Topiramate, Oral Tablet

Medically reviewed by University of Illinois-Chicago, Drug Information Group on June 15, 2017Written by University of Illinois-Chicago, Drug Information Group on December 9, 2017

Highlights for topiramate

  1. Topiramate oral tablet is available as a brand-name drug and a generic drug. Brand name: Topamax.
  2. Topiramate comes in four forms: immediate-release tablets, immediate-release sprinkle capsules, extended-release capsules, and extended-release sprinkle capsules. All forms are taken by mouth.
  3. Topiramate oral tablet is used to treat certain types of seizures and to prevent migraine headaches.

Important warnings

  • Metabolic acidosis warning: This drug may raise your risk of a medical condition called metabolic acidosis. This can come on with no symptoms. Or it may happen with side effects on the kidneys (kidney stones), bones (osteoporosis, increased risk of broken bones), or growth delays. Symptoms of this condition include:
    • hyperventilation (rapid breathing)
    • tiredness
    • loss of appetite
    • changes in your heart rhythm
    • trouble thinking clearly
  • Vision loss warning: This drug can cause a blockage of fluid in your eye, which results in increased pressure in the eye. This can lead to permanent vision loss.
  • Birth defects warning: This drug can cause birth defects if it’s taken during pregnancy. These birth defects can occur early in pregnancy, before a woman even knows she’s pregnant. Women of childbearing age should use effective forms of birth control while taking this drug. Ask your doctor about good options. This drug can cause birth control pills to be less effective.

What is topiramate?

Topiramate is a prescription drug. It comes in four forms: immediate-release tablets, immediate-release sprinkle capsules, extended-release capsules, and extended-release sprinkle capsules. All forms are taken by mouth.

Topiramate oral tablet is available as the brand-name drug Topamax. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

This drug may be taken in combination with other drugs to treat epilepsy.

Why it's used

Topiramate oral tablet is used to:

  • treat certain types of seizures alone (without use of other drugs). The seizures treated are partial onset seizures and primary generalized tonic-clonic seizures.
  • treat certain types of seizures in combination with other drugs. The seizures treated are partial onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome.
  • prevent migraine headaches.

How it works

Topiramate belongs to a class of drugs called sulfamate-substituted monosaccharide anticonvulsants or antiepileptic drugs (AEDs). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how this drug works. It’s thought that it works on certain chemicals, channels, receptors, and enzymes in your brain to help control seizures and prevent migraines.

Topiramate side effects

Topiramate oral tablet causes drowsiness. You shouldn’t drive, use machinery, or do other tasks that require alertness until you know how this drug affects you.

This drug can also cause other side effects.

More common side effects

The more common side effects of topiramate include:

  • tingling in your arms and legs
  • increased bleeding (such as nosebleeds)
  • increased bruising
  • loss of appetite
  • nausea
  • a change in the way foods taste
  • diarrhea
  • weight loss
  • nervousness
  • upper respiratory tract infection
  • speech problems
  • tiredness
  • dizziness
  • slowed reactions
  • trouble with memory
  • abdominal pain
  • fever
  • eye problems (such as double vision, blurred vision, and uncontrolled eye movements)

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • High ammonia levels. Symptoms can include:
    • confusion
    • slowed alertness
    • tiredness
    • vomiting
  • Kidney stones. Symptoms can include:
    • severe pain in the back or side
    • painful or frequent urination
    • pink, red, or brown urine
    • nausea or vomiting
  • Effects on thinking and alertness, such as:
    • confusion
    • problems concentrating, remembering, paying attention, and speaking
  • Dizziness or loss of muscle coordination
  • Eye problems (especially during the first month of treatment). Symptoms can include:
    • a sudden decrease in ability to see distances, with or without pain and redness
    • a blockage of fluid in your eye causing increased pressure in the eye (secondary angle closure glaucoma), which can lead to permanent vision loss
  • Fever and decreased sweating
  • Metabolic acidosis (increased level of acid in your body). Symptoms can include:
    • hyperventilation (rapid breathing)
    • feeling tired
    • loss of appetite
    • changes in your heart rhythm
    • trouble thinking clearly
  • Suicidal thoughts or actions. Symptoms can include:
    • thoughts about suicide or dying
    • attempts to commit suicide
    • new or worsened depression
    • new or worsened anxiety
    • feeling agitated or restless
    • panic attacks
    • trouble sleeping
    • new or worsened irritability
    • anger
    • acting aggressive or violent
    • acting on dangerous impulses
    • an extreme increase in activity and talking (mania)
    • other unusual behavior or mood changes

