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

What is Topamax?

Topamax (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.

Topamax is also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. This medicine will only prevent migraine headaches or reduce the number of attacks. It will not treat a headache that has already begun.

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

Important information

Topamax may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant while taking Topamax for seizures. Do not start or stop taking this medicine during pregnancy without your doctor's advice.

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Seek emergency medical attention if you have a sudden change in vision or pain around or behind the eyes. These may be early signs of a serious and permanent side effect on your vision. Do not stop using Topamax without first talking to your doctor, even if you feel fine. You may have increased seizures if you stop using Topamax suddenly. You may need to use less and less before you stop the medication completely. Contact your doctor if your seizures get worse or you have them more often while taking this medicine.

Before taking this medicine

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

To make sure Topamax 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;

  • liver disease;

  • 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 Topamax. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Topamax 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 Topamax 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.

See also: Pregnancy and breastfeeding warnings (in more detail)

Topamax 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 Topamax. Tell your doctor right away 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 Topamax?

Take Topamax exactly as prescribed by your doctor. 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.

Topamax can be taken with or without food.

Do not chew, crush, or break a tablet. Swallow the tablet whole.

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 this medicine, to prevent kidney stones or an electrolyte imbalance.

Do not stop using Topamax 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 Topamax.

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 Topamax?

Do not drink alcohol. Dangerous side effects or increased seizures can occur when alcohol is combined with Topamax.

Avoid becoming overheated or dehydrated in hot weather. Topamax 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 Topamax.

Topamax 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.

Topamax side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Topamax: 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 Topamax 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 Topamax?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking Topamax 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 Topamax, especially:

  • birth control pills;

  • metformin;

  • 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.

Where can I get more information?

  • Your pharmacist can provide more information about Topamax.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Topamax 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 1996-2014 Cerner Multum, Inc. Version: 13.03. Revision Date: 2014-05-12, 7:24:18 AM.

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