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What not to take with topiramate?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on July 15, 2021.

Official answer

by Drugs.com

Do not drink alcohol while taking topiramate (brand examples: Topamax, Qudexy XR Trokendi XR). Dangerous side effects or increased seizures may occur. Increased sleepiness or dizziness may occur if you drink alcohol while taking topiramate.

Topiramate can cause drug interactions with other medicines and cause side effects. There may be certain medications you should avoid while taking topiramate. Do not start a new prescription or over-the-counter medicine without talking with your healthcare provider first.

Tell your healthcare provider if you take:

  • Valproic acid (brand name examples: Depakote). Taking topiramate when you are also taking valproic acid can cause a drop in your body temperature to less than 95 degrees F (35 degrees C), or can cause tiredness, confusion, or coma. Taking these medicines may also cause raised levels of ammonia in your blood.
  • Zonisamide (brand name example: Zonegran). Using zonisamide with topiramate can cause metabolic acidosis, a condition that causes high levels of acid in your blood. Combining these medicines may increase the risk and severity of this side effect.
  • Glaucoma medications, including eye drops.
  • Birth control pills. Topiramate may make your birth control pills less effective. Tell your doctor if you experience any breakthrough bleeding (menstrual bleeding changes) if you are taking birth control pills and topiramate. Ask your doctor about using a non-hormonal birth control (condom, diaphragm, cervical cap, or contraceptive sponge) to prevent pregnancy.
  • Any medicines that impair or decrease your thinking, concentration, or muscle coordination.

Not all possible drug interactions are listed above. This list is not complete and other medicines can affect topiramate. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter (OTC) medicines, vitamins, and herbal supplements.

Take a list of your medicines to your appointments so your doctor can review for any possible drug interactions. You can also take your medicine bottles (including OTC medications) with you and show them to your doctor if that is easier.

Learn more: Topiramate drug interactions (in more detail)

What else should I avoid while taking topiramate?

Avoid getting dehydrated. Drink plenty of fluids when taking topiramate. Also, avoid becoming overheated or dehydrated in hot weather. Topiramate can increase body temperature and decrease sweating, leading to life-threatening dehydration (especially in children).

It is also important to drink plenty of fluids when taking topiramate to decrease your chances of getting kidney stones.

Topiramate may cause drowsiness, dizziness, blurred vision or impair your thinking or reactions. Avoid driving or operating machinery until you know how topiramate will affect you.

Avoid the use of a ketogenic or "ketosis" diet (high in fat, low in carbohydrates) while you are taking topiramate.

Also avoid activities that could be dangerous if you have an unexpected seizure, such as swimming or climbing in high places.

Do not stop taking topiramate or change your dose without first talking to your doctor. Stopping suddenly or changing your dose on your own can cause serious health problems and may cause or worsen seizures.

All women of childbearing age should talk to their doctors about using other treatments instead of topiramate. Talk to your doctor before you become pregnant. If you take topiramate during pregnancy, your baby has a higher risk for birth defects called cleft lip and cleft palate. These defects can begin early in pregnancy, even before you know you are pregnant.

Also, talk to your doctor about the best form of birth control for you to use. If you are not pregnant or planning to become pregnant, use effective birth control to prevent pregnancy while taking topiramate.

It may not be safe to breastfeed a baby while you are using this medicine. Ask your doctor about any risks.

This is not all the information you need to know about topiramate (Topamax) for safe and effective use and does not take the place of talking to your doctor about your treatment. Review the full patient information for topiramate and discuss this information and any questions you have with your doctor or other health care provider.

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