topiramate
Topiramate is a prescription medication that can be used alone or in combination with other medications to treat certain types of seizures. It can also be used to prevent migraines. It comes in immediate-release and extended-release tablets and capsules, as well as a liquid. Topiramate is typically taken by mouth once or twice daily, depending on what formulation you're using. Some forms of topiramate are available as lower-cost generic medications.
What is Topiramate?
What is Topiramate used for?
Seizures (partial seizures, tonic-clonic seizures, Lennox-Gastaut syndrome)
Migraine prevention
How Topiramate works
Topiramate is an antiepileptic. It's not exactly clear how this medication works to prevent migraines. But in order to control seizures, topiramate blocks your brain from sending certain signals or chemicals that can overly excite your nerves. This helps to reduce the bursts of activity in your brain, which prevents seizures.
Drug Facts
More on Topiramate essentials
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What are the side effects of Topiramate?
Common Side Effects
- Feeling "pins and needles"
- Drowsiness
- Weight loss
- Nervousness
- Fatigue
- Dizziness
- Lack of appetite
- Trouble sleeping
- Upper respiratory tract infection (e.g., cough, stuffy nose, sore throat)
- Fever
- Change in taste
- Trouble moving or keeping balance
Other Side Effects
- Drooling
- Nausea
- Trouble speaking or forming words/sentences
- Feeling numb
- Lack of energy
- Stiff muscle
- Spinning sensation
- Constipation
- Belly pain
- Indigestion or heartburn
- Easier to get sick or the common cold
- Tremor
- Diarrhea
Serious Side Effects
- Suicidal thoughts or behaviors
- Seizures (from withdrawal)
- Vision problems: blurred vision, loss of vision, double vision, blind spots
- Serious bleeds: bleeding that's difficult to stop, vomiting blood, blood in the urine or stool, "coffee-ground" stool
- Severe skin reactions: rash, skin pain or peeling, blisters, fever, sore throat, extreme tiredness, swelling of the face, swollen lips
- Extreme drop in body temperature: shivering, feeling tired, feeling confused, slurred speech, coma
- Dangerously high body temperature: fever, headache, dizziness, feeling confused, nausea, vomiting muscle cramps, skin that's very warm or hot to the touch
- Dangerously high blood acid levels: feeling very tired, breathing very fast, poor appetite, irregular heartbeat, trouble thinking clearly, sharp pain near the side and back from kidney stones
- Extremely high blood ammonia levels: fatigue, poor mental alertness, vomiting
Source: DailyMed
More on Topiramate side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
burning, prickling, or tingling sensations
clumsiness or unsteadiness
confusion
continuous, uncontrolled back-and-forth or rolling eye movements
dizziness
double vision
drowsiness
eye redness or pain
generalized slowing of mental and physical activity
increased eye pressure
memory problems
menstrual changes
nervousness
speech or language problems
trouble in concentrating or paying attention
unusual tiredness or weakness
Less common
Aggression
agitation
chills
discouragement
feeling sad or empty
irritability
lack of feeling or emotion
lessening of sensations or perception
loss of appetite
loss of interest or pleasure
red, irritated, or bleeding gums
stomach pain
trouble sleeping
Rare
Blood in the urine
difficult or painful urination
hearing loss
itching, skin rash
loss of bladder control
lower back or side pain
nosebleeds
pale skin
ringing or buzzing in the ears
swelling
trouble breathing
Incidence not known
Blistering, peeling, or loosening of the skin
clay-colored stools
increased rate of breathing
joint or muscle pain
pain or tenderness in the upper stomach
red skin lesions, often with a purple center
sores, ulcers, or white spots in the mouth or on the lips
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Decreased awareness or responsiveness
dizziness, fainting, or lightheadedness when getting up suddenly from a lying or sitting position
severe sleepiness
unusual drowsiness, dullness, or feeling of sluggishness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Back pain
feeling of warmth
increased sweating
leg pain
redness of the face, neck, arms, and occasionally, upper chest
Rare
Decrease in sexual performance or desire
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Topiramate
Pros
Can be used on its own or with other medications to control seizures
Available in short-acting and long-acting forms, so options to take once or twice daily
Available as a solution (Eprontia), so it's convenient for people who have trouble swallowing
Can be used to treat different types of seizures
Can be used to treat seizures in both adults and children
Cons
Can prevent migraines from happening, but it won't help if you have a migraine attack
Can cause kidney stones
Can cause serious eye problems
Interacts with many medications, such as warfarin (Coumadin), phenytoin (Dilantin), and divalproex (Depakote)
Children taking this medication for long periods of time will need to have their doses adjusted often due to changes in body weight as they grow
Pharmacist tips for Topiramate
Different formulations of topiramate have different directions and age-cut offs. If you (or your child) are just starting or switching to a different formulation of topiramate, double check with your provider that the formulation, dose, and directions are appropriate.
