How effective is Topamax (topiramate) for weight loss?

Key Takeaways

Topamax (topiramate) has been shown to cause weight loss in adults and children when used for either seizure control or migraine prevention. In general, weight loss was seen in 6% to 17% of patients and tended to increase with higher doses. Anorexia (loss of appetite), which may contribute to weight loss, has been reported as a side effect.

Topiramate (used by itself) is not specifically approved by the FDA for weight loss, but some doctors may prescribe it if you have seizures or migraine and need to lose weight, too. However, side effects may hinder its use for weight loss when used alone.

Topiramate is available in an extended-release medicine approved for weight loss known as Qsymia (phentermine and topiramate). Phentermine is an appetite suppressant (anorexiant) with characteristics similar to amphetamine. Qsymia is used along with diet and exercise to treat people with obesity or overweight with other risk factors like high blood pressure, high cholesterol or type 2 diabetes.

How it's used

Topiramate is classified as an anticonvulsant (seizure) medication. It's a prescription medication, taken alone or with other drugs to control certain types of seizures due to epilepsy. Topiramate is used for the treatment of partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut Syndrome.

It is also used for the prevention of migraine headaches, but topiramate will not stop an acute migraine attack once it has started.

Brand names for single agent topiramate available in the U.S. include Topamax, Trokendi XR, Eprontia, and Qudexy XR. Uses and dosage forms differ among products, and they may not be interchangeable.

To learn more about weight loss medicines, see Weight Loss Drugs & Injections: What Are Your Options?

Studies and weight loss with topiramate

Weight loss was reported in studies of both children and adults taking topiramate. In general, weight loss was seen in 6% to 17% of patients, and increased with higher dosages.

Weight loss in adults

Seizure control - Side effects were assessed in patients 16 years and older taking topiramate (Topamax) alone (without other seizure medicines) at two doses: 50 mg / day or 400 mg / day. Weight loss and loss of appetite (anorexia) were two of the most commonly reported side effects.

In the patients taking the lower 50 mg / day dose of topiramate, weight loss occurred in 6% of patients, and in the higher 200 mg/day dose, weight loss was reported in 17% of patients. Anorexia (loss of appetite), which may lead to weight loss, was also seen in patients equal to 4% (50 mg / day dose) and 14% (200 mg / day dose).

When topiramate (Topamax) was studied in adults who used it in addition to other medicines (adjunctive treatment) for seizure control, weight loss occurred in 9% of patients receiving 200 mg / day to 400 mg / day, and 3% of those taking a placebo (an inactive pill). In children, these numbers were 9% and 1%, respectively.

Migraine prevention - In adults using doses of 50 mg / day for migraine prevention, 6% of patients experienced weight loss, while in the 100 mg / day group, 9% of patients reported weight loss. In contrast, 1% of patients in the placebo group lost weight. Anorexia occurred in 9% to 15% of those taking topiramate, but also occurred in 6% of those taking a placebo.

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Weight loss in children

Seizures - In children 6 to 15 years of age taking the 50 mg / day dose of topiramate (Topamax) for seizures, weight loss was seen in 7% of patients. In the higher dosage group (400 mg / day) weight loss occurred in 17% of children. Anorexia (loss of appetite) was not reported in either dose group for children 6 to 15 years old.

Migraine prevention - In adolescents 12 to 17 years of age, weight loss occurred in 7% (50 mg / day dose) and 4% (100 mg / day) compared to 2% in the placebo group. Anorexia occurred in 9% to 10% of patients taking topiramate and 4% of those taking a placebo.

Other side effects

Although weight loss is a common side effect with topiramate, it is not listed in the package insert as a common reason why patients stopped treatment in studies.

In studies, some patients stopped treatment due to other side effects.

• In adults 16 years and older in the high dose group (400 mg / day), 21% of patients stopped treatment due to difficulty with memory, fatigue, asthenia (weakness), insomnia (difficulty sleeping), somnolence (extreme drowsiness), and paresthesia (pins and needles or tingling feeling in extremities, like hands or feet).
• In children 6 to 15 years of age in the high dose group (400 mg / day), 14% of patients stopped treatment due to difficulty with concentration or attention, fever, flushing, and confusion.

Topiramate is linked with many other side effects, including nausea, stomach pain, and taste perversion, which may impact weight loss or anorexia.

This is not all the information you need to know about topiramate for safe and effective use and does not replace your healthcare provider's directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

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Drug information

• Topamax (647 reviews)
• Topiramate (1,343 reviews)
• Trokendi XR (11 reviews)
• Qudexy XR (5 reviews)
• Eprontia

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