Do not double your dose or take more than what is prescribed. Avoid drinking alcohol or using illegal drugs while you are taking topiramate. They may decrease the benefits e. If an overdose occurs call your doctor or You may need urgent medical care.
You may also contact the poison control center at To date, there are no known problems associated with long term use of topiramate. It is a safe and effective medication when used as directed. If this happens, you may get confused, disoriented, or have difficulty thinking. Carbonic anhydrase inhibitors, including acetazolamide, dichlorphenamide, methazolamide, and dorzolamide, increase the risk of kidney stones when taken with topiramate.
It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking topiramate. It will probably take several weeks to see big enough changes in your symptoms to decide if topiramate is the right medication for you. Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder.
Your doctor can best discuss the duration of treatment you need based on your symptoms and course of illness. Last Updated: January This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice.
This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein.
The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein. Search Close Menu.
Sign In About Mental Illness. About Mental Illness Treatments. About Mental Illness Research. Your Journey Individuals with Mental Illness. Your Journey Family Members and Caregivers. Your Journey Identity and Cultural Dimensions. Your Journey Frontline Professionals. Get Involved Become a Fundraiser. Get Involved Awareness Events. Get Involved Share Your Story. Once your condition is under control, you'll usually need to keep taking topiramate for many years.
There are lots of other medicines that can be used for epilepsy and migraines, but they work in different ways. If you have epilepsy, the choice will depend on the type of seizures that you have. If you have migraines, there are other medicines that can be used to reduce the number of migraines you get. These have different side effects and everyone responds differently to them. It varies from person to person, and depends on the type of seizures and how often you have them.
To help to decide, your doctor will take into account your age and gender, the medicines you're already taking and any other health problems you may have. If this medicine is not working well or you're getting side effects, your doctor will generally try you on a different one. If a single medicine is not preventing your seizures, your doctor may recommend taking 2 or more epilepsy medicines at the same time.
If topiramate is giving you side effects or you're worried it's not working for you, ask your doctor or specialist to recommend a different medicine. The choice will normally depend on your age, gender, any other health conditions and how your other medicines have worked for you in the past.
If you want to switch medicines, it's very important to do it exactly as your doctor tells you to. Switching from topiramate to a different medicine will be different for each person. If you want to switch, you'll usually start taking the new one at a low dose and slowly build up the dose while you're still taking topiramate.
Once you're taking the correct dose of the new medicine, you should be able to slowly reduce your dose of topiramate. It can take several weeks or months until you have stopped taking topiramate completely. You're unlikely to get any extra symptoms when you stop taking this medicine. But if you're taking it to prevent migraines, your condition could get worse for a short time after stopping it.
If you're taking topiramate for epilepsy, it's possible that you'll get seizures once you stop taking it. You can prevent these withdrawal seizures by reducing the dose of your topiramate gradually. If you have epilepsy, you're entitled to free prescriptions for all of your medicines, not just your epilepsy ones. To claim your free prescriptions, you'll need a medical exemption certificate. The application form for the medical exemption certificate is called FP92A.
You'll need to fill in the form and your doctor will sign it and send it off. But it may make you feel sleepy or tired, and alcohol and hangovers can bring on seizures in some people with epilepsy. If you do drink, try not to have more than the recommended guidelines of up to 14 units of alcohol a week. A standard glass of wine ml is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol. You may feel sleepy, tired or dizzy when you first start taking topiramate.
If you're affected, do not drive or ride a bike or operate machinery until you feel more alert. If you have epilepsy, you're not allowed to drive until you have had no seizures for 1 year. If you change your epilepsy medicine, your doctor will tell you whether you need to stop driving and for how long. Driving rules if you change or withdraw your medicine , Epilepsy Action. Epilepsy and driving information , GOV. Page last reviewed: 25 February Next review due: 25 February Topiramate On this page About topiramate Key facts Who can and can't take it How and when to take it Side effects How to cope with side effects Pregnancy and breastfeeding Cautions with other medicines Common questions.
