Topamax is a brand-name prescription medication that’s FDA-approved in certain situations to:

* To learn more about the uses of Topamax, see the “Topamax uses” section below.

Drug details

Topamax contains the active drug topiramate. Topamax belongs to a class of drugs called anticonvulsants. (A class of drugs is a group of medications that work in a similar way.) Anticonvulsant drugs work in your brain to help prevent seizures. Some of these drugs, including Topamax, can also prevent migraine headaches. Topamax is typically taken every day.

Topamax comes in two different forms:

  • A tablet that you swallow. It’s available in strengths of 25 milligrams (mg), 50 mg, 100 mg, and 200 mg.
  • A sprinkle capsule. The capsule can be swallowed whole or opened to sprinkle on a spoonful of soft food and swallowed. The capsule is available in strengths of 15 mg and 25 mg.

If you have trouble swallowing Topamax tablets, talk with your doctor about using Topamax sprinkle capsules instead.

Effectiveness

For information about the effectiveness of Topamax, see the “Topamax uses” section below.

Topamax is a brand-name drug that contains the active drug topiramate. This active drug is also available as a generic medication. A generic drug is an exact copy of the active drug in a brand-name medication.

The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

If you’re interested in using the generic form of Topamax, talk with your doctor. They can tell you if it comes in forms and strengths that can be used for your condition.

Topamax can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Topamax. These lists do not include all possible side effects.

For more information about the possible side effects of Topamax, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Topamax, you can do so through MedWatch.

Mild side effects

Mild side effects* of Topamax can include:

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Topamax. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Topamax’s medication guide.
** For more information on this side effect, see the “Topamax for weight loss” section below.
† This side effect could affect your ability to safely drive or use machines. You shouldn’t drive or use dangerous machines until you know how Topamax affects you.
‡ For more information about this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Topamax aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* For more information about this side effect, see “Side effect details” below.

Side effects in children

Topamax is approved for treating certain types of seizures in children ages 2 years and older. It’s also approved for preventing migraine headaches in children ages 12 years and older. (To learn more about the uses of Topamax, see the “Topamax uses” section below.)

Side effects of Topamax in children are similar to those in adults. These side effects are described above and in “Side effect details” below.

One clinical study looked at children ages 6 years and older who took Topamax alone for epilepsy. The most common side effects were:

  • fever
  • weight loss
  • respiratory infections, such as colds

In other clinical studies, children ages 2 to 15 years took Topamax with other medications for epilepsy. The most common side effects in these studies were:

  • fatigue
  • sleepiness
  • loss of appetite

In clinical studies involving children ages 12 years and older who took Topamax for migraine, the most common side effects were:

Children who take Topamax are less likely than adults to have speech problems, slow reactions, and trouble concentrating.

Serious side effect in children

One possibly serious side effect is more common in children than in adults. Children taking Topamax are more likely than adults to have fever and reduced sweating. These problems can lead to hyperthermia (high body temperature), which may need treatment in a hospital.

It’s important to monitor your child in hot weather. If they sweat less than usual or develop a high temperature, call your doctor for advice. A high temperature for children ages 2 years and older is one that’s above 99.5°F (37.5°C) when taken orally.

Side effect details

You may wonder how often certain side effects occur with this drug or whether certain side effects pertain to it. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Topamax. However, it isn’t known how often this side effect may have occurred in clinical studies.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to Topamax, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Hair loss

Some people may have hair loss or hair thinning while taking Topamax.

In one clinical study, hair loss was reported in 3% to 4% of people ages 16 years and older who took Topamax for epilepsy. It’s not known how often this side effect may have occurred in people who took a placebo. Hair loss wasn’t reported in people who took Topamax for migraine.

If you’re concerned about hair loss with Topamax, talk with your doctor. They may be able to suggest ways to help manage this side effect or suggest other treatment options.

Kidney stones

Topamax can raise the risk of developing kidney stones. In clinical studies, kidney stones were reported in an average of 1.5% of adults who took Topamax for epilepsy, depending on the dose.

Topamax was compared with a placebo in some studies. It’s not known how many people experienced kidney stones. But people treated with Topamax had 2 to 4 times more kidney stones than those not treated with Topamax.

It’s not known how many people who took Topamax for migraine may have had kidney stones during clinical studies.

Kidney stones were also reported in children taking Topamax for epilepsy or migraine, though it’s not known how often this occurred.

Symptoms of kidney stones

Symptoms of kidney stones can include:

If you have any of these symptoms while taking Topamax, call your doctor right away. You may need treatment to help your body get rid of any kidney stones.

During Topamax treatment

It’s important to drink plenty of fluids while you take Topamax. This can reduce your risk for developing kidney stones.

While taking Topamax, you’ll also have tests to check the level of acid in your blood. Kidney stones can be a sign that you have metabolic acidosis (a high level of acid in your blood).

If you have metabolic acidosis, your doctor may lower your Topamax dose. If this doesn’t help, you may need to switch to a different treatment.

Eye side effects

Topamax may cause eye side effects. These may include vision changes, such as decreased or blurry vision, and secondary closed-angle glaucoma (sudden raised pressure in your eye). Glaucoma can lead to permanent blindness if not treated.

In clinical studies of people ages 16 years and older, they were given either Topamax or a placebo. This was in addition to one or two other epilepsy drugs. Abnormal vision, such as blurry vision, occurred in:

  • 13% of people in the Topamax group
  • 2% of people in the placebo group

In clinical studies of adults with migraine, they were given 50 milligrams (mg) or 100 mg of Topamax, or a placebo. Blurry vision occurred in:

  • 4% of adults who used 50 mg of Topamax
  • 2% of adults who used 100 mg of Topamax
  • 2% of adults who used a placebo

It’s not known how often glaucoma occurs with Topamax.

Symptoms of eye side effects

Symptoms of eye side effects can include:

If you have symptoms of eye side effects while taking Topamax, talk with your doctor. They may refer you to an eye specialist, who can check the pressure in your eyes. If you have glaucoma, you may need treatment for it. However, eye side effects usually get better after you stop taking Topamax.

If you have eye side effects, your doctor will typically recommend that you stop taking Topamax and switch to a different treatment. Ideally, Topamax should be stopped gradually. Your doctor will explain how to do this. To read more about stopping Topamax treatment, see the “Topamax withdrawal and dependence” section below.

