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Reviewed by Dr Roy Kedem, MD
Information last reviewed 11/24/19
Topiramate is classified as an anti-epileptic or anticonvulsant drug. Originally formulated to treat epileptic seizures, it is now frequently prescribed to prevent migraine headaches. Having received its FDA-approval in 1996, it is available in either tablet or capsule form and sold under the brand names Topamax, Trokendi XR, Topiragen and Qudexy XR.
In addition to treating epilepsy, Topiramate effectively prevents migraines and reduces the frequency at which they occur. However, it should be noted that Topiramate cannot treat a migraine headache that is already occurring.
While Topiramate is typically indicated for episodic migraines (less than 15 attacks per month), it has also proven effective for patients who experience chronic migraines (15 or more attacks per month).
The exact mechanism of how Topiramate works to prevent migraines is unclear. Clinical research suggests that it reduces levels of abnormal or excessive excitability in the nerve cells within the brain that trigger the onset of a migraine attack.
Topiramate is a prescription medication which cannot be purchased over the counter in the United States. Medzino offers Topiramate in 25mg, 50mg and 100mg strengths, in quantities of 30 to 90 tablets per month. We are able to offer first and repeat prescriptions to those who are seeking an effective treatment for frequent or chronic migraines. Our doctors will assess your symptoms through our online consultation service and subsequently individualize your treatment and dosage.
The active ingredient in Topiramate tablets is topiramate.
The inactive ingredients in Topiramate tablets are: carnauba wax, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, pregelatinized starch, purified water, sodium starch glycolate, synthetic iron oxide, and titanium dioxide. (Please note: inactive ingredients can vary between manufacturers).
An allergic reaction to this medication is rare but it is important to keep a look out for symptoms of a severe allergic reaction nonetheless. Please visit emergency medical attention if you notice swelling of the face, difficulty breathing, hives and dizziness shortly after taking the medication.
Topiramate should be administered orally, preferably at the same time each day. Ideally, If you are taking the medication twice daily, you should take each dose 10-12 hours apart. Topiramate can be taken morning and/or night depending on your prescribed dosage and is safe to take with or without food. Swallow the tablets whole with water – do not break, crush or chew the tablets as this will reduce efficacy.
Carefully follow the instructions on your prescription label and do not take more or less than the amount prescribed by your doctor.
The initial dose is 25mg daily. The dose can be increased by 25mg each week based on your response, usually up to 100mg/day. The maximum dose is 200mg/day, but this may come with more side effects.
For the treatment of migraines, the typical daily dose of Topiramate is usually not more than 100 mg daily administered in two separate 50mg doses. Some users may experience relief from a dose as little as 25 mg or 50 mg per day, while others may have to take up to 200 mg. The recommended dosage will be dependent on your medical history as well as your response to the medication.
To reduce the risk of side-effects, your doctor may start you off on a low dose to be taken once daily at bedtime. The dose may be gradually increased and then taken twice daily if needed.
It is important to take Topiramate consistently for the prescribed length of time, as it can take several weeks or months to determine the optimum dose, and gain full benefit from the medication. Always tell your doctor if your migraine symptoms persist or worsen despite taking Topiramate.
You will usually need to take Topiramate for 1 month to experience a reduction in migraine attacks; however, it can take up to 3 months for the medication to have full effect. For most patients, Topiramate is safe to take for several months or even years. Your doctor may advise you to take it on a long-term basis in order to keep your condition under control.
If you forget to take your Topiramate, take it as soon as you remember. However, if your next scheduled dose is in less than 8 hours, skip the missed dose and wait until your next dose is due. Do not take 2 doses at the same time to make up for a missed dose.
Inform your doctor immediately if you have taken too much Topiramate. An overdose can lead to serious side-effects, including:
Occurring in more than 1 in 100 people, the most common side-effects from Topiramate include:
The above side effects are considered mild and usually resolve as your body adjusts to the medication. However, if symptoms persist or worsen, inform your doctor immediately.
More serious side-effects from Topiramate (occurring in less than 1 in 10,000 patients) include:
Tell your doctor immediately if you experience any of the above symptoms or any other side effects that have not been listed.
Be sure to drink plenty of water while taking Topiramate – preferably 6 to 8 glasses per day – as the medication increases the risk of forming kidney stones.
You should not drive or use heavy machinery when taking Topiramate, as it can cause drowsiness, dizziness or weakness. Additionally, avoid alcoholic beverages and marijuana which can augment these potential side effects.
Topiramate can reduce sweating, making it more difficult for your body to cool down. While you are taking the medication, avoid exposure to heat and warm weather, and activities that can cause you to overheat, such as vigorous exercise or use of hot tubs and saunas.
