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    Topamax

    What Is Topamax? Dosage, Efficacy, and More

    Has your doctor prescribed Topamax for you or a loved one? At YourDrugs.com, we strive to provide you with as much information as possible about your prescription medications, including Topamax. So read through the information below to determine if Topamax is the right prescription drug for your needs.

    What Is Topamax? 

    Topamax, which is also known by the generic name, Topiramate, is an anticonvulsant and antiepileptic drug. It’s used to prevent and control seizures and migraines. Because it’s a preventative medication, you can’t use it to treat your migraine once it comes on.

    Additionally, Topamax can be prescribed to help treat sleep-related eating disorder (SRED), which is a medical condition that causes a person to have compulsive eating episodes while they are sleeping. In this case, Topamax is used to help prevent these night-time binge eating sessions, which in turn, helps the person with sleep-related eating disorder lose weight.

    What Does Topamax Treat and Who Is It For? 

    In most cases, Topamax is used as a prophylactic for people living with epilepsy or chronic migraines. Because it’s a preventative drug, those with epilepsy or chronic migraines have to take it on a regular basis.

    It can’t be taken in the midst of a seizure or migraine to treat it.

    Topamax also treats sleep-related eating disorder. This disorder causes compulsive eating and drinking while in a sleeping state.

    It’s dangerous to your health because it can cause weight gain — people with this disorder often binge on foods high in carbohydrates and fat. Also, it can be dangerous for you to prepare a meal while sleeping. Topamax helps prevent these episodes from happening.

    Patient Types 

    Topamax is a medication that’s prescribed to adults and children with epilepsy, chronic migraines, and sleep-related eating disorder as a preventative medication.

    People with these disorders are prescribed Topamax in an effort to prevent episodes from occurring completely. For Topamax treatments to work correctly, you need to take it as directed, on a regular basis.

    The medication can be prescribed for patients as young as two years old as a single-drug treatment for partial onset or primary generalized tonic-clonic seizures. It can also be used in conjunction with other medications to treat these epilepsy types.

    Patients between the ages of 2 and 16 with seizures associated with Lennox-Gastaut syndrome may also be prescribed Topamax as part of their treatment plan — usually alongside other medications. For migraine prevention, Topamax can be prescribed for patients as young as 12 years old.

    What Are the Ingredients of Topamax? 

    Topamax is a sulfate-substituted monosaccharide that’s available in tablet and capsule form. Tablets come in doses of 25 mg, 50 mg, 100 mg, and 200 mg, and capsules are available in 15 mg and 25 mg dosage amounts. The inactive ingredients in topiramate tablets include:

    • Carnauba wax
    • Hypromellose
    • Lactose monohydrate
    • Magnesium stearate
    • Microcrystalline cellulose
    • Polyethylene glycol
    • Polysorbate 80
    • Pregelatinized starch
    • Purified water
    • Sodium starch glycolate
    • Synthetic iron oxide
    • Titanium dioxide

    Topamax Sprinkle capsules contain small beads coated in topiramate. They are enclosed in a gelatin capsule. The inactive ingredients in Topamax capsules include:

    • Black pharmaceutical ink
    • Cellulose acetate
    • Gelatin
    • Titanium dioxide
    • Povidone
    • Sodium lauryl sulfate
    • Sorbitan monolaurate
    • Sugar spheres (sucrose and starch)

    Like other prescription medications, the ingredients in Topamax can vary slightly between manufacturers, so it’s important to note any reactions you have to the medication when you start taking it — both positive and negative.

    If you do this each time your pharmacy gives you medication from a different manufacturer, you’ll know right away if there’s a generic option that doesn’t work well for you.