Personality or mood changes

Topamax can sometimes cause personality changes that affect the way people behave, react, feel, or interact with others. For example, the drug may cause agitation, aggression, or other behavior problems. Topamax may also cause mood changes, such as anxiety, mood swings, and depression. In addition, the medication may raise your risk for suicidal thoughts or behaviors.

All antiepileptic drugs (medications used to treat seizures due to epilepsy) are known to slightly raise the risk of suicidal thoughts and behaviors. These drugs can increase the risk regardless of what condition they’re treating.

Clinical studies looked at people taking an antiepileptic drug for any condition. The people had about twice the risk of suicidal thoughts or behaviors than people taking a placebo. In these studies, suicidal behavior or thoughts occurred in:

  • 0.43% of people taking an antiepileptic
  • 0.24% of people taking a placebo

Symptoms of depression

It’s important for you, your friends, and your family to watch for symptoms of depression while you take Topamax. These symptoms can include:

  • having thoughts about suicide or harming yourself
  • feeling sad or hopeless
  • having trouble sleeping
  • losing interest in usual activities
  • feeling agitated or restless
  • feeling anxious or having panic attacks
  • being irritable, aggressive, or violent
  • having other changes in your mood or behavior

If you have any symptoms of new or worsening depression while taking Topamax, talk with your doctor right away. They can suggest ways to ease this condition. They may also recommend that you switch to a different medication.

If you need to stop taking Topamax, your doctor will explain how to taper off the drug gradually. To read more about stopping Topamax treatment, see the “Topamax withdrawal and dependence” section below.

Weight gain (not a side effect)

Topamax isn’t known to cause weight gain. This side effect wasn’t reported in clinical studies with Topamax. However, weight gain has been reported with some anticonvulsant drugs that are in the same class as Topamax. (A drug class is a group of medications that work in a similar way.)

Topamax can cause weight loss. To read more about this, see the “Topamax for weight loss” section below.

The Food and Drug Administration (FDA) approves prescription drugs such as Topamax to treat certain conditions. Topamax may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Topamax to prevent migraine headaches

Topamax is FDA-approved to help prevent migraine headaches in adults and in children ages 12 years and older.

Migraine is a condition that can cause headaches that are intense, throbbing, and long-lasting. Many people also have nausea, vomiting, and increased sensitivity to light and sound with a migraine attack. Some people also have sensory symptoms, called an aura, before or during the migraine attack.

The aura may cause you to see flashing lights or zigzags, or have blind spots in your vision. The aura can also cause tingling feelings or problems with speech. After a migraine attack, many people feel wiped out, tired, or irritable for up to 2 days.

Migraine attacks can be treated with medications that help relieve the symptoms. But the attacks can be disabling and can often affect your ability to perform your usual activities.

If you have migraine attacks that happen more than once a week or are severe, talk with your doctor. They’ll likely recommend medication to help prevent migraine. Your doctor may also suggest medication to help prevent migraine if drugs for treating migraine aren’t suitable or don’t work for you.

Effectiveness for preventing migraine headaches

Topamax was found effective in preventing migraine headaches in clinical studies.

Two studies involved adults and children ages 12 years and older who had about 5.5 migraine headaches every month. They took Topamax or a placebo (a treatment containing no active drug) every day for 26 weeks. In this study, people who took:

  • Topamax had an average of 1.3 to 2.4 fewer migraine headaches per month, depending on their dose
  • a placebo had an average of 0.8 to 1.1 fewer migraine headaches per month

Another study involved children ages 12 to 17 years. They had 3 to 12 migraine attacks per month. These children took Topamax or a placebo every day for 16 weeks. In this study, children who took:

  • Topamax had an average of 1.7 to 3 fewer migraine headaches per month, depending on their dose
  • a placebo had an average of 1.3 fewer migraine headaches per month

Topamax to treat seizures

Topamax is FDA-approved to treat epilepsy in adults as well as children ages 2 years and older. It’s used as initial monotherapy. This means it’s prescribed before any other medications are added. Topamax is used to treat:

  • Partial-onset seizures. For the purpose of treating partial-onset seizures, Topamax may be used alone or with other drugs to treat seizures. These are called antiepileptic drugs.
  • Generalized tonic-clonic seizures. For the purpose of treating generalized tonic-clonic seizures, Topamax may be used alone or with other antiepileptic drugs.
  • Seizures linked to Lennox-Gastaut syndrome. For this purpose, Topamax is used with other antiepileptic drugs. (Lennox-Gastaut syndrome is type of epilepsy.)

Topamax is taken to help prevent seizures. It is a type of drug called an anticonvulsant. Topamax is also called an antiepileptic drug.

Epilepsy is a condition that causes repeated seizures (excessive electrical activity in certain parts of your brain). The type of seizure you have depends on the part of your brain that’s affected.

Partial-onset seizures

With partial-onset seizures, also called focal seizures, the excessive electrical activity starts in only one part of your brain. Partial seizures don’t make you lose consciousness.

Partial seizures are referred to as simple or complex. With simple partial seizures, you may have muscle twitching in one part of your body or a change in your senses. This could be a tingling feeling or a change in taste, smell, or vision. You may have trouble communicating but still be aware of your surroundings.

With complex partial seizures, you may feel confused or dazed, and may be unaware of your surroundings. You may also have muscle twitching or a change in your senses, as mentioned above.

Generalized tonic-clonic seizures

With generalized tonic-clonic seizures, the excessive electrical activity affects both sides of your brain. This type of seizure makes you lose consciousness, so you may fall. It also causes convulsions, which means your muscles become stiff (tonic) and jerk, shake, or spasm (clonic).

Seizures associated with Lennox-Gastaut syndrome

Lennox-Gastaut syndrome (LGS) is a rare form of childhood epilepsy that causes several different types of seizures. The seizures can be hard to control with medications. Children with LGS may also have learning difficulties and behavior problems, such as hyperactivity or autism.

Effectiveness of Topamax for treating seizures when used alone

A clinical study found Topamax to be effective for treating partial-onset and generalized tonic-clonic seizures when used alone.

In this study, adults and children ages 6 years and older took Topamax alone to treat their seizures. Depending on their dose, between 59% and 76% of people studied had no seizures for 1 year while taking Topamax. Topamax wasn’t compared with a different drug or placebo.

