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Topamax® (topiramate)

Brand and Generic Names

• Brand name: Topamax®
  • Tablets:  25 mg, 50 mg, 100 mg , 200 mg
  • Sprinkle capsules: 15 mg, 25 mg
• Generic name: Topiramate (toe-PIE-ra-mate)

What is Topamax® and what does it treat?

Topiramate is an anticonvulsant medication approved for the treatment of seizures (epilepsy) in adults and children. It can be used alone, or in combination with other anticonvulsants. It is also approved for use in preventing migraine headaches in adults.

While not approved by the FDA for other illnesses, topiramate has been tried and studied in the treatment of tremors, nerve pain, cluster headaches, eating disorders, alcohol dependence and bipolar disorder (also known as manic-depression).

A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

A depressive episode, or depression, is when a person experiences several of the following symptoms at the same time: "low" or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating and thoughts of death (suicidal thinking).

Bipolar disorder is a brain disorder (mental illness) that exposes people to these mood changes over the course of time. Bipolar disorder affects more than two million American each year, but patients with this disorder can lead fulfilling lives when they receive proper treatment. Unfortunately, many people with this illness do not receive treatment.

What is the most important information I should know about Topamax®?

Bipolar disorder requires long-term treatment. Do not stop taking topiramate even when you feel better. Only your healthcare provider can determine the length of topiramate treatment that is right for you. Missing doses of topiramate may increase your risk for a relapse in your mood symptoms and it may also increase the risk of seizures.

• Do not stop taking topiramate or change your dose without first talking to your healthcare provider.
• Topiramate may make you drowsy.  Do not drive or operate machinery until you know how this medication affects you.
• You should not drink or use illegal drugs while taking topiramate.
• Topiramate may be prescribed by itself or along with other medications to help manage your bipolar mood symptoms.

Are there specific concerns about Topamax® and pregnancy?

Topiramate has not been studied in pregnant women. Studies in pregnant animals using doses much larger (by weight) than humans indicate that topiramate may cause birth defects in unborn babies, as well as causing problems in pregnant patients. If you are pregnant or planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions about the risks and benefits of the medications as they relate to the illness and to the fetus. This is a complex decision as untreated bipolar disorder has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.

Breast-feeding is not recommended, since topiramate does pass into breast milk.

What should I discuss with my healthcare provider before taking Topamax®?

You should tell your doctor if you have taken topiramate before.  If you are allergic to it, tell your doctor and pharmacist exactly what the medication did to you before taking even one dose. In addition, you should discuss the following:

• Symptoms that are most bothersome to you about your condition
• If you have thoughts of suicide
• Medications you have taken in the past to treat bipolar disorder, whether they were effective or caused any adverse effects
• All other medications you are currently taking (including over the counter, herbal and nutritional supplements) and any medication allergies you have
• Any medication side effects you have experienced in the past or are currently experiencing
• If you are pregnant, plan to become pregnant, or are breast-feeding
• If you smoke, drink alcohol, or use illegal drugs
• Any medical problems you have, especially those involving the kidneys (including kidney stones), lungs, or liver

How should I take Topamax^®?

Topiramate is generally taken twice a day with or without food. Don’t crush, or chew the tablets. You may notice a bitter taste, this is normal. If you are taking capsules they may be opened and the contents (little beads) sprinkled on a small amount (teaspoonful) of soft food (such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt) and swallowed immediately without chewing.

While the dose usually ranges from 25 mg to 200 mg in bipolar disorder, your healthcare provider will determine the dose that is right for you based upon your response.

What happens if I miss a dose?

If you miss a dose of topiramate, take it as soon as you remember unless it is close to when your next dose is due. If it is close to your next dose, wait until then to take the medication and skip the missed dose. Do not double your next dose or take more than your prescribed dose.

If you miss more than two days of the medication, contact your prescriber.

What should I avoid while taking Topamax^®?

Avoid drinking alcohol or using illegal drugs while you are taking topiramate because the beneficial effects of the medication may be decreased and adverse effects may be increased (e.g. sedation, confusion).

