Key takeaways:
Topamax (topiramate) is a medication that treats seizures and prevents migraines. It’s also sometimes taken off-label for depression, weight loss, nerve pain, and more.
Topamax comes in a variety of formulations, including a generic form called topiramate. It’s available as tablets, sprinkle capsules, and extended-release (ER) capsules. The formulation you’ll receive will likely be based on your insurance coverage and personal preferences.
Your Topamax dosage will depend on your age and health condition(s). Generally, the medication is taken once or twice daily, and it should be taken around the same time every day.
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There’s a good chance you’ve heard of Topamax (topiramate) — perhaps due to its versatility. Topamax is FDA approved to manage seizures and migraines, and it also has several off-label uses.
If you’re prescribed Topamax, it’s important to understand how to take it safely and effectively for your specific condition. Below, we’ll cover 10 useful facts about Topamax.
1. What is Topamax used for? More than you might think
Topamax is approved for epilepsy treatment and migraine prevention. People ages 2 years and older can take it for seizures, while those ages 12 years and older can take it to prevent migraines.
Topamax works as an anti-seizure medication by preventing the overexcitement of certain nerves in the body. It does this by blocking the brain from sending certain signals and reducing the brain’s bursts of activity. The exact way Topamax works to prevent migraines is unknown.
Topamax also has many off-label uses, such as:
Bipolar disorder
Borderline personality disorder
Depression
Post-traumatic stress disorder (PTSD)
Weight loss
Eating disorders, such as bulimia nervosa and binge eating disorder
Nerve pain
Obesity or overweight
Obsessive-compulsive disorder (OCD)
Cluster headache prevention
Neuralgiform attack prevention (a headache disorder involving pain bursts on one side of the head)
Good to know: The FDA hasn’t officially reviewed Topamax’s safety and effectiveness for these off-label uses. But taking medications off-label is a common practice and can allow for the treatment of health conditions that otherwise may not be managed. You and your healthcare professional can decide whether Topamax is a safe and effective option for you.
2. Topamax has a generic version (topiramate) — and it comes in many formulations
The generic version of Topamax is called topiramate, and it comes in a variety of formulations. The tablets and sprinkle capsules are taken once or twice per day. The extended-release (ER) capsules are taken once daily. Across these different forms, the medication is available in doses ranging from 15 mg to 200 mg.
By comparison, brand-name Topamax comes as a tablet and sprinkle capsule. A different version of topiramate, called Eprontia, also comes as an oral solution.
Tips for choosing the best topiramate formulation
The formulation of topiramate you’ll take depends on your needs and preferences. Your insurance coverage may also be a big factor.
For instance, the tablet form of topiramate must be swallowed whole. It’s bitter in taste and shouldn’t be crushed, chewed, or split in half. The same goes for the ER capsules. These forms are good options if you’re OK with swallowing pills.
If you have trouble swallowing pills the oral solution or sprinkle capsules may be better choices. The oral solution is a liquid, while the sprinkle capsules can be opened up and placed into soft foods.
3. The best way to take Topamax varies
There isn’t one best way to take Topamax. Specific Topamax dosages are based on the health condition(s) you have and how old you are. And the dose your healthcare professional prescribes may be different from what the manufacturer of the medication recommends.
Topamax can be taken with or without meals at whatever time of the day you prefer. It’s recommended to take the medication at the same time(s) every day, however. This consistency helps it work effectively.
4. Recommended Topamax dosages depend on a few factors
As mentioned, your specific Topamax dosage will be based on your age and health condition(s). You’ll likely start with a lower dosage to reduce the risk of side effects. Your dosage will then be increased over time until you reach the recommended dosage for your health condition and age.
Below, we review recommended Topamax dosages for the medication’s approved uses.
Topamax dosages for epilepsy
For people ages 10 and older who are taking Topamax by itself for seizure management, the recommended dosage is 400 mg per day. This is taken as two doses over the course of the day.
The recommended dosage for people ages 17 and older taking Topamax along with other anti-seizure medications can range from 200 mg to 400 mg per day. The dosage for children between 2 and 16 years old is based on body weight and the type of seizures being treated.
Topamax dosages for migraines
For people ages 12 and older, the recommended dosage for preventing migraines is 100 mg per day. This is taken as two doses over the course of the day.
5. Topamax can be prescribed for weight loss
The active ingredient in Topamax, topiramate, is used in combination with phentermine in a medication called Qsymia. This medication is approved to be used alongside a low-calorie diet and regular exercise for chronic weight management. Some key studies found that approximately 70% of adults lost at least 5% of their initial body weight after taking Qsymia for 1 year. And nearly half of adults lost at least 10% of their body weight.
To take Qsymia, you must fall into one of the following categories:
You’re an adult with a body mass index (BMI) of at least 27 and at least one weight-related health condition, such as high blood pressure, Type 2 diabetes, or high cholesterol.
You’re an adult with a BMI of 30 or higher.
You’re an adolescent who is at least 12 years old and has a BMI in the 95th percentile or greater (based on your sex and age).
Qsymia is intended as a supplement to, not a replacement for, healthy eating and routine physical activity. And it should only be considered after lifestyle changes have not led to sufficient results. Qsymia is also a controlled substance, meaning there’s a chance it can be habit-forming.