Effectiveness of Topamax for treating seizures when used with other seizure medications

In clinical studies, Topamax was found to be effective in treating partial-onset and generalized tonic-clonic seizures. The following results were found when Topamax was used with other seizure medications. People in the studies took either:

  • Topamax with up to two other antiepileptic drugs (AEDs) or
  • a placebo (treatment with no active drug) with up to two other AEDs

Studies looked at adults with partial-onset seizures. Compared with the number of seizures they had before the studies:

  • at least 50% of those who took Topamax with other AEDs had 24% to 48% fewer seizures, depending on their dose of Topamax
  • at least 50% of those who took a placebo with other AEDs had between 21% more seizures and 20% fewer seizures
  • 24% to 47% of those who took Topamax with other AEDs had at least 50% fewer seizures, depending on their dose of Topamax
  • 0% to 24% of those who took a placebo with other AEDs had at least 50% fewer seizures

One study looked at children ages 2 to 16 years with partial-onset seizures. Compared with the number of seizures they had before the studies:

  • at least 50% of those who took Topamax with other AEDs had 33% fewer seizures
  • at least 50% of those who took a placebo with other AEDs had 11% fewer seizures
  • 39% of those who took Topamax with other AEDs had at least 50% fewer seizures
  • 20% of those who took placebo with other AEDs had at least 50% fewer seizures

A second study looked at adults and children ages 2 years and older with generalized tonic-clonic seizures. Compared with the number of seizures they had before the studies:

  • at least 50% of those who took Topamax with other AEDs had 57% fewer seizures
  • at least 50% of those who took a placebo with other AEDs had 9% fewer seizures
  • 56% of those who took Topamax with other AEDs had at least 50% fewer seizures
  • 20% of those who took placebo with other AEDs had at least 50% fewer seizures

A third study looked at adults and children ages 2 years and older with seizures linked to Lennox-Gastaut syndrome. Compared with the number of seizures they had before the studies:

  • at least 50% of those who took Topamax with other AEDs had 15% fewer seizures that caused the person to fall
  • at least 50% of those who took a placebo with other AEDs had 5% more seizures that caused the person to fall
  • 28% of those who took Topamax with other AEDs had at least 50% fewer seizures that caused the person to fall
  • 14% of those who took placebo with other AEDs had at least 50% fewer seizures that caused the person to fall

Off-label uses for Topamax

In addition to the uses listed above, Topamax may be used off-label for other purposes. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA. (For more information on conditions Topamax is approved to cover, see the “Topamax to prevent migraine headaches” and “Topamax to treat seizures” sections above.)

Below are examples of off-label uses for Topamax.

Topamax for bipolar disorder

Topamax isn’t approved to treat bipolar disorder. There’s not much evidence that the drug works to treat this condition. Despite this, Topamax may sometimes be used off-label to treat bipolar disorder. People with bipolar disorder have episodes of depression and mania.

Research shows that Topamax isn’t effective for treating episodes of mania in bipolar disorder. In addition, there’s a lack of firm evidence from clinical studies to show if Topamax works for stabilizing mood in bipolar disorder. For this reason, your doctor will likely recommend trying Topamax only if other medications haven’t worked for you.

If you have bipolar disorder and are interested in taking Topamax, talk with your doctor.

Topamax for anxiety

Topamax isn’t approved to treat anxiety. However, the drug may sometimes be used off-label to treat people with certain anxiety disorders, such as obsessive-compulsive disorder (OCD). However, it’s not known for sure if Topamax is effective for this purpose.

For example, some studies suggest topiramate may be helpful as an add-on treatment for OCD. (As an add-on treatment, Topamax would be used with certain antidepressants if they aren’t working well enough.) However, a different small study found that Topamax wasn’t effective when used in this way.

Another small study found Topamax to be effective for treating OCD in people with bipolar disorder.

More studies are needed to determine if Topamax can be effective for OCD and when it should be used. If you’re interested in taking Topamax for an anxiety disorder, talk with your doctor.

Topamax for alcoholism

Topamax isn’t approved to treat alcoholism, which is also called alcohol dependence or alcohol use disorder. But the drug may sometimes be used off-label to treat this condition.

For example, various studies have found that Topamax can help people with alcohol dependence drink less alcohol. The drug seems to work by helping to reduce cravings for alcohol.

To learn more about the use of Topamax for alcoholism, talk with your doctor.

Topamax for pain

Topamax isn’t approved to treat pain. However, the drug may be used off-label to treat certain types of chronic pain. (Chronic pain is pain that lasts at least 12 weeks.)

For example, studies have found Topamax to be effective in relieving chronic low back pain. Topamax has also been found effective in treating various forms of nerve pain. For more information, see the “Topamax for nerve pain” section below.

If you’re interested in taking Topamax to treat pain, talk with your doctor.

Topamax for nerve pain

Topamax isn’t approved to treat nerve pain. However, Topamax may be used off-label to treat certain types of nerve pain.

For example, studies have found Topamax to be effective in relieving painful diabetic neuropathy. This is a type of nerve damage that occurs in people with diabetes.

One small study found Topamax to be similar to gabapentin (Neurontin) in its ability to treat nerve pain. Gabapentin is widely used for nerve pain. Topamax could be a useful alternative if you’ve tried gabapentin and had side effects that you couldn’t tolerate.

If you’re interested in taking Topamax to treat nerve pain, talk with your doctor.

For more information on conditions Topamax is approved to cover, see the “Topamax to prevent migraine headaches” and “Topamax to treat seizures” sections above.

Topamax and children

Topamax is FDA-approved in certain situations to:

For details on these conditions and uses, see “Topamax to prevent migraine headaches” and “Topamax to treat seizures” above.

Here’s some information on the use of Topamax with other drugs.

Epilepsy

If you have epilepsy and anticonvulsant drugs aren’t helping control your seizures, your doctor may prescribe Topamax.* (Anticonvulsant drugs are medications that treat seizures, and Topamax is a type of anticonvulsant drug.)

Examples of other anticonvulsant drugs that you may take with Topamax include:

* Topamax is approved to be used alone or with other drugs. For details on the uses of Topamax in treating epilepsy, see the “Topamax uses” section above.