Avoid becoming dehydrated. Drink plenty of water every day, more if you are exercising or out in the heat. This will help prevent kidney stones and help you keep from becoming overheated.

What happens if I overdose?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary.  Call your doctor or emergency medical service (911).  You may also contact the poison control center at 1 (800) 222-1222..

If you take too much topiramate, you will feel sleepy, have slow thinking, loss of appetite, problems seeing clearly and you may have an abnormal heart rate.

A specific antidote for topiramate does not exist.

What are the possible side effects of Topamax^®?

Like all medications, topiramate has side effects. Most of these will get better or even go away completely as your body gets used to the medicine. Everyone responds differently so let your doctor, pharmacist and other healthcare professionals know how the medication is affecting you.

Remember the lists of side effects below are only possible problems. Nobody gets them all and very few people get the more serious side effects. This list is to help you know when to contact your doctor or pharmacist. It is not meant to scare you. Talk with your healthcare provider if you experience side effects that are bothersome to you.

More common side effects are:

Unsteadiness, confusion, tingling sensations, generalized slowing of mental and physical activity, memory problems, nervousness, speech or language problems, trouble in concentrating or paying attention, unusual tiredness or weakness. 

Topiramate makes some people feel clumsy, or dizzy, or drowsy, or have trouble in thinking. Be careful about doing things that require good concentration until you find out how topiramate affects you.

Less common side effects are:

Mood or mental changes, including aggression, agitation, apathy, irritability and depression

Increased eye pressure, uncontrolled back-and-forth or rolling eye movements, stomach pain, fever, chills, or sore throat, loss of appetite, changes in the way food tastes, weight loss, menstrual changes

Topiramate can also cause kidney stones, so drink plenty of water to minimize this risk.

Rare side effects are:

Sexual problems, painful urination, eye pain, hearing loss, itching, loss of bladder control, nosebleeds, pale skin, red or irritated eyes, ringing or buzzing in ears, blisters, allergy (skin rash, swelling, troubled breathing), yellow eyes or skin, easy bruising.  

This medicine may cause some people to have pain around the eye, blurred vision, or double vision. If you have this problem while on topiramate, call your doctor right away.

Talk with your healthcare provider if you experience side effects that are bothersome to you.

Are there any risks for taking this medication for long periods of time?

To date, there are no known problems associated with long term use of topiramate.

What other drugs interact with this medication?

Oral contraceptives (birth control pills) may not work properly if you take them while you are taking topiramate. Unplanned pregnancies may occur. You should use a different or additional means of birth control while you are using topiramate. If you have any questions about this, check with your doctor or pharmacist.

Other drugs that may interact with topiramate include:

acetazolamide (Diamox®)

carbamazepine (Tegretol®)

dichlorphenamide (Daranide®)

dorzolamide (Trusopt®)

ethinyl estradiol (is in many different birth control pills, for example: Loestrin®, LoOvral®, Demulen®)

evening primrose oil (a natural medicine)

fosphenytoin (Cerebyx®), ginkgo ( a natural medicine)

mestranol (Norinyl®, Ortho Novum®)

metformin (Glucophage®)

methazolamide (Naptazane®)

phenobarbital

phenytoin (Dilantin®)

valproic acid (Depakene®, Depakote®)

How long does it take for Topamax^® to work?

Several weeks are often required for topiramate to reach its maximum effectiveness; however, improvement in some symptoms may occur sooner.

It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking topiramate. It will probably take several weeks to see enough changes in your symptoms to decide if topiramate is helpful for you.

Lifelong mood stabilizer treatment is generally needed in persons with bipolar illness.  Your doctor can best discuss the duration of treatment you need based on your symptoms and course of illness.

Updated by
W. Klugh Kennedy, Pharm.D., BCPP
(November 2010)

NAMI wishes to thank the  College of Psychiatric and Neurologic Pharmacists for producing this fact sheet.

Reviewed by Dr. Ken Duckworth, NAMI Medical Director

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