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Topiramate may interact with other medications

Topiramate oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with topiramate are listed below.

Allergy drugs

Allergy drugs slow down the central nervous system. If you take ones of these drugs with topiramate, it increases your risk of certain side effects. These include drowsiness, dizziness, and trouble concentrating or thinking. Examples of these drugs include:

  • diphenhydramine
  • chlorpheniramine
  • hydroxyzine

Antidepressant

Taking amitriptyline with topiramate may increase the levels of amitriptyline in your body. This may lead to increased side effects. Talk to your doctor about whether amitriptyline is safe for you to take with topiramate.

Anxiety drugs

Anxiety drugs slow down the central nervous system. If you take ones of these drugs with topiramate, it increases your risk of certain side effects. These include drowsiness, dizziness, and trouble concentrating or thinking. Examples of these drugs include:

  • alprazolam
  • clonazepam
  • diazepam
  • lorazepam

Diabetes drugs

Taking glyburide or pioglitazone with topiramate may decrease the levels of these diabetes drugs in your body. This may cause these drugs to be less effective in controlling your blood sugar. If you’re taking one of these diabetes drugs with topiramate, your doctor should monitor your blood sugar closely.

Taking metformin with topiramate may put you at risk of certain side effects. This is especially true if you have metabolic acidosis. Talk to your doctor about whether metformin is safe for you to take with topiramate.

Heart drugs

Taking digoxin with topiramate can increase the levels of digoxin in your body. This may lead to increased side effects.

Taking diltiazem with topiramate can cause increased or decreased levels of both diltiazem and topiramate. Talk to your doctor about whether diltiazem is safe for you to take with topiramate.

Diuretic (water pill)

Taking hydrochlorothiazide with topiramate may increase the levels of topiramate in your body. This may lead to more side effects. Your doctor may decrease your dosage of topiramate if you need to take it with hydrochlorothiazide.

Insomnia drugs

These drugs slow down the central nervous system. If you take ones of these drugs with topiramate, it increases your risk of certain side effects. These include drowsiness, dizziness, and trouble concentrating or thinking. Examples of these drugs include:

  • zolpidem
  • eszopiclone
  • triazolam
  • temazepam

Bipolar disorder drug

Taking lithium with high doses of topiramate may increase lithium levels in your body. This can lead to more side effects. Your doctor should monitor your lithium levels if you’re taking high doses of topiramate.

Menopause drugs

Taking pills that contain estrogen with topiramate can make these pills less effective. This means they won’t work as well to prevent symptoms of menopause, such as hot flashes.

Oral birth control pills

Taking oral birth control pills with topiramate can make these pills less effective. This means they won’t work as well to prevent pregnancy.

Pain drugs

These drugs slow down the central nervous system. If you take one of these drugs with topiramate, it increases your risk of certain side effects. These include drowsiness, dizziness, and trouble concentrating or thinking. Examples of these drugs include:

  • hydrocodone
  • oxycodone
  • morphine
  • hydromorphone

Seizure drugs

Taking certain seizure drugs with topiramate can decrease the levels of topiramate in your body. That means topiramate may not work as well. Examples of these drugs include:

  • phenytoin
  • carbamazepine
  • lamotrigine
  • valproic acid

In addition, taking topiramate with valproic acid can lead to high levels of ammonia in your blood or a drop in body temperature.