Migraine

If you’re taking Topamax for migraine, you’ll typically take Topamax alone to help prevent migraine headaches.* However, if you have a migraine attack while you’re using Topamax, you can take pain-relieving medications for your migraine.

Examples of pain relievers used to treat migraine include:

  • over-the-counter pain relievers, such as:
  • prescription pain relievers, such as:
    • acetaminophen/butalbital/caffeine (Fioricet)
    • aspirin/butalbital/caffeine (Fiorinal)
    • acetaminophen/caffeine/dihydrocodeine (Trezix)
    • acetaminophen/codeine (Tylenol with codeine)
  • triptans, such as:
    • almotriptan (Axert)
    • frovatriptan (Frova)
    • naratriptan (Amerge)
    • rizatriptan (Maxalt)
    • zolmitriptan (Zomig)

Topamax isn’t approved for weight loss. However, the drug may reduce your appetite, which may lead you to lose weight.

In clinical studies, weight loss occurred in 6% to 17% of people who took Topamax. This depended on the dosage and condition treated. By comparison, weight loss occurred in 1% to 3% of people who took a placebo (a treatment containing no active drug).

One review of studies looked at the average weight loss in people who took Topamax. It also looked at how long it took them to lose weight when they took the drug. People who took Topamax for at least 4 months lost an average of 11.8 pounds (5.3 kilograms) more than those who took a placebo for the same time period.

Topamax isn’t usually prescribed solely for weight loss. But your doctor might recommend Topamax for preventing seizures or migraine if you would also benefit from weight loss. For example, if you’re at an increased risk for health problems because of excess weight, Topamax might help you. The drug might also be useful if you’re taking other seizure or migraine treatments that can cause weight gain.

There isn’t a particular dosage or best time of day to take Topamax for weight loss. You should take it as prescribed by your doctor for seizures or migraine.

If you’re interested in taking Topamax for weight loss, it’s important to discuss the possible risks and benefits of this treatment with your doctor.

Note: Weight loss is an approved use for the brand-name medication Qsymia. Qysmia contains topiramate (the active drug in Topamax) with another drug called phentermine. Qsymia is approved by the Food and Drug Administration (FDA) for aiding weight loss in people with obesity. The drug is also approved for use in people who are overweight and have an increased risk of health problems. These can include conditions such as high blood pressure, high cholesterol, and type 2 diabetes.

The Topamax dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Topamax to treat
  • your age
  • your body weight
  • your kidney function
  • other medical conditions you may have

Typically, your doctor will start you on a low dose. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dose that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Topamax comes in two different forms:

  • A tablet that you swallow. It’s available in strengths of 25 milligrams (mg), 50 mg, 100 mg, and 200 mg.
  • A sprinkle capsule. The capsule can be swallowed whole or opened to sprinkle on a spoonful of soft food and swallowed. The capsule is available in strengths of 15 mg and 25 mg.

If you have trouble swallowing Topamax tablets, talk with your doctor about using Topamax sprinkle capsules instead.

Dosage for preventing migraine headaches

Topamax is recommended for preventing migraine headaches* in adults and in children ages 12 years and older. The usual recommended dosage is 50 mg taken once in the morning and once in the evening.

Your doctor will gradually increase your dosage to this level over the first 4 weeks of treatment. This allows your body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section above.)

The dosage is usually increased as described below, but it may be raised more slowly if needed:

  • Week 1: 25 mg every evening
  • Week 2: 25 mg every morning and 25 mg every evening
  • Week 3: 25 mg every morning and 50 mg every evening
  • Week 4: 50 mg every morning and 50 mg every evening

* For details on the uses of Topamax, see the “Topamax uses” section above.

Dosage for treating seizures

Topamax is used to treat epilepsy (a condition that causes repeated seizures) in certain situations.*

The recommended dosage depends on whether you’re taking Topamax alone or with other medications for your seizures.

The dosage of Topamax is gradually increased over the first few weeks of treatment. This allows your body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section above.)

* For details on uses of, see the “Topamax uses” section above.

Topamax dosage when used alone

Topamax can be used on its own to treat partial-onset seizures and generalized tonic-clonic seizures.

The usual recommended dosage for treating these types of seizures is 200 mg twice per day. The drug should be taken once in the morning and once in the evening for a total of 400 mg per day. This is the dosage for both adults and children ages 10 years and older.

Your doctor will gradually increase your dose to this level as follows:

  • Week 1: 25 mg twice per day
  • Week 2: 50 mg twice per day
  • Week 3: 75 mg twice per day
  • Week 4: 100 mg twice per day
  • Week 5: 150 mg twice per day
  • Week 6: 200 mg twice per day

Topamax dosage when used with other seizure medications

Topamax can be used with other seizure medications to treat partial-onset seizures, generalized tonic-clonic seizures, and seizures linked to Lennox-Gastaut syndrome (LGS). LGS is a rare form of childhood epilepsy that causes several different types of seizures.

For the first week of treatment, the starting dosage is usually 25 mg to 50 mg per day. After this, your doctor may increase your daily dosage by 25 mg to 50 mg each week until the recommended dosage is reached.

The usual recommended dosages for treating these types of seizures in adults ages 17 years and older are:

  • For partial-onset seizures: 200 mg to 400 mg per day
  • For seizures linked to LGS: 200 mg to 400 mg per day
  • For generalized tonic-clonic seizures: 400 mg per day

The recommended dose per day is split into two equal doses. One dose is taken in the morning and the other is taken in the evening.

Children’s dosage

Topamax is used to treat certain seizures in children ages 2 years and older.* The drug is also used to prevent migraine headaches in children ages 12 years and older.* The recommended children’s dosage for these conditions is described below.

* For details on the uses of Topamax, see the “Topamax uses” section above.

For migraine prevention

The usual recommended dosage of Topamax in children ages 12 years and older is the same as it is for adults. For details, see the “Dosage for preventing migraine headaches” section above.

For treating seizures when used alone

Topamax can be used on its own to treat partial-onset seizures and generalized tonic-clonic seizures.

For children ages 10 years and older, the usual recommended dosage of Topamax is the same as it is for adults. For details, see the “Dosage for treating seizures” section above. Below is information for treating children ages 2 to 9 years.

