Does topiramate cause weight loss?

Key Points

• Yes, topiramate (Topamax) has been shown to cause weight loss when used for both seizure control and migraine prevention.
• Anorexia (loss of appetite), which may contribute to weight loss, has also been reported in studies in both children and adults, although no correlation was made in studies
• 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. 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 who are either obese, or overweight with other risk factors like high blood pressure, high cholesterol or type 2 diabetes.

What is topiramate used for?

Topiramate is classified as an anticonvulsant (seizure) medication.

• Topiramate is 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. Topiramate will not stop a migraine once it has started.

Brand names for topiramate available in the U.S. include Topamax, Trokendi XR, Topamax Sprinkle (discontinued), and Qudexy XR. Uses and dosage forms differ among products, and may not be interchangeable.

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Did weight loss occur in studies with topiramate?

Yes, weight loss was reported in studies of both children and adults. In general, weight loss was seen in 6% to 17% of patients, and tended to increase with higher doses.

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 4% and 14% of patients, respectively.

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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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.

Treatment discontinuation with topiramate

Weight loss is not listed in the product label as a common reason why patients discontinued treatment with topiramate (Topamax).

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).
• 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/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. Review the full topiramate (Topamax) information here, and discuss this and any questions you have with your doctor or other health care provider.