Topamax (topiramate) is a brand-name drug that’s prescribed to help prevent migraine headaches. This article covers topics such as side effects, dosage, and how Topamax works.
Topamax is available in these forms: oral tablets and sprinkle capsules. Topamax belongs to a drug class called anticonvulsants. The medication is available in a generic version.
Read on for more information about Topamax. You can also refer to this article for a comprehensive look at Topamax and its other uses.
Migraine is a nervous system disorder that can cause severe headaches and other symptoms. A migraine episode may last from a few hours to a few days.
Migraine severity, symptoms, and triggers can vary from person to person. Some people have frequent migraine episodes, while others have them occasionally.
Symptoms of migraine
A migraine episode may occur in stages, each with different symptoms.
- Prodrome: This stage can start hours or days before the onset of a headache. It may include symptoms such as fatigue, mood changes, and difficulty concentrating.
- Aura: The aura stage refers to changes in vision, speech, or body sensations that may occur before or during the onset of a headache. Symptoms can include blind spots, difficulty with speech, and numbness or tingling in the arms or legs.
- Headache: This stage may cause severe pain, typically on one side of the head. Other symptoms can include nausea, vomiting, and sensitivity to sound or light.
- Postdrome: This stage may last 1 or 2 days after a headache. Symptoms may include dizziness, confusion, and weakness.
Keep in mind that each migraine episode may not include every stage described above.
Who Topamax is prescribed for
Topamax is prescribed to help prevent migraine headaches in adults and children ages 12 years and older. The drug is not typically prescribed to treat migraine once an episode has already started.
Below are details about how Topamax works to help prevent migraine episodes.
The way Topamax works
The exact way in which Topamax works for migraine prevention isn’t fully understood.
Migraine episodes may be triggered by overactive electrical signals in the brain. Topamax is thought to reduce these signals and help regulate the brain’s electrical activity. In this way, Topamax works to prevent migraine episodes.
Topamax and children
Topamax is approved for migraine prevention in children ages 12 years and older.
Topamax has been shown to be effective in preventing migraine episodes. In clinical trials, Topamax treatment reduced the number of monthly migraine episodes.
To learn more about how Topamax performed in clinical trials, see the drug’s prescribing information or talk with your doctor.
Below is information about the dosage of Topamax for migraine prevention in adults and children ages 12 years and older. However, it’s important to take the dosage your doctor has prescribed.
For more information about the drug’s dosage, you can also see our Topamax dosage article or refer to the drug’s prescribing information.
Dosage for migraine prevention
For migraine prevention, your doctor will start you on a low dose of Topamax. They’ll increase it over time until you reach the recommended dosage.
Below is the typical dosage schedule for Topamax:
- week 1: 25 milligrams (mg) once daily in the evening
- week 2: 25 mg twice daily, once in the morning and once in the evening
- week 3: 25 mg once daily in the morning and 50 mg once daily in the evening
- week 4 and after: 50 mg twice daily, once in the morning and once in the evening
The manufacturer of Topamax recommends a maximum dosage of 100 mg per day to help prevent migraine episodes. However, in clinical trials, dosages of up to 200 mg per day were studied. Your doctor will recommend the maximum Topamax dosage for your specific situation.
Note: In addition to preventing migraine, Topamax has other uses. Keep in mind that the drug’s dosage may differ with these other uses. To learn more, talk with your doctor.
How to take
Topamax comes in two forms: oral tablets and sprinkle capsules.
You’ll swallow the oral tablets whole. They can be taken with or without food.
You can also swallow the sprinkle capsules whole, with or without food. Or, you can open them and sprinkle their contents onto a teaspoon of soft food before swallowing them. Be sure not to chew the food and medication mixture before swallowing.
How often to take
You’ll take Topamax twice daily. You’ll take one dose in the morning and one in the evening.
Your doctor will recommend how long you’ll take Topamax for migraine prevention.
