Topamax Side Effects

Generic Name: topiramate

Note: This page contains side effects data for the generic drug topiramate. It is possible that some of the dosage forms included below may not apply to the brand name Topamax.

It is possible that some side effects of Topamax may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to topiramate: oral capsule, oral capsule extended release, oral tablet

As well as its needed effects, topiramate (the active ingredient contained in Topamax) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking topiramate, check with your doctor immediately:

More common
  • Any vision problems, especially blurred vision, double vision, eye pain, or rapidly decreasing vision
  • burning, prickling, or tingling sensations
  • clumsiness or unsteadiness
  • confusion
  • continuous, uncontrolled back-and-forth or rolling eye movements
  • dizziness
  • drowsiness
  • eye redness
  • generalized slowing of mental and physical activity
  • increased eye pressure
  • memory problems
  • menstrual changes
  • menstrual pain
  • nervousness
  • speech or language problems
  • trouble in concentrating or paying attention
  • unusual tiredness or weakness
Less common
  • Abdominal or stomach pain
  • fever, chills, or sore throat
  • lessening of sensations or perception
  • loss of appetite
  • mood or mental changes, including aggression, agitation, apathy, irritability, and mental depression
  • red, irritated, or bleeding gums
  • weight loss
  • Blood in the urine
  • decrease in sexual performance or desire
  • difficult or painful urination
  • frequent urination
  • hearing loss
  • loss of bladder control
  • lower back or side pain
  • nosebleeds
  • pale skin
  • red or irritated eyes
  • ringing or buzzing in the ears
  • skin rash or itching
  • swelling
  • trouble breathing
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • blisters in the mouth
  • blisters on the trunk, scalp, or other areas
  • bloating
  • clay-colored stools
  • constipation
  • cough
  • diarrhea
  • increased rate of breathing
  • joint or muscle pain
  • pain or tenderness in upper abdomen or stomach
  • red skin lesions, often with a purple center
  • sores, ulcers, or white spots in the mouth or on the lips
  • yellow eyes or skin

If any of the following symptoms of overdose occur while taking topiramate, get emergency help immediately:

Symptoms of overdose
  • Decreased awareness or responsiveness
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • severe sleepiness
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Some topiramate side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Breast pain in women
  • tremors
Less common
  • Back pain
  • chest pain
  • constipation
  • heartburn
  • hot flushes
  • increased sweating
  • leg pain

For Healthcare Professionals

Applies to topiramate: oral capsule, oral capsule extended release, oral tablet


General side effects including fatigue, fever, and malaise have been reported to occur frequently. Oligohidrosis, pain, chest pain, and hyperthermia have also been reported.[Ref]

Nervous system

The majority of cognitive-related adverse events were mild to moderate in severity and frequently occurred in isolation. Rapid titration rate and higher initial doses were associated with higher incidences of cognitive-related adverse events.[Ref]

Nervous system side effects have been common and have included somnolence, dizziness (greater than 25%), ataxia, speech disorders, psychomotor slowing, hypokinesia, vertigo, grand mal seizures, diplopia, nystagmus, tinnitus, and paresthesias. These nervous system adverse reactions do not appear to be dose-related. Dose-related adverse effects have included fatigue (frequently), nervousness, difficulty with concentration or attention, confusion, psychomotor slowing, difficulty with concentration/attention, difficulty with memory, speech, or language problems (particularly word finding difficulties), and tremor. Headache, vertigo, sensory disturbance, and aggravated migraine have also been reported. A case has been reported of cerebrospinal fluid acidosis associated with hyperventilation that was probably caused by topiramate.[Ref]


Hepatic side effects including hepatic failure (sometimes fatal) and hepatitis have been reported.[Ref]


Ocular side effects including cases of secondary angle closure glaucoma characterized by ocular pain, acute myopia, abnormal accommodation, and increased intraocular pressure have been reported. Maculopathy has also been reported.[Ref]

The primary treatment of cases of secondary angle closure glaucoma cause by topiramate is discontinuation of the drug.[Ref]


Gastrointestinal side effects include diarrhea, vomiting, pancreatitis, gastroenteritis, constipation, gastroesophageal reflux, tooth disorder, and flatulence have been reported. Tongue edema has been reported rarely.[Ref]


Cardiovascular side effects including palpitations have been reported frequently. Hypertension and hypotension have been reported infrequently.[Ref]


Hematologic side effects including anemia and epistaxis have been a reported frequently.[Ref]


Metabolic side effects have included metabolic acidosis, dehydration, diabetes mellitus, and weight increase.[Ref]


Musculoskeletal side effects including arthralgia, myalgia, and muscle weakness have been reported. A case of hemiparesis has also been reported.[Ref]


Psychiatric side effects including insomnia, personality disorder, impotence, hallucination, euphoria, psychosis, decreased libido, anxiety, depression, mood problems, and suicide attempts have been reported. Two cases of panic attacks have also been reported.[Ref]

Depression and mood problems were dose related.[Ref]


Genitourinary side effects in the female frequently have included intermenstrual bleeding, leukorrhea, menorrhagia, vaginitis, and amenorrhea. Urinary tract infections, micturition frequency, urinary incontinence, dysuria, and renal calculus have also been reported frequently. Cases of reversible anorgasmia have also been reported. Kidney stones (1.5%) have occurred more frequently in men.[Ref]


Respiratory side effects including pulmonary embolism, coughing, pneumonia, asthma, and bronchitis have been reported.[Ref]


Dermatologic side effects including bullous skin reactions (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), pemphigus, acne, rash, and alopecia have been reported. Pruritus has been reported rarely.[Ref]


Other side effects including taste perversion have been reported frequently. Headaches have also been reported to occur.[Ref]


Renal side effects including kidney stones (1.3% to 1.5%) and renal tubular acidosis have been reported.[Ref]


Hypersensitivity side effects including allergic reaction have been reported.[Ref]


Immunologic side effects have been reported including infection and genital moniliasis.[Ref]


1. Sharief M, Viteri C, Ben-Menachem E, et al. "Double-blind, placebo-controlled study of topiramate in patients with refractory partial epilepsy." Epilepsy Res 25 (1996): 217-24

2. "Product Information. Topamax (topiramate)." Ortho Pharmaceutical Corporation, Raritan, NJ.

3. Shorvon SD "Safety of topiramate: adverse events and relationships to dosing." Epilepsia 37(suppl 2 (1996): s18-22

4. Montcriol A, Meaudre E, Kenane N, Asencio Y, Bordes J, Palmier B "Hyperventilation and cerebrospinal fluid acidosis caused by topiramate." Ann Pharmacother 42 (2008): 584-7

5. Stephen LJ, Maxwell JE, Brodie MJ "Transient hemiparesis with topiramate." Br Med J 318 (1999): 845

6. Bjoro K, Gjerstad L, Bentdal O, Osnes S, Schrumpf E "Topiramate and fulminant liver failure." Lancet 352 (1998): 1119

7. Damsa C, Warczyk S, Cailhol L, et al. "Panic attacks associated with topiramate." J Clin Psychiatry 67 (2006): 326-7

8. Newman LC, Broner SW, Lay CL "Reversible anorgasmia with topiramate therapy for migraine." Neurology 65 (2005): 1333-4

9. Ochoa JG "Pruritus, a rare but troublesome adverse reaction of topiramate." Seizure 12 (2003): 516-8

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.