If you want to stop topiramate, talk with your provider. Don't stop taking topiramate suddenly, because doing so can raise your risk for seizures. Your provider can help you stop this medication safely by lowering your dose slowly over time.
If you're taking topiramate tablets, don't chew the tablets because this can leave a bitter taste in your mouth.
If you're taking Trokendi XR capsule, you must swallow it whole. Don't open up the capsule and sprinkle the contents onto food. Don't chew or crush the capsule.
Other capsules, such as Qudexy XR, can be opened up and sprinkled onto food. If you're not sure whether or not your topiramate capsule can be opened up, ask your provider or pharmacist.
Avoid drinking alcohol while taking topiramate because it can worsen some of the side effects such as sleepiness and dizziness. In particular, don't drink alcohol 6 hours before and 6 hours after taking Trokendi XR.
Use a medication measuring device to measure out your dose of Eprontia solution. Don't use a kitchen spoon, because it might not be accurate. If you don't have a medication measuring device, you can purchase one at the pharmacy or ask your pharmacist.
If you're taking Eprontia solution, make sure to throw away the medication bottle 2 months after you open it, even if there's medication left over. This medication expires 2 months after it has been opened.
Let your provider know right away if you experience symptoms of depression or worsening mood while taking topiramate.
Get immediate medical attention if you experience a lack of energy, aren't able to concentrate, or vomit while taking topiramate. These can be signs of ammonia build-up in your brain.
Drink fluids or water regularly to stay hydrated while you're taking topiramate. Doing so can lower your risk of getting a kidney stones.
Your provider might ask you to routinely get blood tests done while you’re taking topiramate. This is so that they can make sure the amount of acid in your blood is not too high. In some rare cases, high blood acid caused by topiramate can lead to kidney stones or weak bones. In children, this can affect their growth. Tell your provider right away if you have symptoms of high blood acid, such as loss of appetite, fatigue, or irregular heartbeat.
Though rare, topiramate can raise your body temperature and make it difficult for you to sweat. This is more commonly seen in children. If it's hot outside, stay out of direct sunlight and heat. If possible, remain indoors in an air-conditioned room. Stay hydrated by drinking sips of water. Get medical help right away if you or your child develop a fever, have a high body temperature, or have trouble sweating when it's hot.
Talk to a provider if you experience any vision changes, such as blurry vision, double vision, eye pain, or loss of vision while taking topiramate. This is because the medication can cause sudden visual problems.
Topiramate can sometimes cause rash and other severe skin reactions. If you have a rash, skin pain, blisters, or skin peeling, talk with your provider right away.
Topiramate can raise your risk for bleeding. Let your provider know if you're taking over-the-counter pain medications (e.g., ibuprofen (Advil) or aspirin) or if you're on blood thinners such as warfarin (Coumadin). These medications can interact with topiramate and put you at a higher risk for bleeding.
Frequently asked questions about Topiramate
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What are the risks and warnings for Topiramate?
Topiramate can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Vision problems
Topiramate can cause eye problems related to nearsightedness and greater pressure in the eye(s). Symptoms can include redness, blurry vision, and eye pain. These symptoms often appear suddenly, typically about a month after people start the medication. If you develop vision changes, your provider will stop topiramate to prevent your vision from getting worse. They'll help you safely stop topiramate by lowering your dose slowly over time to lower your risk of seizures. Usually, these vision problems will go away after you stop taking topiramate. Let your provider know right away if you experience any changes in your vision.
High body temperature and trouble sweating
Risk factor: Adolescents or children | Hot weather
Though rare, topiramate can make it harder for some people to sweat. This can lead to overheating and high body temperature, which is dangerous. The risk is higher for children and adolescents taking this medication, and for those who are also taking other medications that make it difficult for you to sweat, such as anticholinergic medications. Monitor your (or your child's) body temperature when exercising or when it's hot outside. If you can, try to stay indoors where there's air-conditioning when the weather is hot. Other ways to stay cool include resting in the shade, using a misting fan, and taking sips of water. Call 911 if you or your child experience symptoms of heat stroke or heat exhaustion, such as nausea, muscle cramps, and headache.
