Topamax

The active ingredient in Topamax is topiramate, an antiepileptic drug. It works by blocking your brain from sending signals and chemicals that can cause seizures by overexciting your nerves, which will then help the bursts of activity in the brain. In terms of migraine prevention, it is not exactly known how it works.

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labeling, Instructions for Use, and Medication Guide before using Topamax. However, the following is a synopsis of the general guidelines for the use of Topamax:

• Topamax can be taken with or without food.
• Do not crush, chew, or break the tablets. Swallow the tablets whole.
• If you cannot swallow a Topamax Sprinkle Capsule whole, carefully open the capsule and sprinkle its contents onto a spoonful of soft food. Consume the mixture immediately without chewing, and do not store it for future use.
• In children, Topamax doses are sometimes determined based on weight. If your child gains or loses weight, their dosage may need to be adjusted.
• Stay well-hydrated while taking Topamax to help prevent kidney stones and electrolyte imbalances.
• Regular medical tests will be necessary while using this medication. If you require surgery, inform your surgeon in advance that you are taking Topamax. Ensure all healthcare providers treating you are aware that you use seizure medication.
• Do not stop taking Topamax abruptly, even if you feel well. Sudden discontinuation can lead to an increase in seizures. Follow your doctor’s instructions for gradually reducing your dose.
• Contact your doctor if your seizures worsen or become more frequent while using Topamax.

The most common side effects of Topamax seen in clinical trials include:

• The feeling of “pins and needles” or feeling numb.
• Drowsiness or tiredness.
• Weight loss or loss of appetite or loss of taste.
• Nervousness or anxiety.
• Dizziness.
• Trouble sleeping.
• Fevers.
• Upper respiratory tract infection (e.g., cough, stuffy nose, sore throat).
• Trouble moving or keeping balance.
• Nausea.
• Drooling.

Some individuals may experience serious side effects while using Topamax. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Suicidal thoughts.
• Withdrawal-related seizures.
• Vision issues include blurred vision, vision loss, double vision, eye pain, or eye problems.
• Severe bleeding, such as uncontrollable bleeding, vomiting blood, blood in urine or stool, or stool resembling coffee grounds.
• Serious skin reactions such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) with symptoms including skin rash, skin pain, peeling, blisters, fever, sore throat, extreme fatigue, facial swelling, or swollen lips.
• Critically low body temperature causes shivering, fatigue, confusion, slurred speech, or coma.
• Dangerously high body temperature, with symptoms like fever, headache, dizziness, confusion, nausea, vomiting, muscle cramps, or excessively warm skin, especially in hot weather.
• Critically high blood acid levels lead to extreme fatigue, rapid breathing, poor appetite, irregular heartbeat, difficulty thinking, or sharp pain near the sides or back from kidney stones.
• Excessively high ammonia levels in the blood, result in fatigue, decreased mental alertness, and vomiting.

These are not all of the possible side effects of Topamax. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Topamax, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• Avoid using Topamax if you are allergic to topiramate. Refrain from consuming alcohol while taking this medication.

Inform your doctor if you are experiencing diarrhea or if you have a history of:

• Glaucoma or other eye issues
• Metabolic acidosis (elevated acid levels in the blood)
• Kidney disease, kidney stones, or dialysis
• Lung disease or breathing problems
• Mood disorders, depression, or suicidal thoughts/actions
• Liver disease
• Growth disorders
• Soft or brittle bones (osteoporosis or osteomalacia)
• Topamax may raise acid levels in your blood (metabolic acidosis), potentially weakening bones, causing kidney stones, or affecting growth in children. It may also harm an unborn baby. Blood tests may be necessary to monitor for metabolic acidosis, particularly during pregnancy.
• Some individuals may experience suicidal thoughts while taking anticonvulsants. Regular check-ins with your doctor are essential, and family or caregivers should monitor for mood or behavioral changes.
• Using Topamax during pregnancy might increase the risk of cleft lip or palate in the baby, a defect that can occur early in pregnancy. However, seizures during pregnancy can also pose serious risks to both mother and baby. Notify your doctor immediately if you become pregnant.
• If you are pregnant while taking Topamax, your doctor will assess whether the benefits of preventing seizures outweigh the potential risks. Other medications may be safer alternatives. Do not start or stop this medicine without consulting your doctor.
• If you are not pregnant, use effective birth control to prevent pregnancy while taking Topamax.
• Topamax can reduce the effectiveness of birth control pills. Discuss alternative contraceptive methods with your doctor, such as injections, implants, skin patches, vaginal rings, condoms, diaphragms, cervical caps, or contraceptive sponges.
• Topamax may cause vision problems that could become permanent if not addressed promptly. Contact your doctor immediately if you experience a sudden loss of vision.
• This medication can raise body temperature and reduce sweating, which may result in life-threatening dehydration. Inform your doctor if you notice decreased sweating, a high fever, or hot, dry skin.
• Some individuals may experience suicidal thoughts while using seizure medication. Be vigilant about changes in mood or symptoms, and report any new or worsening issues to your doctor.
• Do not abruptly stop taking Topamax, as this could lead to an increase in seizures.
• Topamax is a carbonic anhydrase inhibitor anticonvulsant, therefore use with other inhibitors of carbonic anhydrase inhibitors (e.g. acetazolamide) has an increased risk of kidney stones.

