- A Visual Guide to Migraine Headaches Slideshow
- Headache and Migraine Triggers Slideshow
- Take the Migraines Quiz
- What is topiramate, and how does it work (mechanism of action)?
- What brand names are available for topiramate?
- Is topiramate available as a generic drug?
- Do I need a prescription for topiramate?
- What are the side effects of topiramate?
- What is the dosage for topiramate?
- Which drugs or supplements interact with topiramate?
- Is topiramate safe to take if I'm pregnant or breastfeeding?
- What else should I know about topiramate?
What is topiramate, and how does it work (mechanism of action)?
Topiramate is an oral drug that is used to prevent the 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
What are the side effects of topiramate?
The most common side effects of topiramate are:
- coordination problems,
- weight loss,
- 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 week 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 in order 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.
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.
Is topiramate safe to take if I'm pregnant or breastfeeding?
Topiramate is excreted in human milk at levels 10% to 20% the levels in the mother's blood.
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).
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
Migraine or Headache? Migraine Symptoms, Triggers, Treatment
What does a migraine feel like? Discover the difference between headaches and migraines. Learn to spot migraine symptoms early,...
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...
Bipolar Disorder (Mania) Quiz: Test Your Emotional Wellness IQ
Who is at risk for developing bipolar disorder? Are you? Take this Bipolar Disorder Quiz to learn more about bipolar disorder, if...
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...
12 Surprising Headache Triggers Tips
Painful headaches can ruin your productivity and quality of life. But what triggers headaches and migraines? Learn some...
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...
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....
Related Disease Conditions
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches,...
Migraine headache is a type of headache associated with a sensitivity to light, smells, or sounds, eye pain, severe pounding on...
Seizures Symptoms and Types
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from...
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are...
Cluster headaches are a type of headache that recurs over a period. Episodes can last one to three times a day during this time,...
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment...
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...
Cocaine and Crack Abuse
Cocaine is an addictive stimulant that is smoked, snorted, and injected. Crack is cocaine that comes in a rock crystal that is...
Compulsive gambling is a disorder that affects millions in the U.S. Symptoms and signs include a preoccupation with gambling,...
Binge Eating Disorder
Characteristics of binge eating disorder include eating more quickly than usual, eating until uncomfortably full, eating a lot of...
People with bulimia nervosa, an eating disorder that involves episodes of bingeing and purging, experience symptoms and signs...
Nightmares are dreams that cause high anxiety or terror. Nightmares may be a part of posttraumatic stress disorder (PTSD), and...
Treatment & Diagnosis
- Headaches FAQs
- Epilepsy and Seizures FAQs
- Bipolar Disorder Mania FAQs
- Medication Disposal
- Dangers of Mixing Medications
- 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: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- 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.