Generic Name: topiramate (toe PYRE a mate)
Brand Name: Qudexy XR, Topamax, Topamax Sprinkle, Trokendi XR
What is topiramate?
Topiramate is a seizure medicine, also called an anticonvulsant. Topiramate is used to treat seizures in adults and children who are at least 2 years old. Trokendi XR is for use in adults and children who are at least 6 years old.
Extended-release topiramate has a higher minimum age (at least 10 years old) when used as the child's only seizure medicine.
The Topamax brand of this medicine is also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. Topamax 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 extended-release topiramate if you have metabolic acidosis and are also taking metformin. Do not take Trokendi XR within 6 hours of drinking alcohol.
What should I discuss with my healthcare provider before taking topiramate?
You should not use topiramate if you are allergic to it. Do not take Trokendi XR within 6 hours before or 6 hours after drinking alcohol. You should not use extended-release topiramate if you have metabolic acidosis (high levels of acid in your blood) and are also taking metformin for diabetes.
To make sure topiramate is safe for you, tell your doctor if you have:
glaucoma or other eye problems;
kidney disease, a history of kidney stones, or if you are on dialysis;
severe breathing problems;
a history of mood problems, depression, or suicidal thoughts or actions;
soft or brittle bones (osteoporosis, osteomalacia);
a growth disorder;
if you take lithium; or
if you are sick with diarrhea.
Some people have thoughts about suicide while 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.
Topiramate can increase the level of acid in your blood (metabolic acidosis). This can weaken your bones, cause kidney stones, or cause growth problems in children or harm to an unborn baby. You may need blood tests to make sure you do not have metabolic acidosis, especially if you are pregnant.
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. There may be other seizure medicine that can be more safely used during pregnancy. Tell your doctor right away if you become pregnant while taking topiramate.
Topiramate can make birth control pills less effective. Use a barrier form of birth control (such as a condom or diaphragm with spermicide) to prevent pregnancy while taking topiramate. 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, or break a topiramate tablet. Swallow it whole. The Trokendi XR extended-release capsule must be swallowed whole. Do not break or open.
The Qudexy XR and Topamax Sprinkle Capsule can be swallowed whole. Or you may open the capsule and sprinkle the medicine into a spoonful of applesauce or other soft food. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.
Carefully follow the swallowing instructions for your medicine.
While using topiramate, you may need frequent blood tests.
Drink plenty of liquids while you are taking topiramate, to prevent kidney stones or an electrolyte imbalance.
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.
Call your doctor if your seizures get worse or you have them more often while taking topiramate.
Any medical care provider who treats you should know that you take seizure medication.
Store at cool room temperature away from moisture, light, and high heat. Keep the bottle tightly closed when not in use.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if you are more than 6 hours late in taking it. Wait until 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, agitation, depression, double vision, thinking problems, problems with speech or coordination, fainting, and seizure (convulsions).
What should I avoid while taking topiramate?
Do not drink alcohol. Dangerous side effects or increased seizures can occur when alcohol is combined with topiramate.
Avoid becoming overheated or dehydrated in hot weather. Topiramate can decrease sweating and increase body temperature, leading to life-threatening dehydration (especially in children). This effect can be worse if you also use: cold or allergy medicine, bladder or urinary medicine, a bronchodilator, medicine for Parkinson's disease, or medicine to treat stomach ulcers or irritable bowel syndrome.
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 may cause blurred vision or impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you.
Also avoid activities that could be dangerous if you have an unexpected seizure, such as swimming or climbing in high places.
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 mood 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, eye pain or redness, sudden vision loss (can be permanent if not treated quickly);
confusion, slowed thinking, memory problems, trouble concentrating, problems with speech;
dehydration symptoms--decreased sweating, high fever, hot and dry skin;
signs of a kidney stone--severe pain in your side or lower back, painful or difficult urination;
signs of too much acid in your blood--irregular heartbeats, feeling tired, loss of appetite, trouble thinking, feeling short of breath; or
signs of too much ammonia in your blood--vomiting, unexplained weakness, feeling like you might pass out.
Common side effects may include:
numbness or tingling in your arms and legs;
flushing (warmth, redness, or tingly feeling);
headache, dizziness, drowsiness, tired feeling;
mood problems, confusion, feeling nervous, problems with thinking or memory;
changes in your sense of taste;
nausea, diarrhea, stomach pain, loss of appetite, indigestion, weight loss; or
rapid back-and-forth movements of the eyes.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. 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 can worsen this effect. 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:
birth control pills;
glaucoma medicine--acetazolamide, methazolamide; or
other seizure medicines--carbamazepine, divalproex sodium, phenytoin, valproic acid, or zonisamide.
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.
More about Topamax (topiramate)
Related treatment guides
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.
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