- help prevent migraine in adults and some children
- treat epilepsy (a disorder that causes seizures) in adults and some children with:
Topamax contains the active drug topiramate. (The active drug is the ingredient that makes a medication work.) Its classification is an anticonvulsant. (The word classification refers to a group of medications that work in a similar way.) Topiramate is also the generic version of Topamax.
Topamax comes in two forms:
- tablets that you swallow whole
- capsules that you may swallow whole, or open and sprinkle on soft food to swallow
Keep reading to learn more about Topamax, including its side effects, uses, dosages, and more.
Like most drugs, Topamax may cause mild or serious side effects. The lists below describe some of the more common side effects it may cause. These lists don’t include all possible side effects.
Keep in mind that side effects of a drug can depend on:
- your age
- other health conditions you have
- other medications you take
Your doctor or pharmacist can tell you more about the potential side effects of Topamax. They can also suggest ways to help reduce side effects.
Mild side effects
Here’s a list of some of the mild side effects that Topamax can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Topamax’s prescribing information.
Mild side effects of Topamax that have been reported include:
- loss of appetite
- belly pain
- changes in how foods taste
- feeling nervous
- insomnia (trouble sleeping)
- memory problems
- slow reactions
- speech problems
- tingling in your arms or legs
- weight loss
- hair loss*
* For more information about this side effect, see the “Side effect focus” section below.
Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome to you, talk with your doctor or pharmacist.
Serious side effects
Serious side effects from Topamax can occur, but they aren’t common. If you have serious side effects from Topamax, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.
Serious side effects of Topamax that have been reported include:
- eye-related side effects, including vision changes, vision loss, and glaucoma
- high body temperature and reduced sweating
- high level of acid in your blood
- high level of ammonia in your blood
- kidney stones
- serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis
- reduced bone strength and decreased growth, in children taking the drug
- mood and personality changes*
- allergic reaction*
* For more information about this side effect, see the “Side effect focus” section below.
Side effect focus
Learn more about some of the side effects Topamax may cause.
Mood and personality changes
Treatment with Topamax can cause mood and personality changes. You may notice changes in how you behave, feel, interact with others, and react. For example, treatment with Topamax may cause:
- aggression or agitation (feeling restless or annoyed)
- shifts in mood
- suicidal thoughts and behaviors
Although these side effects are serious, they’ve been reported very rarely in people taking Topamax.
It’s important to note that all anticonvulsant drugs carry a risk of suicidal thoughts. (Topamax is an anticonvulsant drug.) Also, epilepsy itself is linked to an increased risk of suicidal thoughts and behaviors. It can be hard to tell if this side effect is due to Topamax, the condition being treated, or both.
What might help
Here are some tips to help manage your mood, thoughts, and behaviors while taking Topamax:
- Pay close attention for any changes, especially sudden changes, in your behaviors, feelings, mood, and thoughts. Keeping a journal may help you track and notice any changes or patterns. Talk with your doctor if you notice changes that trouble you.
- Keep all appointments with your doctor. It’s very important to see them on a regular basis while you take Topamax. This helps your doctor monitor your behaviors and mood during treatment.
- Talk with your doctor if you want to stop taking Topamax. You should not stop treatment unless you first speak with them. If you suddenly stop taking Topamax, serious problems can occur, including new or worsening seizures.
Talk with your doctor right away if you notice any of the following symptoms while taking Topamax:
- aggressive or violent behavior
- feeling restless, irritated, or agitated
- new or worsened anxiety or depression
- panic attacks
- thoughts about suicide or dying
- insomnia (trouble sleeping)
- other unusual changes in your behaviors or mood
If you have mood or personality changes with Topamax, you and your doctor can decide the best action to take. For example, they may suggest changing your dose. Your doctor could also recommend ways to treat your side effects. Or they may advise you to stop taking Topamax and switch to a different medication.
You should not stop taking Topamax unless you first speak with your doctor. They can help you taper (slowly wean off) the drug over time. Stopping the drug suddenly may cause seizures in some people.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call the 988 Suicide and Crisis Lifeline at 988.
- Text HOME to the Crisis Textline at 741741.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you are not in the same household, stay on the phone with them until help arrives.
Treatment with Topamax may cause sleepiness as a side effect. This was one of the most common side effects reported by people taking Topamax to treat epilepsy in studies. Sleepiness was less common in people who took Topamax to help prevent migraine in these studies.
People often need to stop taking Topamax due to the sleepiness that the drug can cause.