    Common Topamax Side Effects 

    All prescription medications have side effects — Topamax included. Unfortunately, there’s no way to determine whether or not you’ll experience any of them before you start taking it. Some of the more common Topamax side effects include:

    • Diarrhea
    • Drowsiness
    • Dizziness
    • Loss of coordination
    • Tingling of the hands or feet
    • Bad taste in your mouth
    • Tiredness
    • Loss of appetite
    • Weight loss

    In some cases, Topamax can cause kidney stones. Because of this, it’s important to drink at least eight glasses of water per day. You should contact your doctor immediately if you have signs of kidney stones, which include:

    • Severe pain in your back, groin, side, abdomen
    • Fever
    • Chills
    • Painful/frequent urination
    • Bloody/pink urine

    Some people who take an anticonvulsant to treat seizures, bipolar disorder or pain experience depression, suicidal thoughts, and/or other mood problems. You should contact your doctor if you experience any sudden or unusual mood changes.

    You should also notify your doctor immediately if you experience:

    • Fast, slow, or irregular heartbeat
    • Bone pain
    • Loss of consciousness
    • Broken bones
    • Unusual bleeding or bruising

    There are also a few very rare, but serious, side effects you should watch for, including:

    • Serious eye problem that begins with sudden vision changes, such as decreased or blurred vision, eye pain, or redness. It’s important to seek medical treatment if this occurs because in very rare cases, this eye problem can result in permanent blindness.
    • Serious metabolic problem, which causes a high amount of ammonia in the blood. Symptoms of this condition include sudden, unexplained tiredness, mental changes such as decreased alertness, and vomiting.
    • Very serious allergic reaction that may have symptoms including rash, severe dizziness, itching and swelling, especially in the mouth, throat, and face, and trouble breathing.

    Topamax Dosage

    It’s important to follow your doctor’s recommendation when taking Topamax. However, there are common dosage amounts that vary depending on your age, weight, and the condition you’re treating.

    Monotherapy Epilepsy Treatment Dosages

    When used as monotherapy (single-dose therapy) to treat epilepsy in patients age 10 or older, the recommendation is to take 400 mg of Topamax daily, divided into two doses. However, patients don’t typically start out taking a full 400 mg per day.

    Instead, your doctor will probably prescribe your medication in a way that allows you to take it on the following dosage schedule and you would take one dose in the morning and one at night before bed.

    • Week one: 25 mg
    • Week two: 50 mg
    • Week three: 75 mg
    • Week four: 100 mg
    • Week five: 150 mg
    • Week six: 200 mg

    After the initial six weeks, you would continue to take 200 mg doses of Topamax twice per day.

    Patients between the ages of two and nine are prescribed Topamax based on their weight and tolerance. Like patients age 10 and older, the medication is prescribed in a way that the dose is increased on a weekly basis until the desired dosage is met.

    Minimum and maximum dosage amounts are suggested by the patient’s weight as follows:

    • Up 11 kgs/24 pounds: minimum maintenance dose of 150 mg per day and maximum maintenance dose of 250 mg per day
    • Between 12 kg/26 pounds and 22 kg/48 pounds: minimum maintenance dose of 200 mg per day and maximum maintenance dose of 300 mg per day
    • Between 23 kg/50 pounds and 31 kg/68 pounds: minimum maintenance dose of 200 mg per day and maximum maintenance dose of 350 mg per day
    • Between 32 kg/70 pounds and 38 kg/83 pounds: minimum maintenance dose of 250 mg per day and maximum maintenance dose of 350 mg per day
    • More than 38 kg/83 pounds: minimum maintenance dose of 250 mg per day and maximum maintenance dose of 400 mg per day

    Adjunctive Therapy for Epilepsy Treatment

    When treating patients age 17 and older using adjunctive therapy (Topamax alongside other medications), the recommended dose is between 200 mg and 400 mg. This treatment is typically initiated in either 25 mg or 50 mg doses and slowly increased to the desired amount.

    Like with monotherapy treatment, when Topamax is used in conjunction with other medications, it’s taken twice per day — once in the morning and once at night.

    For patients with epilepsy between the ages of two and 16, Topamax is typically prescribed by weight. The recommended dosage amount is between 5 mg and 9 mg of Topamax per kilogram daily, divided into two doses.

    The dosage is increased every two weeks until the desired dose is reached, and the dosage amount should not exceed 400 mg.

    Migraine Prevention Dosage Recommendations

    People age 12 and older who are living with chronic migraines can take Topamax to help prevent the onset of them. It’s recommended that for migraine prevention, a dose of 100 mg per day, divided into two doses, is taken.

