Topamax Interactions: Alcohol, Medications, and Others

Introduction

Topamax (topiramate) is a prescription drug that’s used to:

• treat epilepsy in adults and certain children who have any of the following types of seizures:
  • focal-onset seizures (also known as partial seizures)
  • primary generalized tonic-clonic seizures
  • seizures caused by Lennox-Gastaut syndrome
• help prevent migraine attacks in adults and some children

Like other drugs, Topamax may have interactions. Some interactions occur because one substance causes another substance to have a different effect than expected. For example, sometimes alcohol, another drug, or a supplement can affect how a drug acts in your body. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Topamax’s possible interactions, including what you should not take with Topamax. And for more information about Topamax, including details about its uses, see this article.

Does Topamax interact with alcohol?

You should avoid drinking alcohol while taking Topamax. Both alcohol and Topamax reduce activity in your central nervous system. So consuming alcohol with Topamax can increase the risk and severity of certain side effects, such as:

• dizziness
• sleepiness
• confusion
• trouble concentrating, remembering, or speaking

In some cases, drinking alcohol with Topamax could cause serious, life threatening side effects. These include:

• respiratory depression (slow, shallow breathing)
• unconsciousness
• coma

If you have concerns about drinking alcohol while taking Topamax, talk with your doctor.

Does Topamax interact with other drugs?

Before you start taking Topamax, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Topamax interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Topamax?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The chart below lists drugs that may interact with Topamax. Keep in mind that this chart does not include all drugs that may interact with Topamax. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug interactions explained

Learn more about certain drug interactions that can occur with Topamax.

Interaction with selective serotonin reuptake inhibitors

Topamax may interact with selective serotonin reuptake inhibitors (SSRIs), a group of antidepressants. These drugs can cause some of the same side effects as Topamax, including an increased risk of bleeding.

Examples of SSRI medications include:

• citalopram (Celexa)
• escitalopram (Lexapro)
• sertraline (Zoloft)

What could happen

If you take Topamax with an SSRI, you may be more likely to bruise easily, or have nosebleeds, bleeding gums, or heavy periods. You may also have an increased risk of more serious bleeding, such as bleeding inside your body.

What you can do

If you take Topamax with an SSRI and have unusual bleeding, contact your doctor. But if you have symptoms of serious bleeding, such as blood in your urine, coughing or vomiting blood, or passing black, tar-like stools, see your doctor immediately.

If you have problems with bleeding, your doctor may recommend switching either your Topamax or SSRI treatment.

Interaction with metformin

Topamax can interact with metformin (Riomet, Fortamet, others), which is a drug used to treat diabetes. Both drugs can cause some similar side effects, including metabolic acidosis (high level of acid in your bodily fluids).

What could happen

Taking Topamax with metformin could increase the level of metformin in your blood. It’s not known whether this increases the risk of metformin side effects. But taking Topamax with metformin could increase your risk of developing metabolic acidosis, since both drugs can cause this side effect.

What you can do

If you take Topamax with metformin, your doctor may order blood tests from time to time to check the level of acid in your blood.

While taking these drugs together, try to drink plenty of nonalcoholic fluids to avoid becoming dehydrated, especially if you have vomiting or diarrhea. Dehydration can raise your risk of metabolic acidosis.

See your doctor if you develop symptoms of metabolic acidosis, which may include:

• loss of appetite
• headache
• confusion
• fast, shallow breathing
• increased heart rate
• extreme sleepiness
• feeling weak and generally unwell

If you develop metabolic acidosis, your doctor will likely prescribe medication to treat it. They may also recommend changes to your Topamax or metformin treatment to avoid the interaction happening again.

Interaction with Wellbutrin

Topamax can interact with bupropion (Wellbutrin SR, Wellbutrin XL, others), which is an antidepressant medication. These drugs have some similar side effects, such as sleepiness and memory problems. Bupropion can also make Topamax less effective at managing seizures.

What could happen

Taking Topamax with bupropion could raise your risk of side effects such as sleepiness or memory problems. As well, bupropion can lower your seizure threshold, which means you may be more likely to have a seizure. If you take Topamax for epilepsy, taking bupropion can make it harder for Topamax to manage your seizures.

What you can do

If you take Topamax for epilepsy, your doctor will likely not prescribe bupropion as well. They can discuss with you suitable alternatives.

If you take Topamax for migraine and you also take bupropion, tell your doctor if you have any bothersome side effects. They may recommend switching to a different antidepressant or migraine treatment to avoid the interaction.

Are there other interactions with Topamax?

Topamax may have other interactions. They could occur with foods, supplements, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Topamax.

Does Topamax interact with food?

Yes, it can. Following a ketogenic diet while taking Topamax can increase your risk of metabolic acidosis (a high level of acid in your bodily fluids). Untreated metabolic acidosis may increase your risk of kidney stones.

A ketogenic diet is one that’s high in fat and low in carbohydrates and protein. Following this type of diet can help reduce seizures in some people with epilepsy. But it may sometimes increase the amount of acid in the blood. Topamax can also increase the amount of acid in the blood.

If you follow a ketogenic diet or want to try it while taking Topamax, talk with your doctor. They can discuss with you whether it’s safe to do so while taking Topamax.

Does Topamax interact with supplements?

Before you start taking Topamax, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Topamax and herbs

There are currently no reports of Topamax interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Topamax.

