Topiramate

Topiramate is an anticonvulsant medication used to treat seizures, including partial-onset or primary generalized tonic-clonic seizures in adults and children who are at least 2 years old, as monotherapy. It can be used with other medicines to treat partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome in adults and children 2 years and older. Topiramate reduces the frequency and duration of seizures.

Topiramate is also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. This medicine helps to prevent migraine headaches or reduce the number of attacks; it will not treat a headache that has already begun.

Topiramate has also been used off-label for binge eating disorder (BED), alcohol dependence, and essential tremor.

Topiramate brand names are Topamax, Eprontia, Qudexy XR, and Trokendi XR. Generic topiramate is also available.

Topiramate and phentermine are the active ingredients in Qsymia, an appetite suppressant used for weight loss.

Topiramate FDA approval was first granted on December 24, 1996, for the Topamax brand by Jansen Pharmaceuticals.

It is thought that topiramate works by dampening down excessive nerve firing, enhancing the actions of GABA, and blocking the effects of other chemical messengers.

Topiramate mechanism of action is not fully understood, but evidence suggests its effect is due to blocking sodium channels (stops rapid firing), enhancing GABA-mediated inhibition, inhibiting glutamate-mediated excitation, and weakly inhibiting carbonic anhydrase.

Take topiramate exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Topiramate can be taken with or without food.

Swallow the tablets whole and do not crush, chew, or break a tablet.

If you cannot swallow a Topamax Sprinkle Capsule whole, open the capsule and sprinkle the medicine into a spoonful of applesauce or other soft food. Swallow the mixture right away without chewing, and drink fluids right after to make sure it is all swallowed. Do not save it for later use.

Carefully follow the swallowing instructions for your medicine.

If you are taking the oral solution, measure your dose with a marked measuring device or medicine syringe. Do not use a household spoon.

Topiramate doses are sometimes 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 this medicine to prevent kidney stones or an electrolyte imbalance.

You will need frequent medical tests. If you need surgery, tell the surgeon ahead of time that you are using topiramate. Any medical care provider who treats you should know that you take seizure medication.

Do not stop using this medicine 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 topiramate.

Store at cool room temperature away from moisture, light, and high heat. If you are using the oral solution, throw away any unused medicine 90 days after you first open the bottle.

Topiramate 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.

Topiramate can increase body temperature and decrease sweating, which may lead to life-threatening dehydration. 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 topiramate suddenly or you could have increased seizures.

You should not use this medication if you are allergic to topiramate. You should not drink alcohol while taking this medicine.

Tell your doctor if you are sick with diarrhea, or if you have ever had:

• glaucoma or other eye problems;
• metabolic acidosis (high levels of acid in your blood);
• kidney disease, kidney stones, or dialysis;
• lung disease, breathing problems;
• mood problems, depression, or suicidal thoughts or actions;
• Liver problems;
• a growth disorder;
• soft or brittle bones (osteoporosis, osteomalacia);
• have diarrhea;
• are on a diet high in fat and low in carbohydrates, which is called a ketogenic diet; or
• are having surgery

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 should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Pregnancy

Taking topiramate 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 while taking this medicine. You and your healthcare provider should decide if you will continue to take topiramate while you are pregnant.

If you take topiramate 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 this medicine without your doctor's advice. Topiramate may also cause your baby to be smaller than expected at birth, and metabolic acidosis caused by topiramate may have harmful effects on your baby.

If you are not pregnant or planning to become pregnant, use effective birth control to prevent pregnancy while taking topiramate.

Topiramate can make hormonal birth control (such as pills, injections, implants, skin patches, and vaginal rings) less effective. Ask your doctor about non-hormonal birth control options such as a condom, diaphragm, cervical cap, or contraceptive sponge.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of topiramate on the baby.

Breastfeeding

Topiramate passes into breast milk and may cause a breastfed baby to be sleepy or have diarrhea. It is not known if it can cause other serious harm. Talk to your healthcare provider about the best way to feed your baby if you take this medicine.

Common topiramate side effects

Common topiramate side effects may include:

• dizziness, drowsiness, tiredness, slow reactions;
• problems with speech or memory, abnormal vision;
• numbness or tingling in your arms and legs, decreased sensation (especially in the skin);
• changes in your sense of taste, feeling nervous;
• nausea, diarrhea, stomach pain, loss of appetite;
• fever, weight loss; or
• cold symptoms such as a stuffy nose, sneezing, sore throat

Serious topiramate side effects

Get emergency medical help if you have signs of an allergic reaction to topiramate (hives, difficult breathing, swelling in your face or throat) or a severe skin or multiorgan reaction (fever, swollen glands, sore throat, sores in your mouth, burning eyes, skin pain, red or purple skin rash with blistering and peeling, dark urine, or yellowing of your skin or eyes).

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• a skin rash, no matter how mild;
• dizziness or loss of coordination;
• vision problems, blurred vision, 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.
• low body temperature--drop in body temperature to less than 95°F, tiredness, confusion, or coma.

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.

The topiramate initial dose, titration, and recommended maintenance dose vary by indication and age group.

Topiramate is available as:

• Topamax
• Eprontia
• Qudexy XR
• Trokendi XR
• Generic topiramate may be available in tablet and capsule form.

Take the medicine as soon as you can. Do not take two doses at one time. Skip a missed topiramate dose if your next dose is due in less than 6 hours. Call your doctor if you have missed more than one dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of topiramate can be fatal. Overdose can cause drowsiness, agitation, depression, double vision, thinking problems, problems with speech or coordination, fainting, and seizure (convulsions).

Do not drink alcohol. Dangerous side effects or increased seizures may occur.

Avoid becoming overheated or dehydrated in hot weather. Topiramate can increase body temperature and decrease sweating, leading to life-threatening dehydration (especially in children).

Avoid the use of a ketogenic or "ketosis" diet (high in fat, low in carbohydrates) while you are taking topiramate.

Topiramate may cause blurred vision and may impair your thinking or reactions. Avoid driving or hazardous activities 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.

Using topiramate with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or depression.

Tell your doctor about all your other medicines, especially:

• zonisamide;
• 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 drug interactions are listed here.