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Topamax (Topiramate) is a neuronal stabilizing agent, also known as an anticonvulsant medication. It affects several chemicals in the brain that help to reduce seizure activity and prevent migraine headaches from occurring.

Uses Topiramate (toe-PIR-a-mate) is used with other drugs to control various types of convulsions and seizures of epilepsy. This medication has proven to be effective as a migraine preventive for some patients. How to take Topiramate comes as a tablet and a sprinkle capsule to take by mouth. It is usually taken with or without food twice a day in the morning and evening. Take Topiramate at around the same times every day. Topiramate tablets have a bitter taste and lose their effectiveness quickly when broken, so you should swallow them whole. Do not split, chew, or crush them. As with other drugs in this category, patients should start at a low dosage and slowly taper up to therapeutic levels. The daily dose should be taken in two divided doses approximately 12 hours apart. If discontinuing this medication, it is essential to slowly taper off rather than discontinuing abruptly. Side effects Seek immediate medical attention if you experience blurred vision, changes in vision, or pain in or around the eyes during treatment with Topiramate. These may be early signs of a serious side effect. Check with your doctor as soon as possible if any of the following most common side effects occur: any vision problems, especially blurred vision, double vision, eye pain, rapidly decreasing vision, eye redness, increased eye pressure; burning, prickling, or tingling sensations; clumsiness or unsteadiness; confusion, continuous, uncontrolled back-and-forth or rolling eye movements; dizziness, drowsiness, generalized slowing of mental and physical activity; memory problems, menstrual changes or pain; nervousness, speech or language problems; trouble in concentrating or paying attention; unusual tiredness or weakness. Check with your doctor as soon as possible if any of the following less common side effects occur: abdominal pain, fever, chills, or sore throat; lessening of sensations or perception; loss of appetite, mood or mental changes including aggression, agitation, apathy, irritability, and mental depression; red, irritated, or bleeding gums; weight loss. Check with your doctor as soon as possible if any of the following rare side effects occur: blood in urine, decrease in sexual performance or desire; difficult or painful urination; eye pain, frequent urination, hearing loss, itching, loss of bladder control, lower back or side pain; nosebleeds; pale skin; red or irritated eyes; ringing or buzzing in ears; skin rash, swelling, troubled breathing. These side effects may go away during treatment as your body adjusts to the medicine. Symptoms of overdose may include agitation, depression, lethargy, loss of coordination, mental impairment, seizures, severe drowsiness or dizziness; severe or persistent stomach pain; stupor, vision problems (eg, blurred or double vision). If you suspect an overdose of Topiramate, seek medical attention immediately. Precaution Some medical conditions may interact with Topiramate. 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 have liver or kidney problems, kidney stones, osteoporosis (weak bones), or metabolic problems, you drink alcohol regularly, or you are on a ketogenic diet; If you have diarrhea, lung or breathing problems, or low bicarbonate levels in the blood, 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). Do not stop taking Topiramate without first talking to your doctor, even if your symptoms have improved. It is important to continue taking Topiramate to prevent seizures from recurring. Carry or wear a medical identification tag to let others know that you are taking Topiramate in the case of an emergency. Use caution when driving, operating machinery, or performing other hazardous activities. Topiramate may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Topiramate; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Alcohol may also increase the risk of having a seizure. Drink several extra glasses of fluid each day during treatment with Topiramate to minimize the risk of kidney stone formation. Ketogenic diets (high protein, very low carbohydrate diets that may induce ketosis) may increase the risk of kidney stone formation and should be avoided during treatment with Topiramate. This medicine may reduce sweating, which could raise body temperature. This risk is greater in hot weather and/or during vigorous exercise. Drink plenty of fluids. Dress lightly while 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, or if you have mental or mood changes, headache, or dizziness. Tell your doctor or dentist that you take Topiramate 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 Topiramate. To prevent pregnancy, use an extra form of birth control (eg, condoms). If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Topiramate while you are pregnant. Topiramate is found in breast milk. If you are or will be breast-feeding while you use Topiramate, check with your doctor. Discuss any possible risks to your baby. Drug interactions Anticholinergics (eg, benztropine), carbonic anhydrase inhibitors (eg, acetazolamide, Diamox), haloperidol, or tricyclic antidepressants (eg, nortriptyline) because the risk of decreased sweating may be increased; Valproic acid (Depakene, Depakote) 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 Topiramate with Metformin or pioglitazone; Hydrochlorothiazide because it may increase the risk of Topiramate's side effects; Carbamazepine or hydantoins (eg, phenytoin, Dilantin, Tegretol) because they may decrease Topiramate's effectiveness; Amitriptyline because the risk of its side effects may be increased by Topiramate; Lithium because this medicine may have an effect on lithium blood levels; Hormonal birth control (eg, birth control pills) or risperidone because their effectiveness may be decreased by Topiramate; Dichlorphenamide (Daranide). This may not be a complete list of all interactions that may occur. Ask your health care provider if Topiramate 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. Missed dose If you miss a dose of Topiramate, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Storage Store Topiramate 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 Topiramate out of the reach of children and away from pets.

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