About topiramate Topiramate is a medicine used to treat epilepsy. Help us improve our website Can you answer a quick question about your visit today? You can take it with or without food. Common side effects of topiramate include feeling sleepy, dizziness, diarrhoea and feeling sick. These are usually mild and go away by themselves. If taking topiramate for epilepsy, it usually takes a couple of weeks for it to work. If taking topiramate to prevent migraines, it can take up to 3 months for it to work fully.
Topiramate is also called by the brand name Topamax. Topiramate can be taken by adults and children aged 2 years and over. Topiramate is not suitable for some people. Tell your doctor before starting the medicine if you: have ever had an allergic reaction to topiramate or any other medicines in the past have kidney problems, especially kidney stones have a blood disorder called acute porphyria have a history of blood metabolic acidosis, where the body produces too much acid or cannot remove it properly have eye problems, especially glaucoma have liver problems need to take high doses of vitamin C or calcium supplements are pregnant.
Topiramate is a prescription medicine. It's important to take it as instructed by your doctor. How much will I take? How much you take will depend on what you're using topiramate for. It's usual to start topiramate at a low dose of 25mg to 50mg a day. This will be increased over several weeks to the usual doses for: epilepsy - mg to mg a day, taken as 2 doses epilepsy if you take another epilepsy medicine with topiramate - mg to mg a day, taken as 2 doses migraines - 50mg to mg, taken as 2 doses In children, the dose of topiramate will depend on the weight of your child.
Your doctor will be able to give the right dose to your child. How to take it It's usual to take topiramate twice a day. What if I forget to take it? The usual recommended dosage of Topamax in children ages 12 years and older is the same as it is for adults.
For children ages 10 years and older, the usual recommended dosage of Topamax is the same as it is for adults. Below is information for treating children ages 2 to 9 years. For the first week of treatment, the starting dosage is 25 milligrams mg taken every evening. If your child tolerates this well, for the second week of treatment, their doctor may increase the dosage to 25 mg twice per day. This is a total of 50 mg daily. This will take place over the first few weeks until the recommended dose is reached.
After this, their doctor may increase their daily dosage by 25 mg to 50 mg each week. This is done until your child is at the minimum recommended dose for their body weight. This increase will continue until your child is at the maximum dose for their body weight. For children ages 2 to 9 years, the usual recommended dosage of Topamax is based on body weight as follows:. Children ages 17 years and older typically take the same dosage of Topamax as adults. The following sections discuss the dosages for children ages 2 to 16 years.
For the first week of treatment, the starting dose per day is usually about 1 milligram mg to 3 mg per kilogram kg of body weight. Topamax is typically taken as a single dose every evening. This allows their body to get used to the medication and helps reduce the frequency and severity of side effects. The medication is split into two equal doses.
The daily dose is increased until your child is at the minimum recommended dose for their body weight. For children ages 2 to 16 years, the usual recommended daily dose is 5 mg to 9 mg per kg of body weight. The recommended daily dose is split into two equal doses. One dose is taken in the morning, and the other dose is taken in the evening. Take your next dose at your usual time. This can include setting an alarm on your phone or downloading a reminder app.
A kitchen timer can work, too. Topamax is meant to be used as a long-term treatment. You should avoid drinking alcohol with Topamax. Drinking alcohol during Topamax treatment can increase the frequency and severity of Topamax side effects, such as:. In serious cases, drinking alcohol with Topamax may lead to serious side effects.
These may include slow, shallow breathing, loss of consciousness, coma, and in rare cases, death. Topamax is more likely to make you feel sleepy, low in energy, or a bit dazed and confused. You may also have trouble with concentration, memory, or speech while taking it. Topamax has a half-life of about 21 hours. The half-life of a drug is the time it takes for the amount of the drug in your body to fall by half.