The risk of sleepiness from Topamax increases with higher doses of the medication.
What might help
Due to the risk of sleepiness with Topamax, it’s important to avoid certain activities until you know how the drug will affect you. These activities include driving and operating machinery.
It’s possible that sleepiness caused by Topamax will go away on its own. Talk with your doctor if you have sleepiness that’s bothersome to you or doesn’t go away. They may lower your Topamax dose. Or they may recommend a different medication.
Hair loss is possible with Topamax. But this side effect wasn’t common in the drug’s studies in people who were treated for epilepsy. Hair loss wasn’t reported in people who took the medication to help prevent migraine.
What might help
Talk with your doctor if you have hair loss that bothers you while taking Topamax. They may be able to suggest a treatment for this side effect. But they may also recommend switching to a medication other than Topamax.
Some people may have an allergic reaction to Topamax.
Symptoms of a mild allergic reaction can include:
- skin rash
- flushing (temporary warmth, redness, or deepening of skin color)
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.
Call your doctor right away if you have an allergic reaction to Topamax. But if you think you’re having a medical emergency, call 911 or your local emergency number.
Topamax is not a weight loss drug. And this isn’t an approved use for Topamax.
Topamax did cause loss of appetite and minor weight loss in studies. The average weight loss with Topamax was a few pounds. You can ask your doctor how long it took to lose weight with the drug in these studies.
Unlike some other drugs used to treat epilepsy, Topamax isn’t known to cause weight gain.
Topiramate (the active drug in Topamax) is sometimes prescribed off-label* for weight loss in combination with a medication called phentermine. This combination is also available as a brand-name drug called Qsymia.
Qsymia is prescribed to help with weight loss in certain adults and children ages 12 and older. Your doctor can tell you more about Qsymia and its uses, including the best time to take it for weight loss.
Talk with your doctor if you’re interested in learning about ways to manage your weight. They can discuss possible treatments with you, including medications approved for weight loss. They can also help suggest other ways to manage weight, including healthy eating and exercise habits.
* Off-label use is when a drug is prescribed to treat a condition other than those it’s approved for.
Find answers to some commonly asked questions about Topamax.
Does Topamax treat bipolar disorder, anxiety, or alcoholism?
Topamax is not approved to treat bipolar disorder, anxiety, or alcoholism, also called alcohol use disorder. But the drug may be used off-label for treating these conditions. “Off-label” use is when a drug is prescribed to treat a condition other than those it’s approved for.
To learn more about off-label uses of Topamax, talk with your doctor or pharmacist. They can help answer any concerns you have, such as what the dosage for bipolar disorder would be.
Can stopping Topamax treatment cause withdrawal symptoms? If so, what’s the withdrawal timeline?
Stopping Topamax treatment shouldn’t cause withdrawal symptoms. However, if you suddenly stop treatment, you could develop seizures, more frequent seizures, or worsened seizures.
To help reduce this risk, Topamax has a recommended withdrawal timeline. Each week, the daily dose is decreased by 25 milligrams (mg) to 50 mg. This is how the drug treatment was stopped in studies.
It’s important that you do not stop taking Topamax unless you first speak with your doctor. They can help you taper (slowly wean off) the drug over time. This helps reduce your risk of seizures. Your doctor can help answer any questions you have.
How does Topamax work? And how long does it stay in your system?
It’s not known exactly how Topamax works to treat epilepsy or help prevent migraine. It’s thought that the drug works by affecting electrical and nerve signals in your brain. This is believed to help prevent incorrect signals in your brain that may cause seizures or migraine.
You can determine how long a drug stays in your system by looking at its half-life. This is how long it takes your body to get rid of half a dose. Topamax’s half-life is about 21 hours.
Is Topamax a mood stabilizer? Also, is it a controlled substance?
Topamax may be used off-label as a mood stabilizer for treating bipolar disorder. With off-label use, a drug is prescribed to treat a condition other than those it’s approved for. Mood stabilizers are medications that help prevent extreme mood changes.
Topamax is not a controlled substance. A controlled substance is a medication with a high potential for misuse and dependence. The term misuse means taking a drug in a way that your doctor didn’t prescribe or using more of it than prescribed. The term dependence means needing a drug to feel as you usually do.
How do you flush Topamax out of your system?
Topamax takes time to leave your body, so there isn’t a way to flush it out of your system. Once you stop taking the drug, you’ll need to wait until it’s cleared from your body. This usually takes about 5 days.
