at certain pharmacies with a free GoodRx discount.
Table of contents
Topiramate is an oral medication that was first approved in 1996 to treat different types of seizures in people with epilepsy. Since then, it has also been approved to prevent migraines in people ages 12 and older.
Topiramate is available in a few different forms, including immediate-release (IR) and extended-release (ER) products. You may be most familiar with the brand-name product, Topamax. But topiramate has several other brand names, including Eprontia, Qudexy XR, and Trokendi XR.
Below, we’ll go over typical topiramate dosages. Keep in mind that these are recommendations from the manufacturers. Your healthcare provider might give you different instructions for taking topiramate.
What’s the typical topiramate dosage for adults?
There are a few different topiramate dosage forms available: oral tablets, capsules, and a liquid solution. All of them are approved to treat partial onset or generalized tonic-clonic seizures in adults. They can be taken on their own (known as monotherapy), or as an add-on treatment along with other medications. Additional uses include treating seizures associated with Lennox-Gastaut syndrome and preventing migraines.
If you’re just getting started on topiramate, you’ll likely start with a low dose and increase it over time — usually weekly. This can help reduce your risk of side effects.
If you’re taking the solution (Eprontia), tablets, or sprinkle capsules, you’ll likely take your dose twice a day. But if you’re prescribed ER capsules (Qudexy XR or Trokendi XR), you’ll take the medication once daily. This is because these forms last longer in your body.
All forms of topiramate are taken by mouth, with or without food. If you have trouble swallowing pills, the sprinkle capsules and Qudexy XR capsules can be opened. The contents inside can be sprinkled onto a small amount of soft food and swallowed right away.
Keep in mind: Alcohol can affect how Trokendi XR is released into your body. You should avoid drinking alcohol within 6 hours of taking this medication.
Epilepsy (monotherapy)
When topiramate solution, IR tablets, or sprinkle capsules are taken as a monotherapy for epilepsy, the typical dosage for adults is 400 mg daily (taken in 200 mg doses twice a day). Your healthcare provider will start you at a low dose and slowly raise it over 6 weeks until you reach 400 mg per day, usually following this schedule:
| Schedule | Morning dose | Evening dose |
|---|---|---|
| Week 1 | 25 mg | 25 mg |
| Week 2 | 50 mg | 50 mg |
| Week 3 | 75 mg | 75 mg |
| Week 4 | 100 mg | 100 mg |
| Week 5 | 150 mg | 150 mg |
| Week 6 | 200 mg | 200 mg |
For topiramate ER capsules, the typical dosage is 400 mg once daily, after 6 weeks of slowly raising your dose according to the following schedule:
| Schedule | Daily dose |
|---|---|
| Week 1 | 50 mg |
| Week 2 | 100 mg |
| Week 3 | 150 mg |
| Week 4 | 200 mg |
| Week 5 | 300 mg |
| Week 6 | 400 mg |
Epilepsy (add-on treatment)
When topiramate is taken along with other medications to treat epilepsy, the typical daily dosage is between 200 mg and 400 mg for people ages 17 and older. This is true of all dosage forms. This amount is split into two doses throughout the day if you’re taking the solution, tablets, or sprinkle capsules.
Your topiramate dosage will depend on the type of epilepsy you’re treating. Typically, the starting dosage is 25 mg to 50 mg per day. Your dose is slowly raised every week until you reach the recommended maintenance dose (up to 400 mg per day).
Migraine prevention
The typical dosage for topiramate solution, tablets, and sprinkle capsules is 50 mg twice a day when used for migraine prevention. Your healthcare provider will start you on a low dose and slowly raise it over the first 4 weeks:
| Schedule | Morning dose | Evening dose |
|---|---|---|
| Week 1 | None | 25 mg |
| Week 2 | 25 mg | 25 mg |
| Week 3 | 25 mg | 50 mg |
| Week 4 | 50 mg | 50 mg |
For topiramate ER capsules, the typical dosage is 100 mg once a day, after slowly raising the dose over the first 4 weeks:
| Schedule | Daily dose |
|---|---|
| Week 1 | 25 mg |
| Week 2 | 50 mg |
| Week 3 | 75 mg |
| Week 4 | 100 mg |
What’s the typical Topamax dosage for children?
All forms of topiramate are FDA-approved to treat the same conditions in children as in adults. But it’s important to note that Trokendi XR is only approved for children ages 6 and older. All the other forms or topiramate can be used in children ages 2 and older.
For epilepsy, the dosage for children depends on their body weight. For migraine prevention, the dosage will be the same as for adults.
Epilepsy (monotherapy)
Dosages for children ages 10 and older, are the same as those for adults with all forms of the medication when used as a monotherapy to treat epilepsy.