Starting treatment

For the first week of treatment, the starting dosage is 25 milligrams (mg) taken every evening. If your child tolerates this well, for the second week of treatment, their doctor may increase the dosage to 25 mg twice per day. (This is a total of 50 mg daily.)

When starting treatment, your child’s doctor will likely increase your child’s dose gradually. This will take place over the first few weeks until the recommended dose is reached. This allows your child’s body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section above.)

Increasing dosage

After this, their doctor may increase their daily dosage by 25 mg to 50 mg each week. This is done until your child is at the minimum recommended dose for their body weight. If your child’s seizures aren’t controlled with this dose, their doctor may gradually raise the dose. This increase will continue until your child is at the maximum dose for their body weight.

Recommended dosage

For children ages 2 to 9 years, the usual recommended dosage of Topamax is based on body weight as follows:

Weight (lb)Weight (kg)Dose per day (mg)
Up to 25Up to 11150 to 250
26 to 4812 to 22200 to 300
49 to 6823 to 31200 to 350
69 to 8332 to 38250 to 350
84 and higher38 and higher250 to 400

The recommended dose per day is split into two equal doses. One dose is taken in the morning and the other is taken in the evening.

For treating seizures when used with other seizure medications

Topamax can be used with other seizure medications to treat:

  • partial-onset seizures
  • generalized tonic-clonic seizures
  • seizures in Lennox-Gastaut syndrome

Children ages 17 years and older typically take the same dosage of Topamax as adults. The following sections discuss the dosages for children ages 2 to 16 years.

Starting treatment

For the first week of treatment, the starting dose per day is usually about 1 milligram (mg) to 3 mg per kilogram (kg) of body weight. Topamax is typically taken as a single dose every evening.

When starting treatment, your child’s doctor will gradually increase their dose over the first few weeks until the recommended dose is reached. This allows their body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section above.)

After the first week, your child’s doctor may increase their daily dose by 1 mg to 3 mg per kg of body weight every 1 to 2 weeks. The medication is split into two equal doses. One dose is taken in the morning and the other is taken in the evening.

The daily dose is increased until your child is at the minimum recommended dose for their body weight. If your child’s seizures aren’t controlled with this dose, their doctor may gradually raise the dose. This increase will continue until your child is at the maximum dose for their body weight.

Recommended daily dose

For children ages 2 to 16 years, the usual recommended daily dose is 5 mg to 9 mg per kg of body weight. The recommended daily dose is split into two equal doses. One dose is taken in the morning, and the other dose is taken in the evening.

Dosage questions

Below are answers to some questions you may have about taking Topamax.

What if I miss a dose?

If you miss a dose of Topamax and it’s more than 6 hours until your next dose is due, you should take the missed dose. But if it’s less than 6 hours until your next dose is due, skip the missed dose. Take your next dose at your usual time. Don’t take a double dose to make up for a missed dose.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Topamax is meant to be used as a long-term treatment. If you and your doctor determine that Topamax is safe and effective for you, you’ll likely take it long term.

You should avoid drinking alcohol with Topamax. Drinking alcohol during Topamax treatment can increase the frequency and severity of Topamax side effects, such as:

  • sleepiness
  • dizziness
  • confusion
  • trouble with concentration, memory, or speech

In serious cases, drinking alcohol with Topamax may lead to serious side effects. These may include slow, shallow breathing, loss of consciousness, coma, and in rare cases, death.

If you have questions about the safety of drinking alcohol with Topamax, talk with your doctor.

Here are answers to some frequently asked questions about Topamax.

Will Topamax make me feel ‘high’?

It depends on how you define feeling “high.” Typically, feeling “high” describes feelings of pleasure or extreme happiness. Topamax doesn’t have this type of effect.

Topamax is more likely to make you feel sleepy, low in energy, or a bit dazed and confused. You may also have trouble with concentration, memory, or speech while taking it. But some people may also describe these very different effects as feeling “high.”

How long does it take to flush Topamax out of your system?

Topamax has a half-life of about 21 hours. The half-life of a drug is the time it takes for the amount of the drug in your body to fall by half. It takes about five half-lives for a drug to be almost completely removed from your body. So for Topamax, most of the drug will be flushed out of your system within about 5 days after you stop taking it.

Is Topamax a controlled substance?

No, it’s not. Topamax is available only by prescription from your doctor, but it’s not a controlled substance.

Controlled substances are drugs that have certain effects that give them a high potential for being misused. They also have a high risk of leading to drug dependence. Because of these risks, there are special rules about how controlled substances are prescribed and dispensed. Topamax doesn’t have a high risk of misuse or dependence.

Is Topamax a mood stabilizer?

Topamax is sometimes used off-label* as a mood stabilizer in people with bipolar disorder. Mood stabilizers are drugs that help prevent extreme changes in mood, such as those that occur with bipolar disorder. People with bipolar disorder typically have episodes of depression and episodes of mania. Mania is a mood disorder that gives you an unnatural feeling of physical and mental energy.

Several anticonvulsant medications also work as mood stabilizers in people with bipolar disorder. Topamax, which is an anticonvulsant medication, is sometimes used in this way. However, there’s not much evidence that Topamax is effective for this use. To read more about this, see the “Topamax uses” section above.

* Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

What’s Topamax’s drug classification?

Topamax belongs to a class of drugs called anticonvulsants. (A class of drugs is a group of medications that work in a similar way.) Anticonvulsants are also called antiepileptic drugs.

Anticonvulsants are mainly used to treat epilepsy (a condition that causes repeated seizures). But many drugs in this class, including Topamax, are also effective for other conditions that don’t involve seizures. These include migraine and nerve pain.

There haven’t been studies on whether Topamax can cause drug dependence.

However, once Topamax controls your condition, you will need to keep taking it to continue to prevent seizures or migraine. If you stop taking Topamax, your seizures or migraine headaches may happen more often. They could also become more severe. Sometimes people without epilepsy have had seizures after suddenly stopping Topamax.

You shouldn’t stop taking Topamax without first talking to your doctor. If you and your doctor decide to stop treatment, you may need to stop taking Topamax gradually. This can help reduce your risk for seizures. Your doctor will explain how to do this.

Topamax can interact with several other medications. It can also interact with certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Topamax and other medications

Below are examples of medications that can interact with Topamax. This section doesn’t contain all drugs that may interact with Topamax.