You should not stop taking Topamax unless you first speak with your doctor. Suddenly stopping treatment can cause withdrawal symptoms. To learn more, see the question above to learn more about withdrawal symptoms.
Is Topamax used for sleep problems or pain?
Topamax is not approved to treat sleep problems or pain, including nerve pain. But the drug may be used off-label for treating these conditions. Off-label use is when a drug is prescribed to treat a condition other than those it’s approved for.
To learn more about off-label uses of Topamax, talk with your doctor or pharmacist.
Are there interactions between Topamax and metformin? Or between Topamax and Wellbutrin SR or Wellbutrin XL?
Topamax has possible interactions with metformin. While Topamax is not known to interact with Wellbutrin, certain people should not take bupropion. (The active drug in Wellbutrin SR and Wellbutrin XL is bupropion.)
A study showed that when Topamax is taken with metformin, the level of metformin in the body may increase slightly. Also, the rate at which your body gets rid of Topamax may slow a bit. It’s not known whether these effects are strong enough for you to notice or make a difference in how the medications are used.
Regarding Wellbutrin, doctors typically won’t prescribe this drug to people with seizure disorders. Keep in mind that Topamax is approved to treat seizure disorders in adults and some children. This is because Wellbutrin is known to cause seizures. Taking Wellbutrin can also increase the risk of seizures in certain situations, such as after an anticonvulsant drug is suddenly stopped.
If you’re concerned about interactions between Topamax and other medications, talk with your doctor or pharmacist.
Topamax is used to help prevent migraine in people ages 12 years and older.
Migraine is a condition that causes intense headaches. You may experience other symptoms with headaches. These can include nausea and vomiting, sensitivity to light and sound, and trouble thinking or speaking. It’s not fully understood what causes migraine or why it affects certain people. It’s thought that incorrect electrical and chemical signaling in the brain causes migraine.
Topamax does not treat migraine episodes that are already happening. The drug is a treatment you take every day to help prevent migraine.
How Topamax works to help prevent migraine isn’t known exactly. It’s believed that the drug affects electrical and nerve signals in your brain. This may help prevent incorrect signals in your brain that may cause migraine.
Topamax is also used to treat epilepsy in certain people. See the section just below called “Is Topamax used for other conditions?” to learn more.
Topamax is used to treat epilepsy in people ages 2 years and older. For this purpose, Topamax may be used on its own to treat two kinds of seizures: focal-onset or primary generalized tonic-clonic seizures.
The drug may be used together with other medications for epilepsy to treat the following types of seizures:
Epilepsy is a condition in which seizures keep occurring. (A seizure is a sudden surge of electrical activity in your brain.) It’s not understood exactly what causes epilepsy or why it affects certain people. In some cases, such as traumatic brain injury, the cause of seizures is known. But in many cases, no cause can be determined.
It’s not fully known how Topamax works for treating epilepsy. It’s thought that the drug works by affecting electrical signals in your brain. This is believed to help prevent incorrect signals in your brain that may cause seizures.
Topamax may also be prescribed off-label for other conditions. Off-label use is where a drug that’s approved for certain conditions is prescribed for a different use. Talk with your doctor for more information.
In addition, Topamax is used to help prevent migraine in certain people. See the section above called “Is Topamax used for migraine?” to learn more.
Your doctor will recommend the dosage of Topamax that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.
Forms and strengths
Here’s some information about the forms and strengths of Topamax:
- Tablets that you swallow whole. These are available in four strengths: 25 milligrams (mg), 50 mg, 100 mg, and 200 mg.
- Capsules that you may swallow whole, or open and sprinkle on soft food to swallow. These are available in two strengths: 15 mg and 25 mg.
For helping prevent migraine, you’ll likely start by taking Topamax once per day. If this dosage doesn’t cause problems, your doctor will likely increase it to the maximum dosage of twice per day.
Here are the recommended dosages of Topamax for treating epilepsy on its own:
- People ages 10 years and older will likely take Topamax twice per day.
- Children ages 2 to 9 years may take Topamax once or twice per day.
Here are the recommended dosages of Topamax for treating epilepsy when used with other medications:
- People ages 17 years and older will likely take Topamax twice per day.
- Children ages 2 to 16 years may take Topamax once or twice per day.
Whether you take Topamax for migraine or epilepsy, it’s common for your doctor to adjust your dosage over time. You’ll work together to find the dosage that’s right for you.
Questions about Topamax’s dosage
Here are some questions you may have about Topamax’s dosage and their answers.