It takes about five half-lives for a drug to be almost completely removed from your body. So for Topamax, most of the drug will be flushed out of your system within about 5 days after you stop taking it. Controlled substances are drugs that have certain effects that give them a high potential for being misused. They also have a high risk of leading to drug dependence. Because of these risks, there are special rules about how controlled substances are prescribed and dispensed.
Mood stabilizers are drugs that help prevent extreme changes in mood, such as those that occur with bipolar disorder. People with bipolar disorder typically have episodes of depression and episodes of mania.
Mania is a mood disorder that gives you an unnatural feeling of physical and mental energy. Several anticonvulsant medications also work as mood stabilizers in people with bipolar disorder.
Topamax, which is an anticonvulsant medication, is sometimes used in this way. Anticonvulsants are also called antiepileptic drugs. Anticonvulsants are mainly used to treat epilepsy a condition that causes repeated seizures.
These include migraine and nerve pain. However, once Topamax controls your condition, you will need to keep taking it to continue to prevent seizures or migraine. If you stop taking Topamax, your seizures or migraine headaches may happen more often.
They could also become more severe. Sometimes people without epilepsy have had seizures after suddenly stopping Topamax. If you and your doctor decide to stop treatment, you may need to stop taking Topamax gradually. This can help reduce your risk for seizures. Topamax can interact with several other medications. It can also interact with certain foods. Different interactions can cause different effects.
For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe. Below are examples of medications that can interact with Topamax. Before taking Topamax, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use.
Sharing this information can help you avoid potential interactions. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Topamax can make birth control drugs that contain estrogen less effective at preventing pregnancy. Topamax treatment can also make certain birth control medications less effective at preventing pregnancy. These include:. If you use birth control that contains estrogen, your doctor may recommend switching to a different type of birth control medication while you take Topamax. Taking Topamax with phenytoin Dilantin or carbamazepine Tegretol can lower the level of Topamax in your blood.
This could make Topamax less effective at preventing seizures or migraine headaches. If you need to take Topamax with phenytoin or carbamazepine, your doctor may prescribe a higher dosage of Topamax. This should increase the chances that the drug works for you.
If you need to take Topamax with valproic acid, your doctor may recommend blood tests. These will monitor the amount of ammonia in your blood. Taking Topamax with drugs called carbonic anhydrase inhibitors can raise your risk for a side effect called metabolic acidosis a high level of acid in your blood.
Metabolic acidosis can also raise your risk for kidney stones. If you need to take one of these drugs with Topamax, you may need more frequent blood tests than usual. These tests will check the level of acid in your blood. Central nervous system CNS depressants are medications that slow down activity in your central nervous system brain and spinal cord. These medications typically cause you to feel drowsy and less alert.
But in serious cases, they can also cause slow, shallow breathing , loss of consciousness , coma , and in rare cases, death.
There have been no studies involving people who took Topamax with a CNS depressant. However, taking the two drugs together could raise your risk for the side effects mentioned above. For this reason, you should avoid CNS depressants while taking Topamax. These drugs can sometimes cause reduced sweating. Topamax can also reduce sweating. Therefore, taking Topamax with anticholinergic drugs could raise your risk for overheating and hyperthermia high body temperature , especially in hot weather.
Examples of anticholinergic drugs that could raise your risk for hyperthermia with Topamax include:. If you need to take one of these drugs, talk with your doctor about whether Topamax is right for you.
Hydrochlorothiazide Microzide is a diuretic medication used to treat high blood pressure. Taking Topamax with hydrochlorothiazide may increase the level of Topamax in your blood. However, your doctor may prescribe a lower dose of Topamax if you need to take hydrochlorothiazide as well. Pioglitazone Actos is a medication for type 2 diabetes. Taking Topamax with pioglitazone may decrease the level of pioglitazone in your blood. However, if you need to take pioglitazone with Topamax, your doctor may monitor your blood sugar more often.
This is to check that pioglitazone is still working you. Lithium Lithobid is a medication used for certain psychiatric illnesses, such as bipolar disorder and severe depression. Taking high doses of Topamax with lithium may increase the level of lithium in your blood.
