- Side Effects
- Drug Interaction
- Preparation & Storage
What is topiramate, and how does it work (mechanism of action)?
Topiramate is an oral drug that is used to prevent seizures of epilepsy. It is an anti-epileptic or anti-seizure drug. It is used primarily among patients who are not controlled by other anti-epileptic drugs. About 1 in 4 Americans diagnosed with epilepsy has seizures that resist treatment with other anti-epileptic drugs. Topiramate also prevents migraine headaches.
Seizures are due to the abnormal activity ("firing") of nerves in the brain, and the abnormal activity spreads to smaller or larger portions of the brain. Although topiramate's exact mechanism of action is unknown, scientific studies suggest that it may alter neurotransmitters within the brain. Neurotransmitters are chemicals that nerves manufacture and use to communicate with other nearby nerves. By altering the production or action of the neurotransmitters, topiramate may suppress the abnormal activity of the nerves in the brain that cause the seizures or may prevent the abnormal activity from spreading to other nerves. Other studies suggest that topiramate may suppress the nerves directly (i.e., not by altering neurotransmitters) and make them less likely to fire. The FDA approved topiramate as a tablet in 1997. The sprinkle capsules were approved in October 1998.
What brand names are available for topiramate?
Topamax, Qudexy XR, Topamax Sprinkle, Topiragen, Trokendi XR
Is topiramate available as a generic drug?
Generic name: topiramate
Do I need a prescription for topiramate?
What are the side effects of topiramate?
The most common side effects of topiramate are:
- coordination problems,
- weight loss,
- loss of appetite,
- speech problems,
- changes in vision or
- double vision,
- tingling or prickling sensation in hands and feet,
- difficulty with memory, and
- sensory distortion.
Other important side effects include:
What is the dosage for topiramate?
- Most commonly, topiramate immediate-release tablets and sprinkles are started in low doses, 25 or 50 mg per day, and then increased slowly by 25 to 50 mg per week until an effective daily dose is reached for treatment of seizures.
- For children 10 years or older and adults, the dose may be increased by 100 mg in weeks 5 and 6 when topiramate is used alone.
- This slow approach to treatment reduces side effects. The recommended final adult dose is 200-400 mg administered as two divided doses daily.
- In children, the starting dose is up to 25 mg (1 to 3 mg/kg/day), taken nightly for the first week.
- The dose is then increased at 1 or 2-week intervals by 1 to 3 mg/kg/day administered in two divided doses.
- The target dose is 5 to 9 mg/kg per day in two divided doses.
- Migraine is treated 25 mg nightly for the first week then increased by 25 mg weekly up to a maximum dose of 100 mg administered in two divided doses.
- Patients should maintain an adequate fluid intake to minimize the risk of kidney stones.
- The recommended dose for extended-release capsules is 200-400 mg once daily.
Which drugs or supplements interact with topiramate?
The following medications, when taken with topiramate, increase the risk of kidney stones and metabolic acidosis: acetazolamide (Diamox), dorzolamide (Trusopt), methazolamide (Neptazane), dichlorphenamide (Daranide).
- Carbamazepine (Tegretol) and phenytoin (Dilantin) markedly decrease the amount of topiramate in the body by increasing its elimination from the body. As a result, topiramate may lose effectiveness unless doses are increased.
- Combining valproic acid (Depakote, Depakote ER, Depakene, Depacon, Stavzor) with topiramate may increase the blood ammonia levels and cause hypothermia.
- Topiramate may decrease the amount of estrogen in the body in women taking oral contraceptives, possibly increasing the chances of unwanted pregnancy and breakthrough bleeding.
- Patients with seizure disorders taking anticonvulsant medications, including topiramate, may develop nerve toxicity from a chemical, 4'-O-methylpyridoxine, found as a contaminant in some ginkgo preparations.
- Topiramate may cause metabolic acidosis. Metformin (Glucophage) is contraindicated in patients with metabolic acidosis.
- Topiramate may increase lithium (Eskalith, Lithobid) levels at higher doses.