- What if I miss a dose of Topamax? If you miss a dose of Topamax, try and take it as soon as you remember. But if it’s within 6 hours of your next Topamax dose, take your next dose as scheduled and skip the missed dose. You should not take more than one dose of Topamax at a time.
- Will I need to use Topamax long term? If you and your doctor agree that Topamax works well for you, you’ll likely use Topamax long term.
- How long does Topamax take to work? Topamax begins working as soon as you take a dose. But it may take a few days or weeks before you notice your symptoms ease.
Before taking Topamax, there are important considerations to discuss with your doctor. Be sure to talk with them about your overall health and any medical conditions you may have.
You should also tell your doctor about all medications you take, including any over-the-counter medications. They’ll need to check for any interactions with Topamax.
Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.
Before taking Topamax, be sure to tell your doctor about all medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Topamax.
Interactions with drugs or supplements
Topamax can interact with several kinds of drugs. These drugs include:
- other anticonvulsant drugs, such as valproic acid (Depakote, Depakote ER), carbamazepine (Carbatrol, Tegretol, others), and phenytoin (Dilantin)
- carbonic anhydrase inhibitors, such as acetazolamide and zonisamide (Zonegran)
- medications that lower activity of the central nervous system, such as:
- birth control, including:
- the diuretic (water pill) hydrochlorothiazide
- the diabetes drug pioglitazone (Actos)
- the mood stabilizer lithium (Lithobid)
- the antidepressant amitriptyline
This list does not contain all types of drugs that may interact with Topamax. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of Topamax.
Topamax may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Topamax. Factors to consider include those in the list below.
- Diarrhea. If you take Topamax and have frequent or uncontrolled diarrhea, your risk of metabolic acidosis may increase. This is a condition in which you have too much acid in your blood. Talk with your doctor about whether taking Topamax is safe for you.
- Breathing or lung problems. If you take Topamax and have breathing or lung problems, you may have an increased risk of metabolic acidosis. An example of a breathing problem is chronic obstructive pulmonary disease (COPD). Talk with your doctor about whether taking Topamax is right for you.
- Eye problems, such as glaucoma. In rare cases, Topamax can cause eye problems, including glaucoma. If you already have eye problems, such as glaucoma, taking Topamax may worsen your condition. Your doctor can help determine whether treatment with Topamax is safe for you.
- Ketogenic diet. A ketogenic diet is a diet high in fat and low in carbohydrates. If you take Topamax and follow this diet, your risk of metabolic acidosis may increase. Talk with your doctor about whether Topamax is the right option for you.
- Kidney problems. If you take Topamax and have kidney problems, your risk of metabolic acidosis may increase. Kidney problems can include undergoing dialysis (a kind of treatment to filter blood). The problems can also include having kidney stones (solid masses that form into crystals in your urinary tract). Your doctor can help determine whether Topamax is safe for you.
- Liver problems. If you take Topamax and have liver problems, such as hepatitis, you may have an increased risk of hyperammonemia. This refers to high levels of ammonia in your blood. Ask your doctor about whether Topamax is right for you.
- Mood problems, including depression and suicidal thoughts. Like all anticonvulsant drugs, Topamax can cause mood problems, including depression. Topamax may also increase the risk of suicidal thoughts and behaviors. If you have a mood problem, taking the drug could worsen it or a new one could develop. Your doctor can help determine if you should take Topamax.
- Weak, brittle, or soft bones. Topamax can cause metabolic acidosis. Left untreated, metabolic acidosis can weaken your bones, possibly causing osteoporosis or other bone problems. Your doctor can advise you on whether Topamax is right for you.
- Allergic reaction. If you’ve had an allergic reaction to Topamax or any of its ingredients, your doctor will likely not prescribe Topamax. Ask them what other medications may be better options for you.
Topamax and alcohol
You should not drink alcohol while taking Topamax.
Consuming alcohol while taking Topamax can increase your risk of certain side effects or make them worse. These side effects include trouble concentrating or speaking, sleepiness, confusion, and dizziness.
In serious cases, drinking alcohol during Topamax treatment can cause serious or life threatening side effects. These may include loss of consciousness, coma, and in extreme cases, death.
If you drink alcohol and have more questions about the safety of drinking alcohol while taking Topamax, talk with your doctor.
Pregnancy and breastfeeding
Topamax may cause harm if taken during pregnancy. Talk with your doctor about the risks of Topamax if you’re pregnant or planning to become pregnant. Other medications may be more suitable for you.