Before taking Topamax, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

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

Topamax and birth control

Topamax can make birth control drugs that contain estrogen less effective at preventing pregnancy.

Examples of birth control pills that can be made less effective by Topamax include:

  • levonorgestrel/ethinyl estradiol (Lessina, Levora, Seasonique)
  • desogestrel/ethinyl estradiol (Bekyree, Kariva)
  • norethindrone/ethinyl estradiol (Balziva, Junel, Loestrin/Loestrin Fe, Microgestin/Microgestin Fe)
  • norgestrel/ethinyl estradiol (Cryselle)
  • drospirenone/ethinyl estradiol (Loryna, Yaz)
  • norgestimate/ethinyl estradiol (Ortho Tri Cyclen/Ortho Tri Cyclen Lo, Sprintec, Tri-Sprintec)

Topamax treatment can also make certain birth control medications less effective at preventing pregnancy. These include:

  • the birth control patch (norelgestromin/ethinyl estradiol), called Xulane
  • the vaginal ring (ethinyl estradiol/etonogesterel), called NuvaRing

If you use birth control that contains estrogen, your doctor may recommend switching to a different type of birth control medication while you take Topamax.

Topamax and certain other seizure medications

Taking Topamax with phenytoin (Dilantin) or carbamazepine (Tegretol) can lower the level of Topamax in your blood. This could make Topamax less effective at preventing seizures or migraine headaches.

If you need to take Topamax with phenytoin or carbamazepine, your doctor may prescribe a higher dosage of Topamax. This should increase the chances that the drug works for you.

Topamax and Depakote

Taking Topamax with valproic acid/divalproex sodium (Depakote) can raise your risk for certain side effects. These include:

  • hyperammonemia (an increased level of ammonia in your blood)
  • hypothermia (low body temperature)

Both conditions can be very serious and, in rare cases, life threatening.

If you need to take Topamax with valproic acid, your doctor may recommend blood tests. These will monitor the amount of ammonia in your blood.

Topamax and carbonic anhydrase inhibitors

Taking Topamax with drugs called carbonic anhydrase inhibitors can raise your risk for a side effect called metabolic acidosis (a high level of acid in your blood). Metabolic acidosis can also raise your risk for kidney stones.

Examples of carbonic anhydrase inhibitors include:

  • acetazolamide
  • zonisamide (Zonegran)

If you need to take one of these drugs with Topamax, you may need more frequent blood tests than usual. These tests will check the level of acid in your blood.

Topamax and CNS depressants

Central nervous system (CNS) depressants are medications that slow down activity in your central nervous system (brain and spinal cord). These medications typically cause you to feel drowsy and less alert. But in serious cases, they can also cause slow, shallow breathing, loss of consciousness, coma, and in rare cases, death.

There have been no studies involving people who took Topamax with a CNS depressant. However, taking the two drugs together could raise your risk for the side effects mentioned above. For this reason, you should avoid CNS depressants while taking Topamax.

Examples of CNS depressants that should be avoided with Topamax include:

* For more information, see the “Topamax and alcohol” section above.

Topamax and anticholinergic medications

Anticholinergic drugs are used to treat many different conditions, including overactive bladder, asthma, and Parkinson’s disease. These drugs can sometimes cause reduced sweating. Topamax can also reduce sweating. Therefore, taking Topamax with anticholinergic drugs could raise your risk for overheating and hyperthermia (high body temperature), especially in hot weather.

Examples of anticholinergic drugs that could raise your risk for hyperthermia with Topamax include:

If you need to take one of these drugs, talk with your doctor about whether Topamax is right for you.

Topamax and hydrochlorothiazide

Hydrochlorothiazide (Microzide) is a diuretic medication used to treat high blood pressure.

Taking Topamax with hydrochlorothiazide may increase the level of Topamax in your blood. It’s not known if this increases your risk for side effects. However, your doctor may prescribe a lower dose of Topamax if you need to take hydrochlorothiazide as well.

Topamax and pioglitazone

Pioglitazone (Actos) is a medication for type 2 diabetes.

Taking Topamax with pioglitazone may decrease the level of pioglitazone in your blood. It’s not known if this makes pioglitazone less effective. However, if you need to take pioglitazone with Topamax, your doctor may monitor your blood sugar more often. This is to check that pioglitazone is still working you.

Topamax and lithium

Lithium (Lithobid) is a medication used for certain psychiatric illnesses, such as bipolar disorder and severe depression.

Taking high doses of Topamax with lithium may increase the level of lithium in your blood. This could raise your risk for lithium side effects. These include slurred speech, memory problems, kidney failure, and muscle tremors or twitches. A high lithium level can be serious.

If you need to take Topamax with lithium, your doctor may order more frequent blood tests than usual. These tests will check your lithium level. Your doctor may need to adjust the doses of your medications as needed.

Topamax and amitriptyline

Amitriptyline is an antidepressant medication that’s also used for nerve pain and to prevent migraine headaches.

Taking Topamax with amitriptyline can increase the level of amitriptyline in your blood. This could raise your risk for amitriptyline side effects. These side effects include drowsiness, dizziness, irregular heartbeats, and seizures.

If you need to take Topamax with amitriptyline, tell your doctor if you have any new side effects. Also, be sure to tell them if any side effects become more severe or occur more often. Your doctor may adjust the doses of your medications as needed.

Topamax and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Topamax. However, you should still check with your doctor or pharmacist before using any of these products while taking Topamax.

Topamax and foods

A ketogenic diet is low in carbohydrates and protein, and high in fat. Following a ketogenic diet while you’re taking Topamax could raise your risk for a side effect called metabolic acidosis. This is a high level of acid in your blood.

If not treated, metabolic acidosis can raise your risk for kidney stones and weakening of your bones. Metabolic acidosis can also increase the risk of reduced growth in children.

You should avoid following a ketogenic diet while taking Topamax to lower your risk for these side effects.

Note: For some people, following a ketogenic diet can reduce the number of seizures they have. This type of diet is sometimes recommended for people with epilepsy that’s not well controlled with medication. If you’re on a ketogenic diet or want to start one, you should discuss this with your doctor before taking Topamax.

Topamax is an anticonvulsant drug that’s mainly used to treat epilepsy. However, as with several other anticonvulsant drugs, Topamax also helps prevent migraine headaches.