Is topiramate safe to take if I'm pregnant or breastfeeding?
What else should I know about topiramate?
What preparations of topiramate are available?
- Tablets: 25, 50, 100, 200 mg
- Sprinkle capsules: 15 and 25 mg
- Capsule (Extended Release): 25, 50, 100, 150, 200 mg
How should I keep topiramate stored?
- Topiramate tablets should be stored at room temperature, 15 C to 30 C (59F to 86 F).
- Sprinkle capsules should be stored at or below 25 C (77 F).
Latest Neurology News
Daily Health News
Topiramate (Topomax, Qudexy XR, Topamax Sprinkle, Topiragen, Trokendi XR) is a drug prescribed for the prevention of the seizures of epilepsy and prevention of migraine headaches. Side effects, drug interactions, pregnancy safety, and warnings and precautions should be reviewed prior to taking this medication.
Multimedia: Slideshows, Images & Quizzes
16 Surprising Headache Triggers and Tips for Pain Relief
Do you have frequent headaches? Learn the most common headache triggers for tension headaches, sinus headaches, cluster headaches...
Migraine or Tension Headache? Symptoms, Triggers, Treatments
What does a migraine headache feel like compared to a tension headache? Learn to spot migraine symptoms early, how to identify...
Pictures of Famous People Coping With Migraines
See how celebrities cope with the pain caused by migraines. Learn their methods used to prevent and relieve migraine pain.
Bipolar Disorder (Mania) Quiz
Who is at risk for developing bipolar disorder? Are you? Take this Bipolar Disorder Quiz to learn more about bipolar disorder, if...
Epilepsy & Seizures Quiz: What Causes Seizures?
Do you know the difference between seizures and epilepsy? What are the types of seizures? Take the Epilepsy & Seizures Quiz to...
Headaches Quiz: Learn About Headache Pain
If you're plagued with headaches, our Headaches Quiz may help you identify causes, triggers, symptoms, and treatments for...
Migraine Headaches: 14 Non-Drug Treatments for Migraines
Learn about 14 non-drug treatments for migraines. Acupuncture, biofeedback and massage therapy are among this list of non-drug...
Related Disease Conditions
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Migraine headache is a type of headache associated with a sensitivity to light, smells, or sounds, eye pain, severe pounding on one side of the head, and sometimes nausea and vomiting. The exact cause of migraine headaches is not known. Triggers for migraine headaches include certain foods, stress, hormonal changes, strong stimuli (loud noises), and oversleeping. Treatment guidelines for migraines include medicine, pain management, diet changes, avoiding foods that trigger migraines, staying hydrated, getting adequate sleep, and exercising regularly. Prevention of migraine triggers include getting regular exercise, drinking water daily, reducing stress, and avoiding trigger foods.
Types of Traumatic Brain Injury (TBI) Medications
Traumatic brain injury and related conditions, may require diuretics, anticonvulsants, sedatives, antidepressants, muscle relaxers, pain relievers, and stimulants to treat deficits in cognitive functions such as attention, memory, learning and language.
Cocaine and Crack Addiction
Cocaine is an addictive stimulant that is smoked, snorted, and injected. Crack is cocaine that comes in a rock crystal that is heated to form vapors, which are then smoked. Cocaine has various effects on the body, including dilating pupils, constricting blood vessels, increasing body temperature, heart rate, and blood pressure.
Bipolar Disorder in Children, Teen, and Adults
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood-stabilizer medications, antidepressants, and psychotherapy.
Fragile X Syndrome
Fragile X syndrome is the most common inherited form of mental retardation. It's caused by a mutation on the X chromosome. People with Fragile X syndrome suffer from physical, social, emotional, speech, language, sensory, intelligence, and learning impairments. There is no definitive treatment for Fragile X, though there are ways to minimize the symptoms.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Cluster headaches are a type of headache that recurs over a period. Episodes can last one to three times a day during this time, which may last from 2 weeks to 3 months. The three main types of treatments for cluster headaches are, 1) Abortive medications that work to stop the process in the brain that causes migraines and stops the symptoms too. 2) Preventive prescription medications, or 3) surgery which involves blocking the trigeminal nerve.