6. Topamax can affect people with liver or kidney problems
People with moderate-to-severe kidney problems may need a lower dosage of Topamax. This is because the medication leaves your body through the kidneys. If your kidneys aren’t able to get rid of enough medication, it could build up in your system and lead to extra side effects.
However, people who receive dialysis for more severe kidney problems may need a higher dosage of Topamax. Dialysis helps the kidneys filter medication at a faster rate. This could make Topamax less effective.
If you have kidney disease, tell your prescriber about the kidney treatments you’re receiving. This will help them recommend a dosage of Topamax that’s safe for you.
In rare cases, Topamax can cause liver damage. This risk is higher if you take it alongside other anti-seizure medications. Tell your prescriber if you’ve been diagnosed with a liver condition in the past. They may monitor how you respond to the medication extra closely.
7. Topamax may cause harm to fetuses
Topamax isn’t typically recommended for people who are pregnant or planning to become pregnant. This is because Topamax carries a risk of causing birth defects like cleft lip or cleft palate. However, there are cases in which prescribers believe the benefits (e.g., seizure control) may outweigh the possible risks.
If you’re pregnant or trying to become pregnant, talk with your prescriber about the risks of taking Topamax before you start treatment. And if you are taking Topamax and become pregnant, contact your prescriber right away to discuss next steps.
8. Topamax has side effects
Just like with any medication, Topamax can cause side effects. These side effects can vary from person to person and tend to get better over time.
The most common Topamax side effects include:
Tingling in the arms and legs
Loss of appetite
Cognitive impairment (mental slowing)
Dizziness
Drowsiness
Decreased sweating
Rare but serious side effects may include:
Suicidal thoughts and behaviors
Vision problems
Serious bleeding
Skin reactions
Metabolic acidosis (an acid-base imbalance)
Abnormal blood test levels (high blood acid and blood ammonia levels)
If you’re experiencing any side effects that feel serious, contact your prescriber without delay. If any symptoms feel life-threatening, it’s better to call 911 or go to the nearest ER.
9. Topamax is used to treat seizures in children
Topamax can treat epilepsy in children ages 2 and older.
If your child is prescribed Topamax, talk with their pediatrician about how to properly give the medication to your child. Your child’s dosage will depend on a number of factors, most notably their age, body weight, and the type of seizures they have. Like adults, children typically start with a lower dosage, which is then raised over time, depending on how much they can tolerate.
Some of the same side effects adults experience with Topamax can be expected in children, as well. Common side effects include:
Fever
Weight loss
Mood problems
Trouble focusing
Confusion
Infection
Burning or tingling sensation
10. You should watch your alcohol use if you’re taking Topamax
If you’re taking Topamax for epilepsy, drinking small amounts of alcohol might be OK. But there isn’t enough research to say for sure.
That said, if you have a history of alcohol use disorder or if you have had seizures caused by alcohol, you’re better off avoiding alcohol altogether. This is because alcohol withdrawal can raise your risk for seizures.
Similarly, drinking alcohol isn’t recommended if you’re taking Topamax to prevent migraines. Though it’s unclear whether alcohol causes migraines, having just one alcoholic drink can lead to dehydration and inflammation, which can worsen migraines. Taking topiramate with alcohol can also make any side effects you experience more intense.
If you’re taking a longer-acting version of topiramate (Trokendi XR), it’s recommended to avoid drinking for at least 6 hours before and after taking your medication. Alcohol can affect how this formulation releases medication throughout the day.
The bottom line
Topamax (topiramate) is FDA approved to treat epilepsy and prevent migraines, but it has other off-label uses that people may not know about. Some top examples include treating bipolar disorder, depression, and alcohol use disorder.
Topamax dosages for adults depend on age and what condition is being treated. In children, both age and body weight are factors. Common side effects of Topamax include tingling in the arms and legs, nausea, and lack of appetite. Your prescriber or your child’s prescriber can tell you more about what to expect with Topamax.
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References
American Migraine Foundation. (2021). What are SUNCT and SUNA?
Azurity Pharmaceuticals, Inc. (2023). Eprontia - topiramate solution [package insert].
Fariba, K. A., et al. (2023). Topiramate. StatPearls.
Janssen Pharmaceuticals, Inc. (2023). Topamax - topiramate tablet, coated [package insert].
Khivsara, A., et al. (2017). Topiramate-induced acute liver injury: A rare adverse effect. Indian Journal of Pharmacology.
Manitpisitkul, P., et al. (2014). Pharmacokinetics of topiramate in patients with renal impairment, end-stage renal disease undergoing hemodialysis, or hepatic impairment. Epilepsy Research.
MedlinePlus. (2022). Prader-Willi syndrome.
MedlinePlus. (2023). Topiramate.
RemedyRepack Inc. (2023). Topiramate - topiramate tablet, film coated [package insert].
Supernus Pharmaceuticals. (2022). Trokendi XR - topiramate capsule, extended release [package insert].
U.S. Food and Drug Administration. (2018). FDA drug safety communication: Risk of oral clefts in children born to mothers taking Topamax (topiramate).
Vivus LLC. (2023). Qsymia - phentermine and topiramate capsule, extended release [package insert].