For details on the uses of Topamax, see the “Topamax uses” section above.

What happens with epilepsy and migraine?

Epilepsy and migraine are both neurological conditions. (“Neurological” refers to the brain and nerves.) With epilepsy, you have seizures. With migraine, you have headaches, among other symptoms. But the conditions are considered to be linked, and many people have epilepsy and migraine together.

The causes of epilepsy and migraine aren’t fully understood. But with both conditions, it seems that nerve cells in your brain are oversensitive to certain triggers, such as flickering lights or hormones.

The trigger causes electrical signals to build up in the nerve cells in your brain. This causes them to fire inappropriate signals to other nerve cells. These nerve cells then pass on signals to other parts of your body. The increased electrical signaling can lead to a seizure in people with epilepsy. In people with migraine, it can lead to auras and headaches.

What does Topamax do?

Topamax has several effects on the nerve cells in your brain. One is that the drug blocks sodium channels (tiny openings through which sodium moves through your cells). This prevents excessive electrical signals from building up in the nerve cells. As a result, the nerve cells stop firing inappropriate or excessive signals.

In addition, Topamax affects two neurotransmitters. (Neurotrasmitters are natural body chemicals that help pass signals between nerve cells.) These neurotransmitters are called gamma-aminobutyric acid (GABA) and glutamate. The neurotransmitters also help pass signals between nerve cells and other cells in your body.

GABA reduces nerve signaling, causing fewer signals to be sent. Glutamate stimulates nerve signaling, causing more signals to be sent. Topamax increases the effect of GABA and blocks the effect of glutamate. This helps calm nerve activity in your brain.

The actions of Topamax help prevent the nerve cells in your brain from sending inappropriate signals that lead to seizures or migraine.

How long does it take to work?

Topamax starts working within a couple of hours after you start taking it. However, when you start treatment, your dose is increased slowly over a few weeks. Therefore, it may take a few weeks before the medication level builds up enough for you to notice your seizures or migraine easing.

Even if you don’t notice an improvement in your condition right away, it’s important to keep taking Topamax as prescribed.

Using more than the recommended dosage of Topamax can lead to serious side effects. Do not use more Topamax than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

  • convulsions
  • drowsiness
  • slurred speech
  • trouble with coordination
  • blurred or double vision
  • abdominal (belly) pain
  • agitation (being anxious or restless)
  • dizziness
  • stupor (a state of not being alert to your surroundings)

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

Topamax can harm a fetus if taken during pregnancy. Studies show that babies born to females* who took Topamax in pregnancy are more likely to have a cleft lip or cleft palate. (This is also known as an “oral cleft.”) These babies are also more likely to be born small for their gestational age (SGA).

Babies who are SGA can have a lower birth weight, length, and head size than expected. Babies are more likely to be SGA when born to females who took a high dose of Topamax or took Topamax throughout their pregnancy.

Pregnancy studies in the United States looked at babies who were exposed to topiramate (the active ingredient in Topamax) in the first 3 months of pregnancy. The studies showed that 1.1% of these infants had oral clefts. In comparison, oral clefts occurred in 0.12% of infants born to females who didn’t have epilepsy and hadn’t taken seizure medications during pregnancy.

These studies also showed that, in the U.S., 19.7% of infants exposed to topiramate during pregnancy were SGA at birth. In comparison, 5.4% of infants born to females who didn’t have epilepsy and hadn’t taken seizure medications during pregnancy were SGA.

If you’re pregnant or plan to become pregnant, talk with your doctor about the risks and benefits of Topamax. Other medications may be more suitable for you.

* Use of the term “female” or “male” within this article refers to a person’s gender assigned at birth.

Pregnancy registry

If you do take Topamax during pregnancy, you’re encouraged to sign up with the North American Antiepileptic Drug Pregnancy Registry. This registry monitors and records birth defects or changes affecting babies of females who took antiepileptic drugs, such as Topamax, while pregnant.

The registry helps healthcare professionals collect information about the safety of drugs such as Topamax during pregnancy. This can help you make informed decisions about the treatments you take during pregnancy.

You can register by visiting the program website or calling 888-233-2334.

Topamax can harm a fetus if taken during pregnancy. For more information about taking Topamax during pregnancy, see the “Topamax and pregnancy” section above.

If you’re sexually active and could become pregnant, talk with your doctor about your birth control needs while using Topamax.

For females using Topamax

Females using Topamax should use an effective method of birth control to help prevent pregnancy. However, Topamax can make birth control drugs that contain estrogen less effective at preventing pregnancy.

Examples of birth control that can be less effective when taken with Topamax include:

  • levonorgestrel/ethinyl estradiol (Lessina, Levora, Seasonique)
  • desogestrel/ethinyl estradiol (Bekyree, Kariva)
  • norethindrone/ethinyl estradiol (Balziva, Junel, Loestrin/Loestrin Fe, Microgestin/Microgestin Fe)
  • norgestrel/ethinyl estradiol (Cryselle)
  • drospirenone/ethinyl estradiol (Loryna, Yaz)
  • norgestimate/ethinyl estradiol (Ortho Tri Cyclen/Ortho Tri Cyclen Lo, Sprintec, Tri-Sprintec)

Topamax treatment can also make certain birth control medications less effective at preventing pregnancy. These include:

  • the birth control patch (norelgestromin/ethinyl estradiol), which is called Xulane
  • the vaginal ring (ethinyl estradiol/etonogesterel), which is called NuvaRing

If you use birth control that contains estrogen, your doctor may recommend switching to a different type of contraception.

For males using Topamax

The manufacturer of Topamax hasn’t stated that males using this drug need to use birth control. If you have questions about your birth control needs, talk with your doctor.

Topamax can pass into breast milk. Sleepiness and diarrhea have been reported in children breastfed by females taking Topamax.