This could raise your risk for lithium side effects. These include slurred speech, memory problems, kidney failure , and muscle tremors or twitches. A high lithium level can be serious. If you need to take Topamax with lithium, your doctor may order more frequent blood tests than usual. These tests will check your lithium level. Your doctor may need to adjust the doses of your medications as needed.
Taking Topamax with amitriptyline can increase the level of amitriptyline in your blood. This could raise your risk for amitriptyline side effects. These side effects include drowsiness, dizziness, irregular heartbeats , and seizures. If you need to take Topamax with amitriptyline, tell your doctor if you have any new side effects. Also, be sure to tell them if any side effects become more severe or occur more often.
Your doctor may adjust the doses of your medications as needed. However, you should still check with your doctor or pharmacist before using any of these products while taking Topamax. A ketogenic diet is low in carbohydrates and protein , and high in fat.
This is a high level of acid in your blood. If not treated, metabolic acidosis can raise your risk for kidney stones and weakening of your bones. Metabolic acidosis can also increase the risk of reduced growth in children.
You should avoid following a ketogenic diet while taking Topamax to lower your risk for these side effects. Note: For some people, following a ketogenic diet can reduce the number of seizures they have. However, as with several other anticonvulsant drugs, Topamax also helps prevent migraine headaches.
Epilepsy and migraine are both neurological conditions. With epilepsy, you have seizures. With migraine, you have headaches, among other symptoms. But the conditions are considered to be linked , and many people have epilepsy and migraine together. But with both conditions, it seems that nerve cells in your brain are oversensitive to certain triggers, such as flickering lights or hormones. The trigger causes electrical signals to build up in the nerve cells in your brain.
This causes them to fire inappropriate signals to other nerve cells. These nerve cells then pass on signals to other parts of your body. The increased electrical signaling can lead to a seizure in people with epilepsy. In people with migraine, it can lead to auras and headaches.
Topamax has several effects on the nerve cells in your brain. One is that the drug blocks sodium channels tiny openings through which sodium moves through your cells. This prevents excessive electrical signals from building up in the nerve cells. As a result, the nerve cells stop firing inappropriate or excessive signals. In addition, Topamax affects two neurotransmitters. Neurotransmitters are natural body chemicals that help pass signals between nerve cells.
These neurotransmitters are called gamma-aminobutyric acid GABA and glutamate. The neurotransmitters also help pass signals between nerve cells and other cells in your body. GABA reduces nerve signaling, causing fewer signals to be sent. Glutamate stimulates nerve signaling, causing more signals to be sent.
Topamax increases the effect of GABA and blocks the effect of glutamate. This helps calm nerve activity in your brain. The actions of Topamax help prevent the nerve cells in your brain from sending inappropriate signals that lead to seizures or migraine.
Topamax starts working within a couple of hours after you start taking it. However, when you start treatment, your dose is increased slowly over a few weeks. Therefore, it may take a few weeks before the medication level builds up enough for you to notice your seizures or migraine easing. Using more than the recommended dosage of Topamax can lead to serious side effects.
Do not use more Topamax than your doctor recommends. You can also call the American Association of Poison Control Centers at or use their online tool. But if your symptoms are severe, call or your local emergency number, or go to the nearest emergency room right away. Topamax can harm a fetus if taken during pregnancy. Babies who are SGA can have a lower birth weight, length, and head size than expected.
Babies are more likely to be SGA when born to females who took a high dose of Topamax or took Topamax throughout their pregnancy. Pregnancy studies in the United States looked at babies who were exposed to topiramate the active ingredient in Topamax in the first 3 months of pregnancy.
The studies showed that 1. In comparison, oral clefts occurred in 0. These studies also showed that, in the U. In comparison, 5. Other medications may be more suitable for you. This registry monitors and records birth defects or changes affecting babies of females who took antiepileptic drugs , such as Topamax, while pregnant. The registry helps healthcare professionals collect information about the safety of drugs such as Topamax during pregnancy.
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