There are no obvious contraindications with Topamax. However, let your healthcare provider know if you are allergic to topiramate or have had any allergic reactions to other seizure medications.

For epilepsy, it may take 2 to 4 weeks for Topamax to reach its full effectiveness. For migraines, it can take about 1 month to notice a reduction in the frequency of migraine attacks, but 2 to 3 months for Topamax to work fully in managing migraines.

When Topamax is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Certain medications for seizures like carbamazepine, lamotrigine, phenobarbital, phenytoin, primidone, valproic acid, zonisamide, divalproex sodium, or valproate sodium.
• Birth control pills.
• Glaucoma medications, including eye drops.
• Lithium.
• Certain medications for depression like amitriptyline, fluoxetine, and sertraline.
• Avoid taking any other medications that make you drowsy as this could worsen the effect.

Seizures (when used alone)

Topamax, Eprontia solution, generic immediate-release tablet, and generic sprinkle capsule

Adults and children (age 10 years or older): The usual starting dose is 25 mg taken orally once or twice daily. The typical maintenance dose is 200 mg taken twice daily.

Children (age 2 to 9 years old): The usual starting dose is 25 mg taken orally at night. Based on body weight, the typical maintenance dose ranges from 75 mg to 200 mg taken twice daily.

Qudexy XR, Trokendi XR, and generic extended-release capsule

Adults and children (age 10 years or older): The usual starting dose is 50 mg taken orally once daily. The typical maintenance dose is 400 mg daily.

Children (age 2 to 9 years old): The usual starting dose is 25 mg taken orally at night. Based on body weight, the typical maintenance dose ranges from 150 mg to 400 mg daily.

Note: Trokendi XR is only approved for children aged 6 to 9 years old when used alone for seizures.

Seizures (when combined with other medications)

Topamax, Eprontia solution, generic immediate-release tablet, and generic sprinkle capsule

Adults and adolescents (age 17 or older): The usual starting dose is 25 mg to 50 mg taken orally once daily. The typical maintenance dose ranges from 200 mg to 400 mg daily, divided into two doses throughout the day.

Children (age 2 to 16 years old): The usual starting dose is 25 mg taken orally at night. Based on body weight, the typical maintenance dose ranges from 5 mg/kg to 9 mg/kg daily, divided into two doses throughout the day. The maximum daily dose is 400 mg.

Qudexy XR, Trokendi XR, and generic extended-release capsule

Adults (age 17 or older): The usual starting dose is 25 mg to 50 mg taken orally once daily. The typical maintenance dose ranges from 200 mg to 400 mg daily, with a maximum daily dose of 400 mg.

Children (age 2 to 16 years old): The usual starting dose is 25 mg taken orally at night. The typical maintenance dose is 5 mg/kg to 9 mg/kg daily, with a maximum daily dose of 400 mg.

Note: Trokendi XR is only approved for children aged 6 to 16 years old when used with other seizure medications.

Migraine

Topamax, Eprontia solution, generic immediate-release tablet, and generic sprinkle capsule

Adults and children (age 12 or older): The usual starting dose is 25 mg taken orally at night. The typical maintenance dose is 50 mg taken twice daily.

Qudexy XR, Trokendi XR, and generic extended-release capsule

Adults and children (age 12 or older): The usual starting dose is 25 mg taken orally once daily. The typical maintenance dose is 100 mg taken once daily.

For a missed dose, take the medicine as soon as you can. Do not take two doses at one time and skip a missed Topamax dose if your next dose is due in less than 6 hours. Call your doctor if you have missed more than one dose.

Store at room temperature, away from light, moisture, and heat. Keep out of reach of children too.

Janssen Pharmaceuticals, Inc. is the company that manufactures Topamax.

There are several lower-cost generics of Topamax available with the active ingredient of topiramate.

If you wish to discontinue Topamax, consult your healthcare provider. Stopping Topamax abruptly can increase the risk of seizures. Your provider can guide you in safely discontinuing the medication by gradually reducing your dosage over time.

Avoid taking Topamax if you are pregnant, as it may lead to significant birth defects or hinder the growth of your unborn baby. If you are planning to become pregnant, consult your healthcare provider to explore safer treatment options. If you discover you are pregnant while using this medication, contact your provider immediately to discuss the potential risks and benefits of continuing treatment.

Consult your healthcare provider to weigh the benefits and risks of using Topamax while breastfeeding. Although there have not been clinical studies on nursing mothers and their infants, it is known to pass into breast milk. Some reports have noted diarrhea and drowsiness in breastfed babies whose mothers were taking Topamax.