Topamax interactions: Alcohol, medications, and other factors

Topamax (topiramate) is a brand-name prescription drug used to help prevent migraine and treat epilepsy in certain situations. As with other medications, Topamax can interact with alcohol and certain other drugs. It can also interact with some supplements and foods. An interaction occurs when one substance causes another substance to have a different effect than expected.

Topamax comes in different forms, which have the same interactions. The forms are:

• oral tablet
• sprinkle capsule

For details about Topamax’s interactions, keep reading. For additional information about Topamax, including details about its uses, see this article.

Drinking alcohol is not recommended if you’re taking Topamax. Since Topamax and alcohol can cause similar side effects, the combination of the two substances may increase your risk of experiencing them. Also, the combination could increase the severity of these side effects. Examples of these side effects include:

• sleepiness
• dizziness
• difficulty concentrating
• confusion
• difficulty breathing
• loss of consciousness
• coma

Some of the side effects can be serious and possibly life threatening. To learn more about Topamax’s side effects, see this article. If you have additional questions, talk with your doctor.

Before you start treatment with Topamax, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Topamax. Keep in mind that this chart does not include all drugs that may interact with Topamax. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* To learn more about the side effects of Topamax, see this article.

Here’s a closer look at certain drug interactions of Topamax.

Selective serotonin reuptake inhibitors (SSRIs)

Topamax can interact with a group of drugs called selective serotonin reuptake inhibitors (SSRIs). These medications may be used to treat depression.

Interaction result. Taking Topamax in combination with an SSRI can increase the risk of side effects of both drugs, especially bleeding. (To learn more about the side effects of Topamax, see this article.)

Interaction explained. Topamax may increase your risk of bleeding. SSRIs can also increase your bleeding risk. So, taking an SSRI with Topamax may make it more likely for bleeding to occur.

Examples of SSRI drugs.

• fluoxetine (Prozac)
• sertraline (Zoloft)
• escitalopram (Lexapro)

Steps you or your doctor may take. If your doctor prescribes an SSRI, tell them if you have any symptoms of bleeding. Thesemay include nosebleeds, bleeding of your gums, and bruising more easily than usual. Your doctor may also monitor you for symptoms.

If you have questions about your risk of bleeding while you’re taking Topamax, talk with your doctor.

Bupropion

It’s possible for bupropion (Wellbutrin XL) to interact with Topamax. This interaction may occur in people taking Topamax for epilepsy (a type of seizure disorder).

Interaction result. TakingTopamax in combination with bupropion can increase the risk of seizures in people with seizure disorders.

Interaction explained. Bupropion can lower your seizure threshold, which means the drug can increase your risk of seizures. If you’re taking Topamax for epilepsy, taking bupropion with Topamax may make your condition worse.

Steps you or your doctor may take. If you’re taking Topamax for epilepsy, your doctor may recommend that you do not take bupropion. If they do prescribe bupropion and Topamax, they may monitor you more often than usual throughout your treatment.

Metformin

It’s possible for metformin (Fortamet) to interact with Topamax.

Interaction result. Taking metformin and Topamax may increase your risk of side effects of both medications, including metabolic acidosis. This is a condition in which the fluids in your body have too much acid. (To learn more about the side effects of Topamax, see this article.)

Interaction explained. Both Topamax and metformin can cause metabolic acidosis. If the drugs are taken in combination, the risk of the condition increases. Sometimes, metabolic acidosis can be severe and possibly life threatening.

Steps you or your doctor may take. If your doctor prescribes Topamax and metformin, they may monitor your blood acid levels throughout your treatment. This helps your doctor see whether your levels are becoming too high.

You can also watch for symptoms of metabolic acidosis and let your doctor know if you develop:

• jaundice
• breathing that’s fast and shallow
• headache
• increased heart rate
• fatigue

If you develop metabolic acidosis, your doctor can work with you to treat it.

Topamax may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Topamax.

Topamax and supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Topamax and herbs

There are no specific reports of herbs interacting with Topamax. However, that doesn’t mean interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Topamax treatment.

Topamax and vitamins

No vitamins have been specifically reported to interact with Topamax. However, that doesn’t mean interactions won’t occur or be recognized in the future. This is why you should talk with your doctor or pharmacist before taking any vitamin product with Topamax.

Topamax interactions with food

Following a ketogenic diet during Topamax treatment may increase your risk of a condition called metabolic acidosis. (With metabolic acidosis, the fluids in your body have too much acid.)

A ketogenic diet is low in carbohydrates and high in fat. Some people with seizure disorders follow a ketogenic diet to decrease the risk of seizures. However, ketogenic diets can increase the level of acid in your blood. Topamax can also increase the level, which can lead to metabolic acidosis. So, if you’re on a ketogenic diet and taking Topamax, your risk of metabolic acidosis may increase.

Metabolic acidosis can lead to other conditions. These can include kidney problems such as kidney stones and bone problems such as osteoporosis.

If you’re following a ketogenic diet, tell your doctor before you start taking Topamax. They can advise you on whether it’s safe to stay on the diet during Topamax treatment. If they approve of you following the diet, your doctor may monitor the levels of acid in your blood while you take the drug.* However, it’s possible they may recommend that you do not follow a ketogenic diet while taking Topamax.

You can talk with your doctor or pharmacist if you have questions about Topamax and any foods.

* Your doctor may also have you watch for symptoms of metabolic acidosis. To learn more, see “Metformin” in “Drug interactions in depth” above.

Topamax and vaccines

Topamax isn’t known to interact with vaccines. To see if you’re due for any vaccines while you take the medication, talk with your doctor or pharmacist.

Topamax and lab tests

No interactions have been reported between Topamax and lab tests. If you have questions about lab tests during your Topamax treatment, talk with your doctor.