Higher level of acid in blood
Risk factors: Kidney problems | Severe breathing problems | Diarrhea | Keto diet | Status epilepticus
In some rare cases, topiramate can raise the level of acid in your blood (metabolic acidosis). If left untreated, high acid levels can raise your risk for kidney stones and bone fractures (break). In children, this condition can cause poor bone growth. Other symptoms of metabolic acidosis include loss of appetite, extreme tiredness, and irregular heartbeat.
Your provider might do regular blood tests to make sure the level of acid in your blood isn't too high. If it is, your provider will either stop or lower your dose of topiramate, or give you medications to lower the acid levels. Remember to never stop topiramate suddenly because this can raise your risk for seizures. Instead, your provider can lower your dose slowly over time so that you can safely stop this medication.
Suicidal thoughts or behavior
Risk factors: History of depression | Taking other seizure medications or medications that affect mood
Topiramate can raise the risk of suicidal thoughts or behavior. This can happen as early as 1 week after you start treatment. Watch for worsening depression or any unusual changes in mood or behavior, especially during the first few months of treatment or when the dose changes. Be aware of changes in behavior that could lead to suicidal thoughts or depression, and report anything concerning to your provider right away.
Problems with mood and thinking clearly
Risk factors: Starting topiramate at a higher dose | Raising (titrating) topiramate dose too fast
Topiramate can make it harder for you to concentrate or remember things. It can also cause problems with speech, coordination, mood (new or worsening depression), and make you more sleepy. Don't drive a car or operate machinery until you know how this medication affects you. You shouldn't take topiramate with alcohol because it can worsen these side effects.
Higher ammonia level in blood
Risk factors: History of metabolic disorders | Taking divalproex (Depakote) or valproic acid | Higher dose of topiramate
Topiramate can cause ammonia to build up in your body, especially if it's taken with valproic acid or divalproex (Depakote). This can cause you to become more tired, unable to concentrate, or vomit. In serious cases, high levels of ammonia in the blood can lead to brain damage. Seek medical attention right away if you notice any of these symptoms.
Serious birth defects
Topiramate can cause serious problems to unborn babies, such as birth defects or slower growth, if used by mothers in pregnancy. Your provider might recommend you to take a form of birth control while on topiramate, if you don't plan on getting pregnant. Since this medication can cause serious birth defects, topiramate should only be used in pregnancy if the benefit is greater than the risk to the unborn baby. If you're pregnant while taking topiramate, you’re encouraged to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. This registry monitors and collects information about your and your baby’s health. Learn more about this registry by calling 1-888-233-2334.
Skin reactions
Topiramate can sometimes cause rash and other severe skin reactions. Let your provider know if you experience these reactions because they'll need to stop topiramate treatment by lowering your dose slowly over time, and also talk with you about safer options to treat your condition. If you have a rash, blisters on your lips, skin peeling, skin pain, mouth sores, or high fever, get medical help immediately.
Withdrawal seizures
Talk to your provider before stopping topiramate. Stopping topiramate suddenly can cause your seizures to come back or become worse. Your provider will work with you to lower your dose slowly over time so this doesn't happen.
Interaction with other medications
Topiramate can interact with many medications.
For example, taking topiramate with medications like acetazolamide and zonisamide (Zonegran) can raise the risk of acid in your blood as well as kidney stones. You can lower your risk of kidney stones by drinking more fluids. Your provider will monitor you closely for symptoms of higher blood acid levels or kidney stones, such as irregular heartbeat, loss of appetite, or sharp pain below the ribs.
Another example is taking topiramate with valproic acid or divalproex (Depakote) can lead to drops in your body temperature. This can cause serious problems, such as extreme tiredness, trouble moving at your typical speed, feeling confused, and coma. Get medical help right away if you have those symptoms.
Let your provider or pharmacist know what other medications you’re taking before and while taking topiramate so they can help you check for interactions.
Topiramate dosage forms
Typical dosing for Topiramate
Your child's provider might calculate their topiramate dose based on their body weight, depending on what product your child is taking.
