Topamax

Pronunciation: toe-PIR-a-mate
Generic Name: Topiramate
Brand Name: Topamax

Topamax is used for:

Treating seizures in certain patients. It may be used alone or with other medicines. It is also used to prevent migraine headaches. It may also be used for other conditions as determined by your doctor.

Topamax is an anticonvulsant that is also effective for preventing migraine headaches. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine headaches from occurring.

Do NOT use Topamax if:

• you are allergic to any ingredient in Topamax


• you are taking a carbonic anhydrase inhibitor (eg, acetazolamide)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Topamax:

Some medical conditions may interact with Topamax. Tell your health care provider if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you may become pregnant


• if you have eye problems (eg, glaucoma), liver or kidney problems, kidney stones, or osteoporosis (weak bones) or soft bones; you drink alcohol regularly; you are on a ketogenic diet; or you are receiving kidney dialysis


• if you have diarrhea, lung or breathing problems, low bicarbonate levels in the blood, or a growth problem, or you will be having surgery


• if you have a history of status epilepticus (continuous seizure activity or a series of seizures without a full return to consciousness) or high blood acid levels (metabolic acidosis)


• if you have a history of mental or mood problems (eg, depression), or suicidal thoughts or actions


• if you take any other medicine for seizures

Some MEDICINES MAY INTERACT with Topamax. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Anticholinergics (eg, benztropine), carbonic anhydrase inhibitors (eg, acetazolamide), haloperidol, or tricyclic antidepressants (eg, nortriptyline) because the risk of decreased sweating may be increased


• Valproic acid because a serious side effect with symptoms of confusion, lethargy, and vomiting may occur


• Metformin or pioglitazone because blood glucose control may be altered; monitor your blood sugar carefully if you use Topamax with metformin or pioglitazone


• Hydrochlorothiazide because it may increase the risk of Topamax's side effects


• Carbamazepine or hydantoins (eg, phenytoin) because they may decrease Topamax's effectiveness


• Amitriptyline because the risk of its side effects may be increased by Topamax


• Lithium because Topamax may have an effect on lithium blood levels


• Hormonal birth control (eg, birth control pills) or risperidone because their effectiveness may be decreased by Topamax

This may not be a complete list of all interactions that may occur. Ask your health care provider if Topamax may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Topamax:

Use Topamax as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Topamax comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Topamax refilled.


• Take Topamax by mouth with or without food.


• Drink plenty of fluids while taking Topamax to prevent kidney stones from forming.


• Swallow Topamax whole. Do not crush, break, or chew before swallowing.


• Do not suddenly stop taking Topamax. Suddenly stopping Topamax may cause seizures to occur more often. If you need to stop Topamax, your doctor will gradually lower your dose.


• If you miss a dose of Topamax, take it as soon as possible. If it is within 6 hours of your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Contact your doctor if you miss more than 1 dose of Topamax.

Ask your health care provider any questions you may have about how to use Topamax.

Important safety information:

• Topamax may cause drowsiness, dizziness, confusion, or trouble concentrating. These effects may be worse if you take it with alcohol or certain medicines. Use Topamax with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not change your dose without checking with your doctor.


• Do not drink alcohol while you take Topamax.


• Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are taking Topamax; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Topamax may reduce sweating, which could raise body temperature, especially in children. This risk is greater in hot weather and/or during vigorous exercise. Drink plenty of fluids. Dress lightly in hot climates or when exercising. Check carefully for signs of decreased sweating. If this occurs, promptly seek cooler or air-conditioned shelter and/or stop exercising. Seek medical attention right away if you have unexplained fever, mental or mood changes, headache, or dizziness.


• Topamax may cause high blood acid levels (metabolic acidosis). The risk may be greater in children and patients with kidney problems, severe breathing problems, or diarrhea. It may also be greater in patients who are taking certain other medicines (eg, acetazolamide), will be having surgery, or are on a ketogenic diet. Over a period of time, metabolic acidosis may cause kidney problems, bone problems, or decreased growth in children. Contact your doctor immediately if you experience fast breathing, unusual weakness or fatigue, sluggishness, persistent loss of appetite, or irregular heartbeat.