If you’re breastfeeding or plan to breastfeed, talk with your doctor about the possible risks and benefits of Topamax.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Topamax, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Alternatives for preventing migraine headaches

Examples of other drugs that may be used to prevent migraine headaches include:

Alternatives for treating seizures

Examples of other drugs that may be used to treat seizures include:

  • carbamazepine (Carbatrol, Equetro, Tegretol, others)
  • gabapentin (Neurontin)
  • pregabalin (Lyrica)
  • perampanel (Fycompa)
  • lacosamide (Vimpat)
  • eslicarbazepine (Aptiom)
  • rufinamide (Banzel)
  • clobazam (Onfi)
  • oxcarbazepine (Oxtellar XR)
  • lamotrigine (Lamictal)
  • levetiracetam (Keppra)

As with all medications, the cost of Topamax can vary. To find current prices for Topamax tablets (or other forms) in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Topamax, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Topamax, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Topamax, or if you need help understanding your insurance coverage, help is available.

Janssen Pharmaceuticals, Inc., the manufacturer of Topamax, offers a savings card that may help lower the cost of Topamax. For more information and to find out if you’re eligible for support, visit the manufacturer’s website.

Generic version

Topamax is available in a generic form called topiramate. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs. To find out how the cost of topiramate compares to the cost of Topamax, visit GoodRx.com.

If your doctor has prescribed Topamax and you’re interested in using topiramate instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

You should take Topamax according to your doctor’s or healthcare provider’s instructions.

Topamax comes in two different forms: a tablet that you swallow and a sprinkle capsule. The capsule can be swallowed whole or opened to sprinkle on a spoonful of soft food and swallowed.

If you have trouble swallowing Topamax tablets, talk with your doctor about using Topamax sprinkle capsules instead.

When to take

When you first start taking Topamax for migraine or seizures,* your doctor will gradually increase your dose. Some people may take Topamax once every evening for the first week of treatment. After this, most people will usually take Topamax twice per day. The best time of day to take Topamax is once every morning and once every evening. Try to take your dose at roughly the same time or times each day.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

*To learn more about Topamax for migraine headaches and seizures, see the “Topamax uses” section above.

Taking Topamax with food

You can take Topamax either with or without food.

Can Topamax be crushed, split, or chewed?

It depends on which form of Topamax you take.

You should not crush, split, or chew Topamax tablets, as they have a very bitter taste. These tablets should be swallowed whole.

If you take Topamax sprinkle capsules, you should swallow them whole. But if you have trouble swallowing them, you can split them open. Then you’ll sprinkle the contents of the capsule onto a spoonful of soft food, and swallow this right away without chewing it.

If you have trouble swallowing Topamax tablets, talk with your doctor about using Topamax sprinkle capsules instead.

Before taking Topamax, talk with your doctor about your health history. There are no contraindications to Topamax. (Contraindications are conditions or factors that would prevent you from taking the medication.) But Topamax may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

Depression or suicidal thoughts. Topamax is a type of drug called an anticonvulsant. Like all anticonvulsant drugs, Topamax can raise your risk for suicidal thoughts and behaviors. If you’ve had depression or suicidal thoughts in the past, talk with your doctor about whether Topamax is right for you.

Glaucoma. Topamax can sometimes cause secondary closed-angle glaucoma (sudden increase in the pressure in your eye). If you have glaucoma, or have had glaucoma in the past, talk with your doctor about whether Topamax is right for you.

Lung or breathing problems. Topamax can sometimes cause a side effect called metabolic acidosis, which is a high level of acid in your blood. Severe lung or breathing problems, such as COPD or asthma, can also increase the level of acid in your blood. If you have lung or breathing problems, you could have a raised risk for metabolic acidosis with Topamax.

Talk with your doctor about whether Topamax is right for you. If you take Topamax, you may need extra blood tests during treatment to check that the level of acid in your blood is safe.

Kidney disease. Topamax can sometimes cause a side effect called metabolic acidosis, which is a high level of acid in your blood. If this condition isn’t treated, it can lead to kidney stones. Kidney disease can also increase the level of acid in your blood. If you have kidney disease, you could have a raised risk for metabolic acidosis and kidney stones with Topamax.

Talk with your doctor about whether Topamax is right for you. If you take Topamax, you may need extra blood tests during treatment. This is to check that the level of acid in your blood is safe. You may also take a lower than usual dose of Topamax.

Ketogenic diet. A ketogenic diet can increase the level of acid in your blood. Topamax can also increase the level of acid in your blood. If you follow a ketogenic diet, you could have a raised risk for metabolic acidosis (a high level of acid in your blood) with Topamax. This type of diet is not usually recommended with Topamax.

Talk with your doctor if you want to follow a ketogenic diet while you take Topamax. You may need extra blood tests to check that the level of acid in your blood is safe.

Diarrhea. If you have frequent or uncontrolled diarrhea, this can increase the level of acid in your blood. If you have diarrhea while taking Topamax, you could have a raised risk for metabolic acidosis (a high level of acid in your blood).

Tell your doctor if you have frequent or uncontrolled diarrhea while you’re taking Topamax.You may need extra blood tests to check that the level of acid in your blood is safe.

Weak, soft, or brittle bones. Topamax can sometimes cause a side effect called metabolic acidosis, which is a high level of acid in your blood. If this condition goes untreated, it can lead to osteoporosis or osteomalacia. These conditions raise your risk for fractures. If you already have weak, soft, or brittle bones, you could be at higher risk for developing these conditions.

Talk with your doctor about whether Topamax is right for you. If you take Topamax, you may need extra blood tests during treatment to check that the level of acid in your blood is safe. You may also have bone scans to monitor your bone density.

Liver problems. If you have liver problems, you may have a raised risk for a side effect called hyperammonemia (a high level of ammonia in your blood) with Topamax. If you have liver problems, such as cirrhosis or hepatitis, talk with your doctor about whether Topamax is right for you. If you take Topamax, you may need extra blood tests during treatment.

Allergic reaction. If you’ve had an allergic reaction to Topamax or any of its ingredients, you shouldn’t take Topamax. Ask your doctor what other medications are better options for you.

Pregnancy. Topamax can harm a developing fetus. For more information, see the “Topamax and pregnancy” section above.

Breastfeeding. Topamax can pass into breast milk and may cause side effects in a breastfed child. For more information, see the “Topamax and breastfeeding” section above.

Note: For more information about the potential negative effects of Topamax, see the “Topamax side effects” section above.

When you get Topamax from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Topamax tablets should be stored at room temperature (59°F to 86°F/15°C to 30°C) in a tightly sealed container away from light. Topamax sprinkle capsules should be stored at or below 77°F (25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Topamax and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.

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 other 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.