Seizures (when used alone)
Topamax, Eprontia solution, generic immediate-release tablet. and generic sprinkle capsule
Adults and children (age 10 years or older): The typical starting dose is 25 mg by mouth, once to twice daily. The typical maintenance dose is 200 mg twice daily.
Children (age 2 to 9 years old): The typical starting dose is 25 mg by mouth nightly. Depending on your child's body weight, their typical maintenance dose can range between 75 mg to 200 mg twice daily.
Qudexy XR, Trokendi XR, and generic extended-release capsule
Adults and children (age 10 or older): The typical starting dose is 50 mg by mouth once daily. The typical maintenance dose is 400 mg daily.
Children (age 2 to 9): The typical starting dose is 25 mg by mouth nightly. Depending on their body weight, the typical maintenance dose can range between 150 mg to 400 mg daily.
Please note: Trokendi XR is only for children age 6 to 9 years old when it's used alone for seizure
Seizures (when combined with other medications)
Topamax, Eprontia solution, generic immediate-release tablet, and generic sprinkle capsule
Adults and adolescents (age 17 or older): The typical starting dose is 25 mg to 50 mg by mouth once daily. The typical maintenance dose ranges between 200 mg to 400 mg daily, split into 2 doses and taken throughout the day.
Children (age 2 to 16): The typical starting dose is 25 mg by mouth nightly. Depending on your child's body weight, their typical maintenance dose can range between 5 mg/kg to 9 mg/kg daily, split into 2 doses and taken throughout the day. The maximum daily dose is 400 mg.
Qudexy XR, Trokendi XR, and generic extended-release capsule
Adults (age 17 or older): The typical starting dose is 25 mg to 50 mg by mouth once daily. The typical maintenance dose ranges between 200 mg to 400 mg daily. The maximum daily dose is 400 mg.
Children (age 2 to 16): The typical starting dose is 25 mg by mouth nightly. The typical maintenance dose is 5 mg/kg to 9 mg/kg by mouth daily. The maximum daily dose is 400 mg.
Please note: Trokendi XR is only for children age 6 to 16 years old when it's used with other seizure medications
Migraine
Topamax, Eprontia solution, generic immediate-release tablet, and generic sprinkle capsule
Adults and children (age 12 or older): The typical starting dose is 25 mg by mouth nightly. The typical maintenance dose is 50 mg twice daily.
Qudexy XR, Trokendi XR, and generic extended-release capsule
Adults and children (age 12 or older): The typical starting dose is 25 mg by mouth once daily. The typical maintenance dose is 100 mg once daily.
Your dose for all these topiramate formulations might differ if you have kidney problems.
More on Topiramate dosage forms
Interactions between Topiramate and other drugs
More on Topiramate interactions
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Benzhydrocodone
- Bromazepam
- Buprenorphine
- Butorphanol
- Calcifediol
- Calcium Oxybate
- Cannabidiol
- Carbinoxamine
- Cetirizine
- Citalopram
- Clobazam
- Codeine
- Desogestrel
- Dienogest
- Dihydrocodeine
- Doxylamine
- Drospirenone
- Esketamine
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Etonogestrel
- Fentanyl
- Flibanserin
- Gabapentin
- Gabapentin Enacarbil
- Gestodene
- Hydrocodone
- Hydromorphone
- Ketamine
- Lemborexant
- Levocetirizine
- Levonorgestrel
- Levorphanol
- Lofexidine
- Loxapine
- Magnesium Oxybate
- Medroxyprogesterone
- Meperidine
- Mestranol
- Methadone
- Metoclopramide
- Midazolam
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Nifedipine
- Nomegestrol
- Norelgestromin
- Norethindrone
- Norgestimate
- Norgestrel
- Orlistat
- Oxycodone
- Oxymorphone
- Pentazocine
- Periciazine
- Piperaquine
- Potassium Oxybate
- Pregabalin
- Remifentanil
- Remimazolam
- Scopolamine
- Segesterone
- Sodium Oxybate
- Sufentanil
- Tapentadol
- Tramadol
- Trazodone
- Ulipristal
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Topiramate cost?
What are alternatives to Topiramate?
Seizures (partial seizures, tonic-clonic seizures, Lennox-Gastaut syndrome)
Migraine prevention
Bipolar disorder
Seizures (focal impaired awareness seizure, absence seizure)
Migraine prevention
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
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