Generic Name: topiramate (toe PYRE a mate)
Brand Name: Topamax, Trokendi XR

What is topiramate?

Topiramate is a seizure medication, also called an anticonvulsant.

Topiramate is used alone or in combination with other medications to treat seizures in adults and children who are at least 2 years old. Trokendi XR (topiramate extended-release capsule) is for use in adults and children who are at least 6 years old.

Topiramate is also used to prevent migraine headaches in adults. Topiramate will only prevent migraine headaches or reduce the number of attacks. It will not treat a headache that has already begun.

Topiramate may also be used for purposes not listed in this medication guide.

What is the most important information I should know about topiramate?

You should not use a topiramate extended-release capsule if you have recently used alcohol (within the past 6 hours), or if you have metabolic acidosis and are also taking metformin (an oral diabetes medicine).

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What should I discuss with my healthcare provider before taking topiramate?

You should not use topiramate if you are allergic to it.

You should not use a topiramate extended-release capsule (Trokendi XR) if you have recently used alcohol (within the past 6 hours), or if you have metabolic acidosis and are also taking metformin (an oral diabetes medicine).

To make sure topiramate is safe for you, tell your doctor if you have:

  • kidney disease, a history of kidney stones, or if you are on dialysis;

  • liver disease;

  • glaucoma or other eye problems;

  • a history of depression or suicide attempt;

  • a growth disorder;

  • a history of metabolic acidosis;

  • osteoporosis or low bone density;

  • asthma, emphysema, or other breathing disorder;

  • if you are sick with diarrhea;

  • if you take other seizure medication; or

  • if you are pregnant or plan to become pregnant while using topiramate.

Some people have thoughts about suicide when first taking an anticonvulsant. Your doctor will need to check your progress at regular visits while you are using topiramate. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category D. Do not start or stop taking topiramate during pregnancy without your doctor's advice. Taking topiramate during pregnancy may increase the risk of cleft lip and/or cleft palate in the newborn. But having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant while taking topiramate for seizures.

Seizure control is very important during pregnancy. The benefit of preventing seizures may outweigh any risks posed by taking topiramate. There may be other seizure medications that can be more safely used during pregnancy. Follow your doctor's instructions about taking this medicine while you are pregnant.

Topiramate can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking topiramate. If you are not planning a pregnancy while taking topiramate, use effective birth control, and tell your doctor if you become pregnant during treatment.

Topiramate can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I take topiramate?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Topiramate can be taken with or without food.

Do not crush, chew, break, or open a Trokendi XR extended-release capsule or Topamax tablet. Swallow it whole.

You may open the Topamax Sprinkle Capsule and sprinkle the medicine into a spoonful of applesauce or other soft food to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

Drink plenty of liquids while you are taking topiramate. This will lower your risk of having kidney stones or an electrolyte imbalance. Call your doctor if you have ongoing vomiting or diarrhea. You can easily become dehydrated while taking this medication.

If you need surgery, tell the surgeon ahead of time that you are using topiramate. You may need to stop using the medicine for a short time.

Do not stop using topiramate suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose.

Contact your doctor if your seizures get worse or you have them more often while taking topiramate.

While using topiramate, you may need frequent blood tests. Your kidney or liver function may also need to be checked.

Wear a medical alert tag or carry an ID card stating that you take topiramate. Any medical care provider or dentist who treats you should know that you are taking a seizure medication.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

If you are less than 6 hours late in taking your medicine, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Call your doctor for instructions if you miss two or more doses.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, dizziness, agitation, depression, thinking problems, lack of energy, double vision, problems with speech or coordination, stomach pain, feeling light-headed, fainting, and seizure (convulsions).

What should I avoid while taking topiramate?

Topiramate may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Avoid drinking alcohol. It can increase certain side effects of topiramate, and can also increase your risk of a seizure. Do not drink alcohol within 6 hours before or 6 hours after you take a topiramate extended-release capsule (Trokendi XR).

Ketogenic or "ketosis" diets that are high in fat and low in carbohydrates can increase the risk of kidney stones. Avoid the use of such diets while you are taking topiramate.

Topiramate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • vision problems, pain around or behind your eyes, sudden vision loss;

  • confusion, slowed thinking, memory problems, trouble concentrating, problems with speech or balance;

  • vomiting, loss of appetite, feeling tired, irregular heartbeats, feeling like you might pass out; or

  • fever, chills, or other flu symptoms;

  • dry mouth, increased thirst, drowsiness, decreased sweating, increased body temperature, and hot, dry skin; or

  • severe pain in your side or lower back, painful or difficult urination.

Common side effects may include:

  • numbness or tingling in your arms and legs;

  • mild dizziness or drowsiness, feeling nervous;

  • changes in your sense of taste;

  • flushing (warmth, redness, or tingly feeling);

  • diarrhea, weight loss; or

  • cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect topiramate?

Taking this medicine with other drugs that make you sleepy or slow your breathing can worsen these effects. Ask your doctor before taking topiramate with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with topiramate, especially:

  • divalproex sodium;

  • metformin; or

  • valproic acid.

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 interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about topiramate.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 13.02. Revision Date: 2013-09-16, 12:31:13 PM.

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