Topamax and cannabis or CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Topamax. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Topamax. The impact of cannabis may affect how well you stick to your Topamax treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Topamax. Before you take Topamax, be sure to talk with your doctor about your health history. Topamax may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Topamax include the following.

Glaucoma or other eye conditions. It’s possible for Topamax to increase your risk of glaucoma or other eye-related conditions. If you already have glaucoma or another eye condition, taking Topamax may make it worse. Your doctor can help determine whether Topamax is a safe treatment option.

Osteoporosis or other bone density problems. Before taking Topamax, tell your doctor if you have osteoporosis or any other bone density problems. The drug may cause metabolic acidosis, which can lead to weak bones. If you already have weak bones, Topamax may worsen your condition. Your doctor can help determine whether Topamax is right for you.

Lung or other breathing problems. Before starting Topamax treatment, tell your doctor about any lung or breathing problems you have. The medication can cause a side effect called metabolic acidosis. Lung or breathing conditions, such as asthma, can increase your risk of metabolic acidosis. Your doctor may monitor you more often than usual throughout your Topamax treatment.

Ketogenic diet. If you’re on a ketogenic diet, tell your doctor before taking Topamax. For details, see “Topamax interactions with food” in “Topamax and other interactions” above.

Diarrhea. Before taking Topamax, tell your doctor if you have frequent or severe diarrhea.

Frequent or severe diarrhea can cause dehydration, which can increase your risk of metabolic acidosis. Topamax can also cause metabolic acidosis. So if you have diarrhea, you may have an increased risk of metabolic acidosis. Your doctor may order blood tests to check the level of acid in your blood throughout your treatment.

Your doctor may also have you watch for symptoms of metabolic acidosis. To learn more, see “Metformin” in “Drug interactions in depth” above.

Kidney problems. If you have kidney problems, such as kidney stones, or if you’re having dialysis, tell your doctor before starting Topamax treatment. This medication can cause a side effect called metabolic acidosis. If you have kidney problems and take Topamax, you may be at an increased risk of worsened kidney problems or metabolic acidosis.

Your doctor can help determine whether Topamax is a safe treatment option for you. They may monitor your blood acid levels throughout your treatment with Topamax. Your doctor may also have you watch for symptoms of metabolic acidosis. To learn more, see “Metformin” in “Drug interactions in depth” above.

History of metabolic acidosis. Tell your doctor if you’ve ever had a condition called metabolic acidosis. Topamax can cause metabolic acidosis. If you have a history of this condition and take the drug, your risk of metabolic acidosis can increase. Your doctor can help determine whether Topamax is right for you.

Liver problems. You may be at an increased risk of side effects from Topamax if you have liver problems, such as hepatitis.

Topamax can increase the level of ammonia in your blood. If you have a liver condition, you may already have a high ammonia level. So taking Topamax when you have a liver problem could cause the ammonia level to increase further.

In addition, it’s possible for Topamax to increase the risk of other liver problems. If you have a liver condition, your doctor can help determine whether Topamax is safe for you.

Pregnancy. Topamax may cause harm to a developing fetus if the drug is taken during pregnancy. Due to these risks, your doctor will likely not prescribe Topamax if you’re pregnant or trying to become pregnant. They can advise you on the right treatment option for you.

Breastfeeding. Topamax may cause sleepiness and diarrhea in a child exposed to the drug through breastfeeding. Your doctor can help determine whether it’s safe to breastfeed while you take Topamax.

Allergic reaction. If you’ve had an allergic reaction to Topamax or any of its ingredients, your doctor will likely not prescribe Topamax. Taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Depression, mood conditions, or suicidal thoughts or behaviors. Topamax may increase the risk of changes in mood as well as suicidal thoughts or behaviors. If you have a history of depression, mood conditions, or suicidal thoughts or behaviors, tell your doctor before taking Topamax. You may be at an increased risk of these side effects. Your doctor can help determine whether Topamax is right for you.

Here are some frequently asked questions about Topamax and possible interactions.

Do SNRIs such as Effexor XR and Cymbalta interact with Topamax?

There aren’t any known drug interactions between serotonin-norepinephrine reuptake inhibitors (SNRIs) and Topamax. So, it’s likely safe to take SNRI drugs with Topamax. SNRIs are often used to treat depression. Examples of SNRIs include:

• venlafaxine (Effexor XR)
• duloxetine (Cymbalta)
• desvenlafaxine (Pristiq)

Medications similar to SNRIs called selective serotonin reuptake inhibitors (SSRIs) may interact with Topamax. For more information, see “Drug interactions in depth” above.

Your doctor and pharmacist can help answer other questions you have about taking an SNRI with Topamax.

Can I take prednisone with Topamax?

Yes, you can likely take prednisone (Rayos) in combination with Topamax. The two drugs aren’t known to interact with each other.

Prednisone is used to help ease inflammation due to conditions such as rheumatoid arthritis and multiple sclerosis.

If you have additional questions about taking prednisone and Topamax, talk with your doctor or pharmacist.

You can take certain steps to help prevent interactions with Topamax. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Topamax label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Topamax doesn’t come with paperwork, ask your pharmacist to print a copy.) Your doctor or pharmacist can help answer any questions you have.

You can also help prevent interactions with Topamax by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Topamax. These resources might help:

• Overview of Topamax. For a general overview of Topamax, you can see this article.
• Side effects. If you’re interested in the side effects of Topamax, see this article. Another option is to refer to the Topamax prescribing information.
• Dosage specifics. To learn about the dosage of Topamax, see this article.
• Facts about your condition. To learn more about Topamax for migraine prevention, see this article. You can also visit our headache and migraine hub. For more information about epilepsy, refer to our epilepsy and seizures hub.

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.