Other drugs

Taking topiramate with these drugs can increase the severity of metabolic acidosis and increase your risk of kidney stones. If you’re taking these drugs with topiramate, your doctor should monitor you for new or worsening metabolic acidosis.

Examples of these drugs include:

  • zonisamide
  • acetazolamide
  • dichlorphenamide

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Topiramate warnings

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

  • rash or hives
  • swelling of the tongue, lips, or face
  • trouble breathing

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Food interactions warning

If you follow a ketogenic diet while taking topiramate, you are at increased risk of a condition called metabolic acidosis. This can occur with no symptoms. Or it may occur with side effects such as kidney stones, osteoporosis or increased risk of broken bones, or growth delays. (A ketogenic diet is a high-fat, low-carbohydrate diet sometimes used to help reduce symptoms in epilepsy.)

Alcohol interaction warning

You shouldn’t drink alcohol while taking topiramate. Taking this drug with alcohol may make your sleepiness and dizziness worse.

Warnings for people with certain health conditions

For people with liver disease: If you have liver problems, this drug may build up in your body. This can increase your risk of side effects.

For people with kidney disease: This drug is cleared from your body by your kidneys. If you have kidney problems, your body can’t clear this drug as well. This may lead to more side effects. Your doctor will give you a lower dosage to reduce your risks.

For people with severe asthma or COPD: You have an increased risk of a condition called metabolic acidosis. This can occur with no symptoms. Or it may occur with side effects such as kidney stones, osteoporosis or increased risk of broken bones, or growth delays.

Warnings for other groups

For pregnant women: Research in humans has shown negative effects to the fetus when the mother takes topiramate. This drug can cause birth defects. These birth defects can occur early in pregnancy, before a woman even knows that she’s pregnant. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask them to tell you about the specific harm that may be done with this drug. It should only be used if the potential risk is acceptable given the drug’s potential benefit.

Women of childbearing age should use effective forms of birth control while taking this drug. Ask your doctor about good options. You should be aware that this drug can cause birth control pills to be less effective.

Pregnant women who do take this drug should enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry. The registry collects information about the safety of antiepileptic drugs during pregnancy. Your doctor can tell you more.

For women who are breastfeeding: This drug passes into breast milk and may cause serious effects in a child who is breastfed. Talk to your doctor about the risks and benefits of using this drug while breastfeeding your child.

For children: For treating seizures: It has not been established that topiramate is safe or effective in children younger than 2 years.

For preventing migraine headaches: It has not been established that topiramate is safe or effective in children younger than 12 years.

How to take topiramate

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Drug forms and strengths

Generic: Topiramate

  • Form: oral tablet
  • Strengths: 25 mg, 50 mg, 100 mg, 200 mg

Brand: Topamax

  • Form: oral tablet
  • Strengths: 25 mg, 50 mg, 100 mg, 200 mg

Dosage for epilepsy (monotherapy)

Partial seizures or generalized tonic-clonic seizures

Adult dosage (ages 18–64 years)

  • Typical dosage of topiramate alone: 400 mg per day. This drug should be taken twice a day, in two divided doses.
  • Dosage increases: Your doctor will start you at a lower dosage. They will slowly increase your dosage until you reach the recommended amount.

Child dosage (ages 10–17 years)

  • Typical dosage of topiramate alone: 400 mg per day. This drug should be taken twice a day, in two divided doses.
  • Dosage increases: Your child’s doctor will start your child at a lower dosage. They will slowly increase the dosage until the recommended amount is reached.

Child dosage (ages 2–10 years)

  • Typical dosage of topiramate alone: Your child’s dosage will be based on their weight. This drug should be taken twice a day, in two equally divided doses.
  • Dosage increases: Your child’s doctor will start your child at a lower dosage. They will slowly increase the dosage until your child reaches the recommended amount.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for epilepsy (add-on therapy)

Adult dosage (ages 17–64 years)

Partial onset seizures:

  • Typical dosage of topiramate as add-on therapy: 200–400 mg per day. This drug should be taken twice a day, in two divided doses.
  • Dosage increases: Your doctor will start you at a lower dosage. They will slowly increase your dosage until you reach the recommended amount.