    In most cases, doctors prescribe the medication in a way that it can be gradually increased. Typically, patients follow this schedule:

    • Week one: no morning dose, 25 mg evening dose
    • Week two: 25 mg dose in the morning and evening
    • Week three: 25 mg morning dose and 50 mg evening dose
    • Week four: 50 mg morning and evening dose

    If you’re having trouble adjusting to the medication, your doctor might suggest longer intervals between dose increases.

    Warnings: Before You Take Topamax, Talk to Your Healthcare Provider if: 

    While Topamax is a fairly safe medication, there are certain medical conditions that may affect the way your doctor prescribes this medication. You should make sure your doctor knows about any kidney problems and/or conditions you have.

    Patients with renal impairment can still safely take Topamax, but the dose they take is smaller. It’s recommended that they actually only take one-half of the normal adult dosage.

    If you’re currently going through dialysis, your doctor will probably suggest you take a supplemental dose of Topamax to prevent rapid drops of topiramate plasma concentration.

    Your doctor will consider the length of your dialysis period, the clearance rate of the dialysis system you use, and your effective renal clearance of topiramate to determine the right supplemental dosage amount for you.

    You also need to inform your doctor if you have any of the following medical conditions:

    • Narrow-angle glaucoma
    • Mood/mental disorders — such as depression, bipolar disorder, or suicidal thoughts
    • Liver problems
    • Lung/breathing problems
    • Metabolic acidosis
    • Long-term diarrhea
    • Osteoporosis

    It’s also important to notify your doctor if you’re on a ketogenic diet — a diet high in fat and low in carbohydrates — because you may need to alter your diet while you’re taking Topamax.

    How Should You Take Topamax?

    Topamax is taken orally, twice per day. The medication has a strong bitter taste, so you shouldn’t try to break the topiramate tablets before taking them.

    If it’s difficult for you to swallow pills, discuss this with your doctor. He or she may be able to prescribe capsules for you instead.

    Capsules can be broken apart before they are taken. To do this, you would break apart the capsule and sprinkle the entire contents on a teaspoon of soft food.

    But it’s important to swallow the entire teaspoon of the food with the contents of the capsule immediately, without chewing, and you should never store food mixed with Topamax capsule contents for future use.

    How Much Topamax Can You Take In One Day? 

    The maximum amount of Topamax you should take in one day depends on the condition you’re treating and your age and/or weight. For adults, the maximum daily dose of Topamax is 400 mg.

    However, this amount is lower if the patient is younger. It may also be lower if you’re being treated for migraines instead of epilepsy. In most cases, when you’re taking Topamax to treat migraines, the maximum dose you should take is 100 mg per day.

    Topamax Addiction Risks

    Topamax isn’t considered an addictive drug. However, it is possible for your body to become dependant on it if you take it for a long period of time.

    Because of this, it’s important to discuss discontinuing your medication with your doctor before you do so.

    While there typically aren’t any withdrawal symptoms associated with discontinuing the use of Topamax, it can bring back the symptoms for which you’re being treated. Because of this, your doctor might want to wean you off of the medication slowly.

    This way, your body slowly prepares itself for symptoms as they return.

    Topamax Withdrawal Symptoms

    Discontinuing your Topamax shouldn’t bring on withdrawal symptoms. However, some people do experience symptoms related to the condition in which they’re treating.

    For example, if you’re taking Topamax to treat migraines, you might experience headaches, nausea, and sensitivity to light when you stop taking it. All of these are symptoms associated with migraines, though. They aren’t withdrawal symptoms you’re getting solely because you stopped taking your Topamax.

    Topamax Interactions: What Should You Avoid Taking with Topamax?

    While Topamax can be taken with other medications, there are some that you should discuss with your doctor before combining them with Topamax, including:

    • Antihistamines
    • Medication to treat sleep or anxiety disorders such as alprazolam, diazepam, and zolpidem
    • Muscle relaxants
    • Narcotic pain relievers such as codeine
    • Any cold or allergy medicines that can cause drowsiness

    It’s also important to note that Topamax can decrease the effectiveness of your birth control, which could result in pregnancy. Because of this, you should discuss whether you need to take additional precautions.

