Topiramate is used alone or with other medications to treat certain types of seizures including primary generalized tonic-clonic seizures (formerly known as a grand mal seizure; seizure that involves the entire body) and partial-onset seizures (seizures that involve only one part of the brain). Topiramate is also used with other medications to control seizures in people who have Lennox-Gastaut syndrome (a disorder that causes seizures and developmental delays). Topiramate is also used to prevent migraine headaches but not to relieve the pain of migraine headaches when they occur. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.
Side Effects Of Topiramate
Topiramate may cause other side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- numbness, burning or tingling in the hands or feet
- slowed reactions
- uncontrollable shaking of a part of the body
- uncontrollable eye movements
- weight loss
- change in the ability to taste food
- dry mouth
- teary or dry eyes
- back, muscle, leg, or bone pain
- missed menstrual periods
- excessive menstrual bleeding
- unusual bleeding or bruising
Some side effects can be serious. If you experience any of the following symptoms or those listed in the WARNINGS and PRECAUTIONS section, call your doctor immediately:
- rash, skin blisters, or skin peeling
- blurred vision
- loss of vision
- double vision
- eye pain
- eye redness
- worsening of seizures
- feeling cold, chills, or low body temperature
- difficulty concentrating
- speech problems, especially difficulty thinking of specific words
- memory problems
- loss of coordination
- pounding or irregular heartbeat
- chest pain
- shortness of breath
- trouble breathing
- fast, shallow breathing
- inability to respond to things around you
- excessive tiredness
- stomach pain
- loss of appetite
- intense back or side pain
- bloody, cloudy, or foul-smelling urine
- the constant need to urinate
- difficulty urinating or pain when urinating
- fever or other signs of infection
- Topiramate may cause osteoporosis (a condition in which bones can break more easily) in adults and rickets (abnormal, curved bone growth) in children. Topiramate may also slow the growth of children and may decrease the final height that children reach. Talk to your doctor about the risks of taking topiramate.
Topiramate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
Warnings & Precautions
Before taking topiramate:
- tell your doctor and pharmacist if you are allergic to topiramate, any other medications, or any of the ingredients in topiramate tablets, sprinkle capsules, and extended-release capsules. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you have metabolic acidosis (a disturbance in the body’s acid-base balance that results in excessive acidity of the blood) and you are taking metformin (Fortamet, Glucophage, Riomet, others). Your doctor will probably tell you not to take metformin if you have metabolic acidosis and you are taking this of medication.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acetazolamide (Diamox); amitriptyline; anticoagulants (‘blood thinners’) such as warfarin (Coumadin); antidepressants; antihistamines; aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); digoxin (Lanoxin); hormonal contraceptives (birth control pills, patches, rings, implants, or injections); hydrochlorothiazide (Microzide, Oretic); lamotrigine (Lamictal); lithium (Lithobid); medications for motion sickness, ulcers, or urinary problems; metformin (Fortamet, Glucophage, Riomet, others); other medications for seizures such as carbamazepine (Epitol, Equetro, Tegretol, Teril), phenytoin (Dilantin, Phenytek), valproic acid (Depakene), and zonisamide (Zonegran); and pioglitazone (Actos, in Actoplus Met ER). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you or any family members have or have ever had kidney stones, and if you have ever thought about killing yourself or tried to do so. Also, tell your doctor if you have or have ever had metabolic acidosis (a disturbance in the body’s acid-base balance that results in excessive acidity of the blood); osteopenia, osteomalacia, or osteoporosis (conditions in which the bones are soft or brittle and may break easily); diabetes; glaucoma (a type of eye disease); any disease that affects your breathing such as asthma or chronic obstructive pulmonary disease (COPD); depression or abnormal moods; a growth problem; or liver or kidney disease. Also, tell your doctor if you have diarrhea or if you develop diarrhea during your treatment.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you are pregnant or plan to become pregnant, your doctor may prescribe a different medication instead of topiramate because topiramate may harm the fetus. If you do not plan to become pregnant, you should use birth control to prevent pregnancy during your treatment with topiramate. Talk to your doctor about what type of birth control you should use, because taking topiramate may decrease the effectiveness of some types of birth control. If you become pregnant while you are taking topiramate, call your doctor right away, but do not stop taking topiramate before talking to your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking topiramate.
- you should know that topiramate may make you drowsy, dizzy, confused, or unable to concentrate. Do not drive a car or operate machinery until you know how this medication affects you.
- if you are taking topiramate to control seizures, you should know that you may continue to have seizures during your treatment. You may need to avoid activities such as swimming, driving, and climbing so that you will not harm yourself or others if you lose consciousness during a seizure.
- tell your doctor if you drink alcohol. You should not drink alcohol within 6 hours before and 6 hours after you take extended-release capsules (Trokendi XR brand only). Your doctor will probably tell you not to drink alcohol while taking topiramate.
- you should know that topiramate can prevent you from sweating and make it harder for your body to cool down when it gets very hot. This happens most often in warm weather and to children who take topiramate. Avoid exposure to heat, drink plenty of fluids and tell your doctor if you have a fever, headache, muscle cramps, or an upset stomach, or if you are not sweating as usual.
- you should know that you may be more likely to develop a kidney stone while you are taking topiramate. Drink 6 to 8 glasses of water every day to prevent kidney stones from forming.
- you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking topiramate for the treatment of epilepsy, mental illness, or other conditions. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took anticonvulsants such as topiramate to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as 1 week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as topiramate, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions, or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.
Topiramate comes as a tablet, a sprinkle capsule (capsule that contains small beads of medication that can be sprinkled on food), and an extended-release (long-acting) capsule to take by mouth. The tablets and sprinkle capsules are usually taken with or without food once or twice a day. The extended-release capsules are usually taken with or without food once a day. Take topiramate at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take topiramate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
There is another medication with a name similar to the brand name for topiramate. You should be sure that you receive topiramate and not the similar medication each time you fill your prescription. Be sure that the prescription your doctor gives you is clear and easy to read. Talk to your pharmacist to be sure that you are given topiramate. If you think you were given the wrong medication, talk to your pharmacist. Do not take any medication unless you are certain it is the medication that your doctor prescribed.
Topiramate tablets have a bitter taste so you should swallow them whole. It is especially important that you not take topiramate tablets that have been broken for any length of time because tablets that are broken may lose their effectiveness over time.
The sprinkle and extended-release capsules (Qudexy XR brand only) may be swallowed whole or opened and poured over soft food. Swallow extended-release capsules (Trokendi XR brand only) whole; do not split, chew, or sprinkle on food.
To take the sprinkle capsules or extended-release capsules (Qudexy XR brand only) with food, follow these steps:
- Prepare a teaspoonful of soft food such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt.
- Hold the capsule upright over the food.
- Twist off the top of the capsule and pour the entire contents onto the spoonful of food.
- Swallow the entire mixture immediately without chewing.
- Drink fluids right after swallowing to wash down the mixture and to be sure that you swallow all of it.
- Your doctor will probably start you on a low dose of topiramate and gradually increase your dose, not more than once every week.
Topiramate may control your seizures or migraines but will not cure your condition. Continue to take topiramate even if you feel well. Do not stop taking topiramate without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking topiramate, you may have severe seizures, even if you have not had seizures in the past. Your doctor will probably decrease your dose gradually.
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body’s response to topiramate.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
All information has been provided courtesy of MedLinePlus from the National Library of Medicine and from the FDA.