• Patients who take Topamax may be at increased risk of suicidal thoughts or actions. The risk may be greater in patients who have had suicidal thoughts or actions in the past. Watch patients who take Topamax closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur.


• Topamax may cause serious eye problems that could lead to permanent loss of vision if not treated. Seek medical attention right away if you experience new eye symptoms (eg, blurred vision or other vision changes, eye pain or redness).


• Tell your doctor or dentist that you take Topamax before you receive any medical or dental care, emergency care, or surgery.


• Hormonal birth control (eg, birth control pills) may not work as well while you are using Topamax. To prevent pregnancy, use an extra form of birth control (eg, condoms). Discuss any questions or concerns with your doctor.


• Lab tests, including serum bicarbonate levels, may be performed while you use Topamax. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.


• Use Topamax with caution in the ELDERLY; they may be more sensitive to its effects.


• Caution is advised when using Topamax in CHILDREN; they may be more sensitive to its effects, especially decreased sweating and decreased bicarbonate levels.


• Topamax may affect growth rate in CHILDREN and teenagers in some cases. They may need regular growth checks while they take Topamax.


• Topamax should be used with extreme caution in CHILDREN for migraines and in CHILDREN younger than 2 years for seizures; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: Topamax may cause birth defects if you take it while you are pregnant. Avoid becoming pregnant by using an effective form of birth control while you are taking Topamax. If you think you may be pregnant or you are planning to become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Topamax while you are pregnant. Topamax is found in breast milk. If you are or will be breast-feeding while you take Topamax, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Topamax:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; decreased sweating; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms; headache; loss of appetite; nausea; nervousness; numbness or tingling of the skin; runny nose; sore throat; stomach pain or upset; taste changes; tiredness; trouble sleeping; weight loss.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in the urine; blurred vision; bone pain; chest pain; confusion; decreased coordination; double vision or other vision changes; eye pain or redness; irregular heartbeat; loss of consciousness; memory problems; menstrual changes; muscle or joint pain, cramps, or weakness; new or worsening mental or mood changes (eg, aggressiveness, agitation, anxiety, depression, exaggerated feeling of well-being, hostility, impulsiveness, inability to sit still, irritability, panic attacks, restlessness); rapid, shallow breathing; red, swollen, blistered, or peeling skin; ringing in the ears; severe or persistent loss of appetite; severe stomach, side, or back pain; significant weight loss; speech problems; stupor; suicidal thoughts or actions; tremor; trouble thinking, concentrating, or remembering things; trouble walking; unexplained fever; unusual bruising or bleeding; unusual eye movements; unusual tiredness; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Topamax side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include agitation; depression; fainting; loss of coordination; mental impairment; seizures; severe drowsiness or dizziness; severe or persistent stomach pain; sluggishness; speech problems; stupor; vision problems (eg, blurred or double vision).

Proper storage of Topamax:

Store Topamax at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, light, and moisture. Do not store in the bathroom. Keep Topamax out of the reach of children and away from pets.

General information:

• If you have any questions about Topamax, please talk with your doctor, pharmacist, or other health care provider.


• Topamax is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Topamax. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Topamax resources

• Topamax Side Effects (in more detail)
• Topamax Use in Pregnancy & Breastfeeding
• Drug Images
• Topamax Drug Interactions
• Topamax Support Group
• 188 Reviews for Topamax - Add your own review/rating

• Topamax Prescribing Information (FDA)


• Topamax Consumer Overview


• Topamax Monograph (AHFS DI)


• Topamax Advanced Consumer (Micromedex) - Includes Dosage Information


• Topiramate Prescribing Information (FDA)


• Topiramate Professional Patient Advice (Wolters Kluwer)


• Topiragen Prescribing Information (FDA)

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