Inform your doctor if you notice any negative changes in your mood or thoughts, including any suicidal thoughts while taking Topiramate.
If for any reason you decide to stop taking Topiramate, always consult your doctor before doing so. Stopping the medication abruptly can result in serious complications. To avoid these potential complications, your doctor will reduce your dosage gradually.
Topiramate may be unsuitable or potentially harmful for some patients. In such cases, your doctor can often prescribe a safe alternative for treating migraines. Always report the following to your doctor before taking Topiramate:
Before taking Topiramate, it is important to inform your doctor of all other medications you are taking as it may decrease the efficacy of certain drugs and/or increase your risk for side-effects, particularly:
While serious side effects are unlikely to occur from mixing alcohol and Topiramate, the combination can lead to drowsiness, dizziness and lethargy, and may impair both judgement and coordination.
You are able to eat and drink as normal while taking Topiramate; however, if you experience nausea as a side-effect, stick to bland foods and try not to eat anything that is rich or spicy.
There are a number of different alternatives to Topiramate that can effectively reduce and prevent migraine attacks. Each one will work differently and produce different side-effects. Always consult your doctor to help determine the best medication for you based on your history and response to therapy.
When switching to a new medication, your doctor will usually advise you to start the new medication at a low dose while continuing Topiramate. As you increase the dose of your new medication to the appropriate level, you should steadily decrease your Topiramate dosage before stopping completely. This process can take several weeks or months.
Beta-blocking medications (such as Propranolol) work by blocking chemicals in the brain that can constrict blood flow and trigger a migraine. They have proven effective in 60 to 80 percent of users, however, they are not normally suitable for patients with respiratory or cardiovascular problems as well as diabetics.
Certain antidepressants such as Amitriptyline can help reduce the frequency and severity of migraines by affecting the level of serotonin and other chemicals in the brain. However, potential side-effects – which can vary between individuals – can make it difficult to comply with these medications; these may include weight gain, fatigue, constipation and dry mouth, among others.
Administered by a doctor, Botox is injected into the muscles of the head and neck and has proven effective in preventing chronic migraines in adults. The procedure will usually have to be repeated every 12 weeks to sustain efficacy. Common side-effects associated with Botox include muscle stiffness and weakness, blurred vision and trouble swallowing for several months.
Never stop taking Topiramate suddenly, even if you start feeling better. Make sure to set up an appointment with your doctor to discuss coming off the medication. Coming off Topiramate all of a sudden can cause serious side effects. Topiramate needs to be gradually lowered over time to ensure that you don’t experience serious side effects. Suddenly stopping Topiramate can cause serious seizures, even if you’ve never experienced seizures before.
If Topiramate is taking for epilepsy, it can take a couple of weeks to work however will reach full effectiveness after 6-8 weeks. If taken for migraines, normally people experience a reduction in migraine occurrence after a month. However, it may take up to 3 months to notice the full benefits of the drug. However, it works differently for everyone. Topiramate stays in your system for 4-6 days following the last time you had your dose.
Some forms of contraception are affected by Topiramate use while others are not. The coil and contraceptive injection are safe to use while on Topiramate. A small number of women have been known to experience contraceptive failure while on the pill (progestogen and combined). If taking the emergency contraceptive, please make sure to let the pharmacist or doctor know you’re taking Topiramate. The pharmacist or doctor might need to prescribe an increased dose.
Topiramate should not be used by pregnant women, especially during the first trimester. The use of Topiramate when pregnant has been linked to an increased risk of birth defects in the child. There is an increased chance of oral cleft palate birth defects with Topiramate use. However, Topiramate use does not affect fertility in men or women.
The side effects of Topiramate include drowsiness, dizziness, and tiredness. You might experience these side effects when staring Topiramate or when your dose is increased. Make sure to let your doctor know if you're experiencing them. If experiencing any of these side effects please make sure not to drive. If you experience epilepsy, you’re not allowed to drive until you have been clear of seizures for a year. Please make sure to talk to your doctor about this.
It has been found that Topiramate can cause suicidal thoughts or tendencies in a small number of people. Topiramate may also trigger or worsen anxiety, mania, insomnia, irritability, aggression, and depressive thoughts. Though not FDA approved for these uses, some individuals use Topiramate to treat anxiety, depression, PTSD and bipolar disorder.
It is unclear why there is a link between Topiramate and weight loss. However, it is thought that in the same way it works by suppressing migraines and seizures, it inhibits the networks in the brain linked to food cravings. Loss of appetite is one of the side effects.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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