The typical dosage for children ages 2 to 9 years old (or 6 to 9 years old for Trokendi XR) is between 150 mg to 400 mg per day. This amount is split into two daily doses day with the solution, tablets, or sprinkle capsules.
Your child’s healthcare provider will typically start them at 25 mg daily, taken a night, for the first week. After that, they’ll raise the daily dose by 25 mg to 50 mg each week. This will continue until they reach the minimum maintenance dose. Additional weekly adjustments may be made up to the maximum daily maintenance dose, as outlined here:
| Body weight (kg) | Minimum daily maintenance dose (mg/day) | Maximum daily maintenance dose (mg/day) |
|---|---|---|
| Up to 11 kg | 150 | 250 |
| 12-22 kg | 200 | 300 |
| 23-31 kg | 200 | 350 |
| 32-38 kg | 250 | 350 |
| More than 38 kg | 250 | 400 |
Epilepsy (add-on treatment)
For all topiramate dosage forms, the typical dosage in children ages 2 to 16 years old (or 6 to 16 years old for Trokendi XR) is 5 mg to 9 mg per kilogram body weight daily when used as an add-on treatment for epilepsy. This amount is split into two doses throughout the day with the solution, tablets, or sprinkle capsules.
Your child’s healthcare provider will typically start their dose at 1 mg to 3 mg per kilogram of body weight nightly (up to 25 mg per day) for the first week. They’ll slowly raise the dose by 1 mg to 3 mg per kilogram of body weight daily every 1 to 2 weeks until your child reaches the recommended maintenance dose (up to 400 mg per day).
Migraine prevention
The dosage for migraine prevention in children ages 12 and older is the same as the adult dosage above. Topiramate isn’t approved for migraine prevention in children under 12 years old.
Are there any dosage adjustments for medical conditions?
Your body gets rid of topiramate mainly through your kidneys. If you have kidney problems, your healthcare provider will likely need to lower your dosage. This is to make sure that too much topiramate isn’t building up in your body.
Dosage adjustments are typically based on your creatinine clearance — an estimate of kidney function that is determined with a lab test. One-half of the typical topiramate dosage is recommended in adults with a creatinine clearance less than 70 mL/min/1.73 m2.
If you’re on dialysis, your healthcare provider might need to give you an extra dose of topiramate. Make sure to keep your provider informed of all of your medical conditions.
What happens if you miss a dose of topiramate?
What should you do if you miss a topiramate dose? The answer depends on which form you’re taking. Never double up on your dose to make up for a missed one, as this may cause side effects.
Topiramate solution, tablets, and sprinkle capsules: If it’s more than 6 hours until your next scheduled dose, take the missed dose as soon as possible. If it’s less than 6 hours until your next dose, skip it and take your next dose at the usual time.
Qudexy XR capsules: If you’ve missed only one dose, take your missed dose as soon as possible. If you’ve missed more than one dose, call your healthcare provider.
Trokendi XR capsules: Ask your healthcare provider.
What should you do if you take too much topiramate?
Taking too much topiramate can lead to severe side effects, including seizures, blurry vision, and low blood pressure. One of the more serious possible issues is metabolic acidosis, which is when there’s too much acid in your body. Symptoms include tiredness, loss of appetite, and changes in your heartbeat.
If you or a loved one might have taken too much topiramate, get medical attention right away or call Poison Control at 1-800-222-1222.
How to save on topiramate
There are many ways to save on topiramate, which is available as a generic medication. Certain topiramate products, like Eprontia and Trokendi XR, are brand-name only.
Save with GoodRx. GoodRx can help you save over 50% off the average retail price of the generic version. Generic topiramate at certain pharmacies is as low as $1.80 with a free GoodRx discount.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Trokendi XR’s price is as little as $0 if you use the manufacturer’s savings card.
The bottom line
Your topiramate dosage depends on your medical conditions, age, and body weight. And dosing frequency depends on which form of the medication you’re taking. You’ll typically start with a low dose that increases slowly over several weeks to allow your body to adjust.
If you have questions about how you should be taking topiramate, contact your healthcare provider.
Why trust our experts?
References
Azurity Pharmaceuticals, Inc. (2022). Eprontia [package insert].
Camber Pharmaceuticals, Inc. (2021). Topiramate tablets [package insert].
DailyMed. (2022). Qudexy XR.
DailyMed. (2022). Trokendi XR.
Fariba, K. A., et al. (2022). Topiramate. StatPearls.
Shahbaz, H., et al. (2022). Creatinine clearance. StatPearls.
Teva Pharmaceuticals USA, Inc. (2022). Topiramate sprinkle capsules [package insert].
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