The use of Topamax for migraine prevention* may cause mild or serious side effects. The lists below include some of the main side effects that have been reported with Topamax.
For information about other potential side effects of the drug, talk with your doctor or pharmacist. You can also see our Topamax side effects article or refer to the drug’s prescribing information.
Note: After the Food and Drug Administration (FDA) approves a medication, it tracks and reviews side effects of the drug. If you develop a side effect while taking Topamax and would like to inform the FDA, visit MedWatch.
* Topamax is also approved to treat other conditions. It’s important to note that side effects from Topamax may differ depending on the condition it’s being used to treat.
Mild side effects
Mild side effects that can occur with Topamax include:
- abdominal pain
- changes in the way things taste
- diarrhea
- difficulty with memory
- loss of appetite
- loss of sensation, such as touch
- numbness or burning in your hands and feet
- nausea
- upper respiratory infection
- weight loss
These side effects of Topamax may be temporary, lasting a few days to weeks. But if they last longer than this, or if they bother you or become severe, it’s important to talk with your doctor or pharmacist.
Serious side effects
Below are serious side effects that can occur with Topamax:
- changes in thoughts or behaviors, including depression and suicidal thoughts or actions
- eye problems, including sudden nearsightedness that can lead to angle-closure glaucoma
- hyperammonemia (high level of ammonia in your body), which can lead to brain damage
- kidney stones
- metabolic acidosis (high level of acid in your body)
- reduced sweating, which can lead to a high body temperature
- severe skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome
- low bone mineral density
- slower growth in children
Call your doctor right away if you develop serious side effects while using Topamax. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.
Allergic reactionFor some people, Topamax can cause an allergic reaction. But this side effect wasn’t reported in the drug’s clinical trials.
In general, symptoms of allergic reaction can be mild or serious.
Ways to manage
For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.
For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Topamax, your doctor may recommend taking a different medication instead.
Before you take Topamax, there’s some important information to keep in mind. The drug may not be a safe option if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.
If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before taking Topamax:
- if you follow a ketogenic diet
- if you’ve ever had depression or suicidal thoughts
- if you have bone problems
- if you have diarrhea that occurs often or isn’t well-managed
- if you have lung or breathing problems
- if you have eye problems, including glaucoma
- if you have a kidney problem
- if you have a liver problem
- if you’re pregnant, nursing, or considering either
- if you consume alcohol
- if you’ve had an allergic reaction to Topamax or any of its ingredients
Read on for answers to some frequently asked questions about Topamax.
What are the pros and cons of taking Topamax for migraine?
There are risks and benefits to taking Topamax for migraine prevention.
For instance, Topamax can help reduce the number of migraine episodes you have. However, the drug may cause bothersome or serious side effects for some people. Examples include difficulty with memory, changes in thoughts or behaviors, and severe skin reactions.
Talk with your doctor to learn more about the risks and benefits of Topamax. They’ll ultimately help you decide whether Topamax is a suitable treatment option.
Is there a best time of day to take Topamax for migraine prevention?
No, there isn’t necessarily a best time of day to take Topamax for migraine prevention.
You should take Topamax as prescribed by your doctor. The drug is typically taken twice daily for migraine prevention, with one dose taken in the morning and one in the evening.
If you have other questions about how to take Topamax for migraine prevention, talk with your doctor.
How much Topamax costs is based on several factors. These can include your prescribed treatment regimen, your insurance plan, the pharmacy you use, and your location.
Topamax is a brand-name drug that’s also available as a generic. Brand-name drugs usually cost more than generics. To learn about this drug’s generic form, talk with your doctor or pharmacist.
To save money on your Topamax prescription, explore these Optum Perks coupons.
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Retail price refers to the manufacturer’s published list price and is up to date as of 3/2023. Retail and discounted prices are U.S.-only and can vary based on region and pharmacy. We cannot guarantee that the discounted price listed here will exactly match the price at your pharmacy. Please contact your pharmacy for the exact price.
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Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.