There is a pregnancy registry that helps healthcare professionals collect information about the safety of drugs, such as Topamax, during pregnancy. This helps you and your doctor make informed decisions about your treatments during pregnancy. If you decide to take Topamax while pregnant, you’re encouraged to sign up by visiting the program website or calling 888-233-2334.
If you can become pregnant, it’s important to use effective birth control while taking Topamax. The drug can interact with many kinds of birth control, possibly causing them to work less well than usual or not at all. For more information, see “Interactions” above. If your doctor prescribes Topamax, be sure to talk with them about effective birth control methods.
Topamax is known to pass into human breast milk. Side effects have been reported in children who were breastfed, including diarrhea and sleepiness.
Talk with your doctor about the possible risks and benefits of Topamax if you’re breastfeeding or plan to breastfeed.
Your doctor will explain how you should take Topamax. They’ll also explain how much to take and how often. Be sure to follow your doctor’s instructions.
How you take Topamax depends on the form your doctor prescribes. The drug is available in the following forms:
- tablets that you swallow whole
- capsules that you may swallow whole, or open and sprinkle on soft food (such as applesauce) to swallow
Accessible medication containers and labels
If it’s hard for you to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies may provide medication labels that:
- have large print
- use braille
- contain a code you can scan with a smartphone to change the text into audio
Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.
Also, if you’re having trouble opening your medication bottles, let your pharmacist know. They may be able to put Topamax tablets in an easy-open container. Your pharmacist may also recommend tools to help make it simpler to open the drug’s container.
Taking Topamax with other drugs
For treating epilepsy, Topamax may be prescribed alone or with other drugs.
Talk with your doctor to learn more about whether you’ll take Topamax alone or with other medications for epilepsy.
Questions about taking Topamax
Here’s a list of common questions about taking Topamax.
- Is there a best time of day to take Topamax? You’ll likely take Topamax twice per day. Most people find that the best times of day to take Topamax for migraine are breakfast and dinner. Food does not affect the medication. Taking your dose with meals may help you remember to take it.
- Can Topamax be chewed, crushed, or split? You should not chew, crush, or split Topamax tablets. The tablets have a very bitter taste. If you have problems swallowing Topamax tablets, talk with your doctor about switching to Topamax capsules. The capsule may be opened and sprinkled on a teaspoonful of applesauce (or other soft food) before swallowing.
- Should I take Topamax with food? You may take Topamax with or without food.
Questions for your doctor
You may have questions about Topamax and your treatment plan. It’s important to discuss all your concerns with your doctor.
Here are a few tips that might help guide your discussion:
- Before your appointment, write down questions such as:
- How will Topamax affect my body, mood, or lifestyle?
- Bring someone with you to your appointment if doing so will help you feel more comfortable.
- If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.
Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, don’t be afraid to ask questions or offer feedback on your treatment.
Do not take more Topamax than your doctor prescribes. Using more than this can lead to serious side effects.
Symptoms of overdose
Symptoms caused by an overdose can include:
- blurry or double vision
- drowsiness or dizziness
- depression or agitation (feeling restless or annoyed)
- extreme tiredness or sluggishness
- low blood pressure
- problems with thinking or coordination
- speech problems
Topamax overdoses have, in a few extreme cases, led to death.
What to do in case you take too much Topamax
Call your doctor if you think you’ve taken too much Topamax. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use its online resource. However, if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.
Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.
Topamax is available as the generic drug topiramate. Generics usually cost less than brand-name drugs. Talk with your doctor if you’d like to know about taking generic topiramate.
If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Topamax manufacturer’s website to see if they have support options.
In addition, you can check out this article to learn more about saving money on prescriptions.
If you’re considering treatment with Topamax, talk with your doctor or pharmacist. Ask questions that help you feel comfortable about the risks and benefits. Some examples to help you get started are:
- Does Topamax cause sexual side effects?
- What should I know about alternative drugs for Topamax? Is it similar to topiramate?
- If I experience side effects from Topamax, are there different doses I can try?
You can also learn more about other medications for treating migraine.
To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.
I’m taking Topamax for migraine prevention. But if I have a migraine episode while taking Topamax, are there other medications I can take to treat it?Anonymous
Yes. Topamax is a drug you take every day to help prevent migraine. It won’t work for a current migraine episode. But there are other medications that treat symptoms of a migraine episode when they happen. These include sumatriptan (Imitrex), rimegepant (Nurtec ODT), and ubrogepant (Ubrelvy).
It’s important to note that you should talk with your doctor before you take any medication to treat a migraine episode. They can help determine if it’s safe to use with Topamax.The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.