Generic name: topiramate (toe PYRE a mate)
Brand name: Topamax, Topamax Sprinkle
Drug class: Carbonic anhydrase inhibitor anticonvulsants
Topamax (topiramate) was originally FDA-approved as a seizure medicine, also called an anticonvulsant. Topiramate is used to treat seizures in adults and children who are at least 2 years old.
Topamax is also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. This medicine will only prevent migraine headaches or reduce the number of attacks. It will not treat a headache that has already begun.
Topamax may also be used for purposes not listed in this medication guide.
Topamax may cause vision problems that can be permanent if not treated quickly. Call your doctor right away if you have a sudden decrease in vision.
Topamax can decrease sweating and may cause life-threatening hyperthermia (especially in children). Avoid becoming overheated or dehydrated. Tell your doctor if you have decreased sweating, high fever, and hot dry skin.
Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.
Do not stop using Topamax suddenly or you could have increased seizures.
Before taking this medicine
You should not use Topamax if you are allergic to topiramate. You should not use extended-release topiramate if you have metabolic acidosis (high levels of acid in your blood) and are also taking metformin for diabetes.
To make sure Topamax is safe for you, tell your doctor if you have ever had:
- glaucoma or other eye problems;
- diabetes, or metabolic acidosis;
- kidney disease, kidney stones, or dialysis;
- lung disease, breathing problems;
- mood problems, depression, or suicidal thoughts or actions;
- an eating disorder;
- liver disease;
- soft or brittle bones (osteoporosis, osteomalacia);
- a growth disorder; or
- if you are sick with diarrhea.
Topiramate can increase the level of acid in your blood (metabolic acidosis). This can weaken your bones, cause kidney stones, or cause growth problems in children or harm to an unborn baby. You may need blood tests to make sure you do not have metabolic acidosis, especially if you are pregnant.
Some people have thoughts about suicide while taking an anticonvulsant. Your doctor will need to check your progress at regular visits while you are using Topamax. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Taking Topamax during pregnancy may increase the risk of cleft lip and/or cleft palate, a birth defect that can develop early in pregnancy even before you know you are pregnant. However, having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant.
If you take Topamax during pregnancy: The benefit of preventing seizures may outweigh any risks posed by this medicine. There may be other medications that are safer to use. Do not start or stop taking Topamax without your doctor's advice.
If you are not pregnant or planning to become pregnant, use effective birth control to prevent pregnancy while taking topiramate.
Topiramate can make birth control pills less effective. Ask your doctor about using a non-hormonal birth control (condom, diaphragm, cervical cap, or contraceptive sponge) to prevent pregnancy.
It may not be safe to breastfeed a baby while you are using this medicine. Ask your doctor about any risks.
How should I take Topamax?
Take Topamax max exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Topamax can be taken with or without food.
Do not crush, chew, or break a Topamax tablet. Swallow the tablet whole.
Topamax Sprinkle Capsule can be swallowed whole. Or you may open the capsule and sprinkle the medicine into a spoonful of applesauce or other soft food. Swallow right away without chewing. Do not save the mixture for later use.
Carefully follow the swallowing instructions for your medicine.
Topiramate doses are based on weight in children. Your child's dose needs may change if the child gains or loses weight.
Drink plenty of liquids while you are taking topiramate, to prevent kidney stones or an electrolyte imbalance.
While using Topamax, you may need frequent blood tests. If you need surgery, tell the surgeon ahead of time that you are using this medicine. Any medical care provider who treats you should know that you take seizure medication.
Do not stop using Topamax suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose.
Call your doctor if your seizures get worse or you have them more often while taking Topamax.
Store at cool room temperature away from moisture, light, and high heat. Keep the bottle tightly closed when not in use.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if you are more than 6 hours late in taking it. Wait until your next scheduled dose. Do not take extra medicine to make up the missed dose.
Call your doctor for instructions if you miss two or more doses.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include drowsiness, agitation, depression, double vision, thinking problems, problems with speech or coordination, fainting, and seizures (convulsions).
What to avoid
Do not drink alcohol. Dangerous side effects or increased seizures may occur.
Avoid becoming overheated or dehydrated in hot weather. Topiramate can decrease sweating and increase body temperature, leading to life-threatening dehydration (especially in children).
Ketogenic or "ketosis" diets that are high in fat and low in carbohydrates can increase the risk of kidney stones. Avoid the use of such diets while you are taking Topamax.
Topiramate may cause blurred vision or impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you.
Also avoid activities that could be dangerous if you have an unexpected seizure, such as swimming or climbing in high places.
Topamax side effects
Get emergency medical help if you have signs of an allergic reaction to Topamax (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).
Report any new or worsening mood symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
- a skin rash, no matter how mild;
- vision problems, eye pain or redness, sudden vision loss (can be permanent if not treated quickly);
- confusion, problems with thinking or memory, trouble concentrating, problems with speech;
- dehydration symptoms - decreased sweating, high fever, hot and dry skin;
- signs of a kidney stone - severe pain in your side or lower back, painful or difficult urination;
- signs of too much acid in your blood - irregular heartbeats, feeling tired, loss of appetite, trouble thinking, feeling short of breath; or
- signs of too much ammonia in your blood - vomiting, unexplained weakness, feeling like you might pass out.
Common Topamax side effects may include:
- fever, weight loss;
- numbness or tingling in your arms and legs;
- flushing (warmth, redness, or tingly feeling);
- headache, dizziness, drowsiness, tired feeling, slow reactions;
- mood problems, feeling nervous;
- nausea, diarrhea, stomach pain, loss of appetite, indigestion;
- cold symptoms such as stuffy nose, sneezing, sore throat; or
- changes in your sense of taste.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Topamax?
Taking Topamax with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking a sleeping pill, opioid pain medication, muscle relaxer, or medicine for anxiety or depression.
Tell your doctor about all your current medicines and any you start or stop using, especially:
- birth control pills;
- divalproex, valproic acid; or
- other glaucoma medications, including eye drops.
This list is not complete. Other drugs may interact with topiramate, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.