Topamax Information

What Is Topamax (Topiramate)?

Topamax is the brand name of topiramate, an anticonvulsant drug used to prevent seizures and reduce the frequency of migraines.

While its exact mechanism of action is unknown, studies suggest Topamax might alter the production or action of neurotransmitters in the brain, suppressing the abnormal activity of the nerves in the brain that cause seizures or preventing the abnormal activity from spreading to other nerves. Other research has suggested that it might suppress the nerves directly, thereby making them less likely to fire.

The Food and Drug Administration (FDA) approved Topamax to treat seizures in 1996.

In 2004, Topamax received FDA approval for the prevention of migraines. Manufactured by Janssen Pharmaceuticals, Topamax is now the number-one prescribed medication for migraine prevention in the United States.

It’s used to stop migraine headaches from occurring in those 12 and older. It cannot be used to treat a headache that has already begun, but it may help to reduce the number of painful migraine.

Topamax (Topiramate) Side Effects

Common Side Effects of Topamax (Topiramate)

Some side effects of Topamax may disappear after your body gets used to the medication. If they don’t go away or worsen, let your doctor know. The more common complaints in this category are tremors and breast pain in women.

Some of the less common side effects may include leg, chest, and back pain along with constipation, heartburn, increased sweating, and hot flushes.

Side effects that require you to speak with your doctor right away:


  • Blurred or rapidly decreasing vision
  • Double vision
  • Eye pain and redness
  • Increased eye pressure
  • Confusion
  • Dizziness
  • Drowsiness
  • Burning, prickling or tingling sensations
  • Nervousness
  • Clumsiness/unsteadiness
  • Other symptoms that require attention:
  • Continuous, uncontrolled back-and-forth or rolling eye movements
  • Memory problems
  • Menstrual pain and changes
  • Slowing of mental and physical activity
  • Trouble concentrating
  • Unusual weakness or tiredness
  • Speech/language problems

Serious Side Effects of Topamax (Topiramate)

  • Mood changes such as aggression, agitation, apathy, and depression
  • Loss of appetite
  • Weight loss
  • Stomach pain
  • Fever, chills or sore throat
  • Reduced sensation or perception
  • Red, irritated, or bleeding gums

Rare side effects:

  • Blood in urine
  • Frequent, difficult or painful urination
  • Loss of bladder control
  • A decrease in sexual performance/desire
  • Ringing or buzzing in the ears
  • Hearing loss
  • Skin rashes
  • Itching
  • Swelling
  • Trouble breathing
  • Nosebleeds
  • Pale skin
  • Red or irritated eyes
  • Lower back or side pain

Topamax (Topiramate) Interactions

Topomax (Topiramate) and Other Drug Interactions

Before starting Topamax, be sure to give your physician a list of all the drugs you are using, including prescription, over-the-counter (OTC), vitamins, herbal supplements, and recreational drugs.

Using carbamazepine (Tegretol) or phenytoin (Dilantin) may increase the elimination of Topamax from your body, making it less effective.

The following drugs might increase your risk of kidney stones and metabolic acidosis:

  • Acetazolamide (Diamox)
  • Dorzolamide (Trusopt)
  • Methazolamide (Neptazane)
  • Dichlorphenamide (Daranide)

If you combine Topamax with valproic acid (Depakote, Depakote ER, Depakene, Depacon, Stavzor) this could raise your blood ammonia levels, causing hypothermia.


Those taking Topamax because they have seizure disorders may develop nerve toxicity from a chemical 4′-O-methylpyridoxine, which is found as a contaminant in some ginkgo preparations.

In addition, Topamax at higher doses might increase levels of lithium (Eskalith, Lithobid).

Topamax (Topiramate) Dosage

Topamax is available in tablets (25 milligrams (mg), 50 mg, 100 mg, and 200 mg), extended release oral capsules (25 mg, 50 mg, 100 mg, 150 mg, 200 mg), and sprinkle capsule (15 mg and 25 mg) that can be taken orally or sprinkled onto soft food.

Those who take Topamax typically start with a low dose of 25 or 50 mg per day (divided over two doses), increasing it slowly by 25 to 50 mg per week until an effective daily dose is reached.

In the case of adults and children 10 years or older, the dose may be increased by 100 mg in week five and six if Topamax is used by itself. The final recommended adult dose is 400 mg, taken in two divided doses daily.

Children should start with up to 25 mg taken each night for the first week, with the dose being increased at 1 or 2 week intervals. The maximum maintenance dose is based on weight.

Migraine patients are usually given 25 mg every night for the first week, with the dose being increased by 25 mg weekly. The maximum dose is 100 mg, to be taken in two divided doses.


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