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How fast does Trokendi XR work for migraines?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 15, 2024.

Official answer

by Drugs.com

You should see your migraine headaches subside within the first month of taking Trokendi XR, but not all patients have a response to the medicine. About 50% of patients have been shown to respond to Trokendi XR in clinical trials. On average, most patients see about 2 fewer migraine headaches per month when using Trokendi XR. Your dose will be slowly increased over a 4-week period.

Trokendi XR taken once a day provides steady blood levels comparable to immediate-release topiramate taken every 12 hours, when given at the same total daily dose (200 mg in studies).

  • In clinical trials evaluating immediate-release topiramate 100 mg/day and 200 mg/day in patients with migraine (ranging from 12 to 70 years of age), about half of patients saw their number of migraine headaches per month reduce by one-half when compared to a placebo.
  • These patients had on average 5.5 migraine headaches per month, and over 28 days saw 2.1 fewer migraine headaches per month compared to 0.8 fewer migraines per month in the placebo group.

Trokendi XR is an extended-release capsule form of topiramate that you take once per day to prevent migraine headaches. It delivers medication coverage for your migraine headache over a 24-hour period. Topiramate will not stop a migraine once it has started.

Trokendi XR is also approved to help prevent certain types of seizures in adults and children who are at least 6 years old.

How do I take Trokendi XR?

The recommended dose of Trokendi XR tablets to help prevent migraine headaches in patients 12 years of age and older is 100 mg once a day. This dose is titrated (slowly increased) over a 4 week period to help you tolerate the medicine better and so that your doctor can observe the benefit.

The recommended titration schedule for Trokendi XR for migraine prevention for adults and adolescents 12 years of age and older is:

  • Week 1: 25 mg once daily
  • Week 2: 50 mg once daily
  • Week 3: 75 mg once daily
  • Week 4: 100 mg once daily

Swallow the capsules whole. Do not break, crush, chew, dissolve or sprinkle the capsule contents on food. If you cannot swallow capsules, tell your healthcare provider.

Do not drink any alcohol within 6 hours before you take Trokendi XR and for 6 hours after you take it.

You can take Trokendi XR with or without food. Drink plenty of fluids during the day to help prevent kidney stones.

Your dose and titration may vary based on your clinical response as determined by your doctor. Do not adjust your medicine dose or stop treatment without talking to your doctor first. Stopping treatment suddenly may lead to serious side effects.

Learn more: Trokendi XR dose (in more detail)

This is not all the information you need to know about Trokendi XR (topiramate extended-release capsule) for safe and effective use. Review the full patient information here and discuss this and any questions you have with your doctor or other health care provider.

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References
  • Brandes JL, Saper JR, Diamond M, et al; MIGR-002 Study Group. Topiramate for migraine prevention: a randomized controlled trial. JAMA. 2004 Feb 25;291(8):965-73. doi: 10.1001/jama.291.8.965. PMID: 14982912.
  • Silberstein SD, Neto W, Schmitt J, et al; MIGR-001 Study Group. Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol. 2004 Apr;61(4):490-5. doi: 10.1001/archneur.61.4.490. PMID: 15096395.
  • Smith J. Preventive treatment of episodic migraine in adults. Up to Date. Revised Jan. 7, 2021. Accessed March 25, 2021 at https://www.uptodate.com/contents/preventive-treatment-of-episodic-migraine-in-adults
  • Trokendi XR (topiramate extended-release capsules) product information. Revised 11/2020. Supernus Pharmaceuticals, Inc., Rockville, Maryland. Accessed March 25, 2021 at https://www.trokendixr.com/assets/TrokendiXRPrescribingInformation.pdf

Read next

Yes, topiramate, the active ingredient in Trokendi XR has been shown to cause hair loss (alopecia) in clinical studies, but it is not a common side effect. Alopecia with topiramate has been reported in 1% to 4% of children ages 6 to 16 years of age, and in 3% to 4% of patients older than 16 years of age. Trokendi XR is an extended-release form of topiramate. Continue reading

Yes, topiramate (Topamax) has been shown to cause weight loss when used for both seizure control and migraine prevention. Topiramate by itself is not specifically approved by the FDA for weight loss, but is used in an "off-label" fashion for this condition. Qsymia, an extended-release medicine that contains phentermine and topiramate, is FDA approved for weight loss, along with diet and exercise. Continue reading

Yes, topiramate has been shown to cause hair loss in studies, but it is not a common side effect. Hair loss (also called alopecia) has been reported in 1% to 4% of children ages 6 to 16 years of age, and in 3% to 4% of patients older than 16 years of age. Higher daily doses (400 mg/day) of topiramate were associated with greater rates of hair loss than lower doses (50 mg/day) in both age groups. Continue reading

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