Topamax and vitamins

There are currently no reports of Topamax interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Topamax.

Does Topamax interact with vaccines?

Topamax isn’t known to interact with vaccines. For information about getting certain vaccines during Topamax treatment, talk with your doctor.

Does Topamax interact with lab tests?

Topamax hasn’t been reported to interact with lab tests. If you’re interested in learning more about having certain lab tests while taking Topamax, talk with your doctor.

Does Topamax interact with cannabis or CBD?

There are currently no reports of Topamax interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Topamax.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Does my health history affect whether I should take Topamax?

Certain medical conditions or other health factors may raise the risk of interactions with Topamax. Before taking Topamax, talk with your doctor about your health history. They’ll determine whether Topamax is right for you.

Health conditions or other factors that might interact with Topamax include:

Eye conditions. Topamax can sometimes cause eye problems, such as glaucoma. If you already have an eye condition, Topamax could make it worse. Talk with your doctor about whether this drug is right for you. If you take Topamax, contact your doctor if you have any changes in your vision.

Liver problems. In people who have liver problems, Topamax may increase the risk of a high level of ammonia in the blood. If you have liver problems, talk with your doctor about whether Topamax is right for you.

Kidney problems. Having kidney problems may affect how your body rids itself of Topamax. These problems may also increase the risk of metabolic acidosis with Topamax. If metabolic acidosis is not treated, it can lead to kidney stones.

If you have kidney problems, tell your doctor before you start taking Topamax. They can let you know whether Topamax is safe for you. If you do take Topamax, your doctor may prescribe a dosage that’s different than usual.

Severe breathing problems. People withsevere breathing problems may have an increased risk of metabolic acidosis from taking Topamax. If you have a lung condition, such as asthma or chronic obstructive pulmonary disease (COPD), let your doctor know. This will help them determine whether Topamax is a good treatment option for you.

Diarrhea. If you have frequent or uncontrolled diarrhea, you may have an increased risk of metabolic acidosis with Topamax. Your doctor can discuss with you whether Topamax is right for you.

Weak, soft, or brittle bones. Topamax can cause metabolic acidosis. If this side effect goes untreated, it can lead to weakening of the bones. This could worsen conditions such as osteoporosis, osteomalacia, and rickets. If you already have problems with weak, brittle, or soft bones, talk with your doctor about whether Topamax is safe for you to take.

Mental health problems. Taking a seizure medication, such as Topamax, can increase the risk of suicidal thoughts and actions. If you’ve ever had mental health problems, such as depression or suicidal thoughts, tell your doctor. This will help them determine whether Topamax is right for you.

Pregnancy. If taken during pregnancy, Topamax may harm a developing fetus. If you’re pregnant or planning to become pregnant, talk with your doctor about other medications that may be safer for your condition.

Breastfeeding. Topamax can pass into breast milk. As a result, it may cause side effects such as sleepiness and diarrhea in a child who’s breastfed. If you’re breastfeeding or plan to breastfeed, talk with your doctor about the risks and benefits of taking Topamax. Your doctor can also advise you on other healthy ways to feed your child.

Allergic reaction. If you’ve had an allergic reaction to Topamax or any of its ingredients, your doctor will likely not prescribe Topamax. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Common questions about Topamax and interactions

Find answers to some frequently asked questions about Topamax and possible interactions.

What allergy medicine can I take with Topamax?

Certain allergy medications can interact with Topamax, but there are also plenty that don’t.

For instance, it’s best to avoid taking antihistamines that have a sedating effect (causes feelings of drowsiness or relaxation) with Topamax. An example of a sedating antihistamine is diphenhydramine (Benadryl). Taking this type of allergy medicine with Topamax could make you very sleepy, confused, or unable to concentrate.

However, it’s usually safe to take nonsedating antihistamines such as loratadine (Claritin) or cetirizine (Zyrtec Allergy) with Topamax. It’s also considered safe to use corticosteroid nasal sprays such as fluticasone (Flonase Allergy Relief) with Topamax.

If you need to use an allergy medicine while taking Topamax, ask your doctor or pharmacist to recommend a suitable product.

Are there interactions between prednisone and Topamax?

No, Topamax hasn’t been reported to interact with prednisone (Rayos).

Prednisone is a type of drug called a corticosteroid. It’s used to reduce inflammation (swelling and damage) caused by many conditions. It’s generally considered safe to take Topamax together with prednisone.

If you have questions about taking prednisone with Topamax, talk with your doctor or pharmacist.

How can I prevent interactions?

Taking certain steps can help you avoid interactions with Topamax. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Topamax treatment.

It’s also important to read Topamax’s label and other paperwork that may come with the drug.

You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Topamax, ask your pharmacist to print a copy for you.) If you have trouble understanding this information, your doctor or pharmacist can help.

Taking Topamax exactly as prescribed can also help prevent interactions.

What should I ask my doctor?

If you still have questions about Topamax and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Does my risk of interactions depend on my dosage of Topamax?
• Could I still take Topamax even if it interacts with a health condition I have?
• If I take Topamax and have certain health conditions, will I be monitored more closely during treatment?
• Do other drugs that could treat my condition have similar interactions?
• Are there forms of birth control that don’t interact with Topamax?

To learn more about Topamax, see these articles:

• What is Topamax?
• Dosage for Topamax: What You Need to Know
• Side Effects of Topamax: What You Need to Know

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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.