Generic name: topiramate [ toe-PYRE-a-mate ]
Brand names: Eprontia, Qudexy XR Sprinkle, Topamax, Topamax Sprinkle, Topiramate ER (Eqv-Qudexy XR), Trokendi XR, Topiragen
Dosage forms: oral capsule (15 mg; 25 mg), oral capsule, extended release (100 mg; 150 mg; 200 mg; 25 mg; 50 mg), oral solution (25 mg/mL), oral tablet (100 mg; 200 mg; 25 mg; 50 mg)
Drug class: Carbonic anhydrase inhibitor anticonvulsants
What is topiramate?
Topiramate is a seizure medicine, also called an anticonvulsant. Topiramate is used to treat certain types of seizures in adults and children who are at least 2 years old. Trokendi XR is for use in adults and children who are at least 6 years old.
Some brands of topiramate are also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. These medicines will only prevent migraine headaches or reduce the number of attacks, but will not treat a headache that has already begun.
Topiramate may also be used for purposes not listed in this medication guide.
Topiramate may cause vision problems that can be permanent if not treated quickly. Call your doctor right away if you have a sudden decrease in vision.
Topiramate can increase body temperature and decrease sweating, which may lead to life-threatening dehydration. Tell your doctor if you have decreased sweating, high fever, and hot dry skin.
Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.
Before taking this medicine
You should not use topiramate if you are allergic to it. Do not take Trokendi XR within 6 hours before or 6 hours after drinking alcohol.
Tell your doctor if you are sick with diarrhea, or if you have ever had:
glaucoma or other eye problems;
metabolic acidosis (high levels of acid in your blood);
kidney disease, kidney stones, or dialysis;
lung disease, breathing problems;
mood problems, depression, or suicidal thoughts or actions;
a growth disorder; or
soft or brittle bones (osteoporosis, osteomalacia).
Topiramate 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.
Some people have thoughts about suicide while taking an anticonvulsant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Taking topiramate during pregnancy may increase the risk of cleft lip and/or cleft palate, a birth defect that can develop early in pregnancy even before you know you are pregnant. However, having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant.
If you take topiramate during pregnancy: The benefit of preventing seizures may outweigh any risks posed by topiramate. There may be other medications that are safer to use. Do not start or stop taking topiramate without your doctor's advice.
If you are not pregnant or planning to become pregnant, use effective birth control to prevent pregnancy while taking topiramate.
Topiramate can make birth control pills less effective. Ask your doctor about other birth control options such as an injection, implant, skin patch, vaginal ring, condom, diaphragm, cervical cap, or contraceptive sponge.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of topiramate on the baby.
It may not be safe to breastfeed a baby while you are using this medicine. Ask your doctor about any risks.
How should I take topiramate?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Topiramate can be taken with or without food.
Swallow the tablet whole and do not crush, chew, or break it. The Trokendi XR extended-release capsule must be swallowed whole. Do not break or open.
Measure liquid medicine with the supplied measuring device (not a kitchen spoon).
If you cannot swallow a Qudexy XR or Topamax Sprinkle Capsule whole, open it and sprinkle the medicine into a spoonful of applesauce or other soft food. Swallow the mixture right away without chewing. Do not save it for later use.
Carefully follow the swallowing instructions for your medicine.
Topiramate doses are sometimes based on weight in children. Your child's dose needs may change if the child gains or loses weight.
Drink plenty of liquids while you are taking topiramate, to prevent kidney stones or an electrolyte imbalance.
You will need frequent medical tests. If you need surgery, tell the surgeon ahead of time that you are using topiramate. Any medical care provider who treats you should know that you take seizure medication.
Do not stop using topiramate 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 topiramate.
Store at cool room temperature away from moisture, light, and high heat. Throw away any unused liquid medicine 60 days after opening the bottle.
What happens if I miss a dose?
Take the medicine as soon as you can. Do not take two doses at one time. Skip a missed Topamax dose if your next dose is due in less than 6 hours. Call your doctor if you have missed more than one dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of topiramate can be fatal.
What should I avoid while taking topiramate?
Do not drink alcohol. Dangerous side effects or increased seizures may occur.
Avoid becoming overheated or dehydrated in hot weather. Topiramate can increase body temperature and decrease sweating, leading to life-threatening dehydration (especially in children).
Avoid the use of a ketogenic or "ketosis" diet (high in fat, low in carbohydrates) while you are taking topiramate.
Topiramate may cause blurred vision and may impair your reactions. Avoid driving or hazardous activity until you know how topiramate will affect you.
Also avoid activities that could be dangerous if you have an unexpected seizure, such as swimming or climbing in high places.
Topiramate side effects
Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).
Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.
Topiramate may cause serious side effects. Call your doctor at once if you have:
a skin rash, no matter how mild;
dizziness or loss of coordination;
vision problems, blurred vision, eye pain or redness, sudden vision loss (can be permanent if not treated quickly);
confusion, problems with thinking or memory, 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 side effects of topiramate may include:
dizziness, drowsiness, tiredness, slow reactions;
problems with speech or memory, abnormal vision;
numbness or tingling in your arms and legs, decreased sensation (especially in the skin);
changes in your sense of taste, feeling nervous;
nausea, diarrhea, stomach pain, loss of appetite;
fever, weight loss; or
cold symptoms such as stuffy nose, sneezing, sore throat.
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.
What other drugs will affect topiramate?
Using topiramate with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or depression.
Tell your doctor about all your other medicines, especially:
birth control pills;
divalproex, valproic acid; or
other glaucoma medications, including eye drops.
This list is not complete. Other drugs may affect topiramate, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Yes, topiramate (Topamax) has been shown to cause weight loss when used for both seizure control and migraine prevention. Topiramate by itself is not specifically approved by the FDA for weight loss, but is used in an "off-label" fashion for this condition. Qsymia, an extended-release medicine that contains phentermine and topiramate, is FDA approved for weight loss, along with diet and exercise. Continue reading
Yes, topiramate has been shown to cause hair loss in studies, but it is not a common side effect. Hair loss (also called alopecia) has been reported in 1% to 4% of children ages 6 to 16 years of age, and in 3% to 4% of patients older than 16 years of age. Higher daily doses (400 mg/day) of topiramate were associated with greater rates of hair loss than lower doses (50 mg/day) in both age groups. Continue reading
You can usually stay on Topamax (topiramate) to help prevent your migraine headaches as long as the treatment is needed and remains safe for you. You and your doctor will decide how long you stay on treatment. This will be based on how well it is working for you and any side effects you may experience. Continue reading
It may take 8 to 12 weeks for you to see the full effect of Topamax on your migraine headaches. In clinical studies, some people had fewer headaches after 4 weeks of treatment. In the treatment of epilepsy, Topamax is also started slowly and the dose is increased over a 6-week period. Continue reading
Topamax stays in your system for approximately 4 to 5 days after the last dose, but this may vary depending on personal factors, such as your age, weight, dosage, and what other medications you currently take. This estimate is based on the half-life of Topamax which is about 21 hours and experts agree that it takes up to 5 half-lives for a drug without active metabolites to be completely removed from the body. A drug’s half-life is the time it takes for 50% of that drug to be removed from the body. Topamax does have some metabolites, but these are not considered active and only make up about 5% of an administered dose. This means it takes 84 to 105 hours for Topamax to leave your body. Continue reading
Trokendi (topiramate) XR can lead to weight loss when used for prevention of migraine headaches or seizures, but it is not approved as a weight loss medicine. Loss of appetite and other digestive issues, which may contribute to weight loss, have been reported in topiramate studies. Continue reading
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