    You should also tell your doctor if you experience breakthrough bleeding or new, abnormal bleeding. These can both be signs that your birth control isn’t working as it should.

    Topamax and Pregnancy

    Unfortunately, Topamax isn’t a completely safe medication for pregnant women. According to the FDA, there is an increased risk of your baby developing a cleft lip or cleft palate if you take Topamax while pregnant.

    Because of this, it’s important to notify your doctor as soon as you find out you’re having a baby. Your doctor may decide to stop your Topamax treatments completely if there is a safer alternative medication you can take.

    There’s also a chance your doctor will suggest you stop your preventative treatment completely during your pregnancy.

    However, there’s a chance your doctor will suggest you take a lower dose while pregnant or continue with your current treatment regimen. This is because the risk of you stopping the medication might be more dangerous than the risk of you taking Topamax while pregnant.

    While there is an added risk of your baby developing a cleft lip or palate, continued usage doesn’t have an increased risk of fetal death.

    One thing you need to consider when you’re taking Topamax is that oral clefts typically develop within the first trimester of pregnancy. In many cases, they develop before women actually discover they are pregnant.

    Because of this, you should consider using birth control while you’re taking Topamax and notifying your doctor if you plan to get pregnant. This way, your doctor can determine the best treatment for you before you actually conceive a child.

    Keep in mind, if you’re taking Topamax as a preventative medication for seizures or migraines, stopping the medication could make you susceptible again. Because of this, it’s important that you follow your doctor’s instructions completely to keep you and your baby safe.

    If your doctor decided to discontinue your treatment, you should notify your doctor after your baby is born to start treatment again.

    Topamax Efficacy: What Does Topamax Do for Your Symptoms?

    Topamax is a preventative medication that’s mainly used to treat epileptic seizures and migraines. When taken properly, the medication blocks sodium channels and increases the activity in your brain’s neurotransmitters.

    When this happens, it inhibits some of your nerve cell receptors, which reduces the electrical activity in your body. This helps prevent seizures and migraines.

    In addition to helping prevent seizures, Topamax lessens the convulsions stemming from seizures if you do happen to have one. This means there’s less strain on your body if a seizure does occur. 

    Topamax Manufacturers

    Topamax was originally produced by Johnson & Johnson Corporation through a joint venture between two of its divisions, Ortho-McNeil Neurologics and Noramco.

    However, there are several other manufacturers who have obtained FDA approval to make a generic form of the medication, know as topiramate, including:

    • Roxane Laboratories
    • Par Pharmaceuticals
    • Mylan Pharmaceuticals
    • Barr Laboratories
    • TEVA Pharmaceuticals
    • USA, Ranbaxy Laboratories
    • CIPLA
    • Glenmark Generics
    • Cobalt Laboratories
    • Apotex, Zydus Pharmaceuticals USA
    • Aurobindo Pharma
    • Torrent Pharmaceuticals
    • Invagen Pharmaceuticals
    • Unichem Laboratories
    • Sun Pharmaceuticals
    • Pliva Hrvatska

    FDA Approval Status of Topamax

    Topamax is a medication that’s fully approved by the FDA. It was originally approved in 1997 for treatment of epileptic seizures. In 2004, the FDA approved Topamax for treatment in patients with chronic migraines. In both cases, the medication is used as a preventative option.

    Related Drugs or Medications 

    When discussing your options with your doctor, there are other medications you can consider in place of Topamax. Medications that help prevent epileptic seizures include:

    • Clobazam
    • Clonazepam
    • Clorazepate
    • Ezogabine
    • Felbamate
    • Lamotrigine
    • Levetiracetam
    • Lorazepam
    • Primidone
    • Valproic acid
    • Zonisamide

    Some medication options you might want to consider for migraine prevention include:

    • Metoprolol tartrate
    • Timolol
    • Zestril
    • Amitriptyline
    • Naproxen
    • Valproate
    • OnabotulinumtoxinA
    • Erenumab-aooe