Seizures Symptoms and Types
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Compulsive gambling is a disorder that affects millions in the U.S. Symptoms and signs include a preoccupation with gambling, lying to family or loved ones to hide gambling, committing crimes to finance gambling, and risking importance relationships and employment due to gambling. Treatment may incorporate participation in Gamblers' Anonymous, psychotherapy, and medications like carbamazepine, topiramate, lithium, naltrexone, antidepressants, clomipramine, and fluvoxamine.
People with bulimia nervosa, an eating disorder that involves episodes of bingeing and purging, experience symptoms and signs such as deteriorating teeth, sore throat, constipation, thinning hair, and dehydration. Treatment of bulimia may involve cognitive behavior therapy, family therapy, nutritional counseling, and medication.
Binge Eating Disorder
Characteristics of binge eating disorder include eating more quickly than usual, eating until uncomfortably full, eating a lot of food despite not being hungry, eating alone due to embarrassment, and feeling disgusted by overeating.
Nightmares are dreams that cause high anxiety or terror. Nightmares may be a part of posttraumatic stress disorder (PTSD), and they usually occur during rapid eye movement (REM) sleep. There are several different treatment options for nightmares, including cognitive-behavioral therapy and medications.
Treatment & Diagnosis
- Headaches FAQs
- Epilepsy and Seizures FAQs
- Bipolar Disorder Mania FAQs
- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- Drugs: The Most Common Medication Errors
- Medication Disposal
- Dangers of Mixing Medications
- Drugs: Buying Prescription Drugs Online Safely
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
Prevention & Wellness
- Many Migraine Sufferers Given Unecessary Opioids, Study Finds
- Marijuana Derivative May Curb Tough-to-Treat Epilepsy
- Study Questions Use of Migraine Meds in Kids, Teens
- Newer Epilepsy Drugs May Be Safer During Pregnancy
- 5 Diet Drugs: Which Ones Work?
- Girls Given Risky Meds Don't Get Contraceptive Advice
- Promise From a New Weight-Loss Drug
- Surgery May Help Teens With Frequent Migraines, Study Contends
- Migraine Drug May Up Risk of Eating Disorders in Some Teens
- Experts See Place for Weight-Loss Drugs in Obesity Treatment
- Contrave, Newest Weight Loss Option: FAQ
- Why Aren't Rx Weight-Loss Drugs More in Demand?
- Several Medications Can Help People Quit Drinking: Study
- Topamax Approval for Migraines Expanded to Younger Users
- Nerve-Stimulating Device Might Ease Migraines
- No Proof Drugs Ease Kids' Migraines: Study
- Weight Loss Pill Qsymia 'Gaining Traction'
- Weight Loss Pill Qsymia Now for Sale
- 2 New Weight-Loss Drugs Won't Reverse U.S. Obesity Crisis
- Qsymia, Belviq: New Weight Loss Drugs Compared
- FDA Approves Diet Drug Qsymia
- FDA Approves Diet Pill Belviq
- Botox Only Modestly Effective for Migraines
- Migraine Guidelines Focus on Prevention
- Prescription Meds Can Put on Unwanted Pounds
- FDA Panel Votes in Favor of Weight Loss Pill Qnexa
- FDA Weighs Fate of Qnexa for Weight Loss, Again
- FDA Reconsiders Weight Loss Drug Qnexa
- Regular Exercise Seems to Guard Against Migraine
- Study: Low Birth Defect Risk From Newer Epilepsy Drugs
- Johnson & Johnson Recalls Topamax Due to Odor
- Qnexa Yields Up to Nearly a 10% Weight Loss: Study
- New Birth Defect Warning for Topamax
- Study: No Proof of Epilepsy Drug Suicide Risk
- FDA Panel Says 'No' to Weight Loss Drug Qnexa
- Weight Loss Pill Also Lowers Blood Pressure
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.