Primary generalized tonic-clonic seizures:

  • Typical dosage of topiramate as add-on therapy: 400 mg per day. This drug should be taken twice a day, in two divided doses.
  • Dosage increases: Your doctor will start you at a lower dosage. They will slowly increase your dosage until you reach the recommended amount.

Child dosage (ages 2–16 years)

Partial onset seizures, generalized tonic-clonic seizures, and Lennox-Gastaut syndrome:

  • Typical dosage of topiramate as add-on therapy:
    • Your child’s dosage will be based on their weight. The typical daily dosage is 5–9 mg/kg of body weight.
    • This drug should be taken twice a day, in two equally divided doses. During the first week, it should be taken at night.
  • Dosage increases: Your child’s doctor will start your child at a lower dosage. They will slowly increase the dosage until they reach an amount that works for your child.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for migraine prevention

Adult dosage (ages 18–64 years)

  • Typical dosage: 100 mg per day. This drug should be taken twice a day, in two divided doses.
  • Dosage increases: Your doctor will start you at a lower dosage. They will slowly increase your dosage until you reach the recommended amount.

Child dosage (ages 12–17 years)

  • Typical dosage: 100 mg per day. This drug should be taken twice a day, in two divided doses.
  • Dosage increases: Your child’s doctor will start your child at a lower dosage. They will slowly increase the dosage until the recommended amount is reached.

Child dosage (ages 0–11 years)

The effectiveness of this drug hasn’t been established in children younger than 12 years.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special dosage considerations

For people with kidney disease: If you have kidney problems, your dosage of topiramate should be half of the typical adult dosage.

For people with hemodialysis: Dialysis clears this drug from your body much more quickly than normal. If you are on dialysis for a long time, topiramate might drop to a level lower than what’s needed to control your seizures. Your doctor may give you an extra dose to prevent this.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Topiramate oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your seizures may not be controlled. If you stop taking this drug suddenly, it can cause serious problems. It could lead to seizures that don’t stop (status epilepticus). This is a medical emergency.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • convulsions
  • drowsiness
  • trouble speaking
  • blurred or double vision
  • slowed thinking or confusion
  • extreme tiredness or drowsiness
  • problems with coordination
  • feeling like you’re in a daze
  • low blood pressure
  • stomach pain
  • feeling agitated or nervous
  • dizziness
  • depression

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you miss one dose of this drug, you should take it as soon as possible. If it’s within 6 hours of your next scheduled dose, you should skip the missed dose and only take one dose at your scheduled time.

Don’t take a double dose if you’ve missed a dose. If you have missed more than one dose, contact your healthcare provider.

How to tell if the drug is working: You should have better seizure control, or fewer migraines.

Important considerations for taking topiramate

Keep these considerations in mind if your doctor prescribes topiramate for you.

General

  • You can take this drug with or without food.
  • Drink plenty of fluids throughout the day. This may help prevent kidney stones.

Storage

  • This drug must be stored at the right temperature. Store the tablets at room temperature between 59°F (15°C) and 86°F (30°C).
  • Keep this drug in a tightly closed container.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

During treatment with this drug, your doctor may do tests to check your:

  • eyes
  • liver function
  • kidney function
  • blood counts
  • electrolyte levels
  • ammonia levels
  • mental status
  • weight

Your doctor may also monitor you for the following:

  • seizures. You and your doctor should monitor how often you have seizures.
  • mental health and behavioral problems. This drug can cause new mental health and behavioral problems, or worsen existing problems. You and your doctor should watch for any unusual changes in your behavior and mood.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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 other healthcare professional before taking any medication. The drug information contained here in 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.

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