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Topamax General Information

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Topamax is used alone or with other medications to prevent and control seizures (epilepsy). Topamax is also used to prevent migraine headaches and decrease how often you get them. Topamax will not treat a migraine headache once it occurs. If you get a migraine headache, treat it as directed by your doctor (such as by taking pain medication, lying down in a dark room).

Topamax is known as an anticonvulsant or antiepileptic drug.

How to Use Topamax

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking Topamax and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take Topamax by mouth with or without food as directed by your doctor, usually twice daily. Swallow the tablets whole since breaking them may leave a bitter taste. To prevent kidney stones from forming, drink plenty of liquids while taking Topamax unless your doctor instructs you otherwise.

Dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight. Your doctor will gradually increase your dose to reduce your risk of side effects. For some conditions, you may start treatment with Topamax once daily at bedtime and slowly increase your dose to twice a day. It may take several weeks or months to reach the best dose for you and to get the full benefit from Topamax.

Take Topamax regularly to get the most benefit from it. To help you remember, take it at the same times each day. Do not stop taking Topamax without consulting your doctor. Some conditions may become worse when Topamax is suddenly stopped. Your dose may need to be gradually decreased.

Tell your doctor if your condition persists or if it worsens.

Topamax Possible Side Effects

Tiredness, drowsiness, dizziness, loss of coordination, tingling of the hands/feet, loss of appetite, bad taste in your mouth, diarrhea, and weight loss may occur. Mental problems such as confusion, slowed thinking, trouble concentrating or paying attention, nervousness, memory problems, or speech/language problems may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed Topamax because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using Topamax do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: signs of kidney stones (such as severe back/side/abdominal/groin pain, fever, chills, painful/frequent urination, bloody/pink urine).

A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.

Tell your doctor right away if any of these rare but serious side effects occur: rapid breathing, fast/slow/irregular heartbeat, bone pain, broken bones, loss of consciousness, unusual bleeding/bruising.

Rarely, Topamax may cause a very serious eye problem, generally within 1 month of starting treatment. If untreated, this eye problem can lead to permanent blindness. Therefore, get medical help right away if any of these side effects occur: sudden vision changes (such as decreased vision, blurred vision), eye pain/redness.

Topamax can rarely cause a serious metabolic problem (high amount of ammonia in the blood), especially if you are also taking valproic acid. Tell your doctor right away if you experience sudden/unexplained tiredness, vomiting, or mental changes (such as decreased alertness).

A very serious allergic reaction to Topamax is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Topamax Precautions

Before taking Topamax, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Topamax may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using Topamax, tell your doctor or pharmacist your medical history, especially of: a certain eye problem (narrow angle glaucoma), kidney problems (such as kidney stones), liver problems, mental/mood problems (such as depression, thoughts of suicide), lung/breathing problems, a certain metabolic imbalance (metabolic acidosis), long-term diarrhea, a diet high in fat and low in carbohydrates (ketogenic diet), brittle bones (osteoporosis).

Topamax may make you dizzy or drowsy or impair your judgment. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages.

Topamax may make you sweat less, making you more likely to get heat stroke. Avoid doing things that may cause you to overheat, such as hard work or exercise in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest. Get medical help right away if you have a fever that does not go away, mental/mood changes, headache, or dizziness.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Children may be more sensitive to the side effects of Topamax, especially weakened bones, slowed growth rate, and decreased sweating. Consult your doctor or pharmacist for more details.

Older adults may be more sensitive to the side effects of Topamax, especially dizziness. Dizziness can increase the risk of falling.

During pregnancy, Topamax should be used only when clearly needed. It may harm an unborn baby. Discuss the use of reliable forms of birth control with your doctor (see also Drug Interactions section). If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor about the benefits and risks of using Topamax during pregnancy. If you are taking Topamax to treat seizures, note that untreated seizures are a serious condition that can harm both a pregnant woman and her unborn baby, so do not stop taking Topamax unless directed by your doctor.

Topamax passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Topamax Possible Intercations

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Topamax may decrease the effectiveness of hormonal birth control products (such as pills, patch, ring). This effect can result in pregnancy. Ask your doctor or pharmacist for details. Discuss whether you should use additional reliable birth control methods while using Topamax. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

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Topamax Certification Information


Topiramate, Properties, Description and Safety Information
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Clinical Trial. A Study of the Efficacy and Safety of Topiramate Treatment in Patients With Epilepsy
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FDA Approved Labeling Text dated October 2012
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