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Topiramate

Common Brand Names: Topamax

Drug Information

Medically reviewed by Jessica Swirble, PharmD
Last updated on April 18, 2025

Drug Information | Side Effects | Use & Dosage | Request an Online Prescription

Quick facts:

  • Brand Name: Topamax
  • Generic Name: Topiramate
  • Uses: Treating epilepsy and preventing migraines
  • Drug Class: Anticonvulsant
  • Availability: Prescription only
  • Generic Status: Yes
  • Controlled Substance: No

What is topiramate?

Topiramate is a prescription medication used to treat seizures that affect the whole body (known as tonic-clonic seizures) or only one part of the brain (known as partial-onset seizures).

Topiramate may also be prescribed to prevent migraines in adults and children over 12.

What is topiramate used to treat?

Topiramate is prescribed to treat different types of seizures. This includes seizures that affect the whole body (known as tonic-clonic seizures) or one part of the brain (partial-onset seizures). It may also be prescribed to treat Lennox-Gestaut syndrome, a childhood disorder that causes severe seizures and developmental delays.

In addition to its use in treating seizures, topiramate may be prescribed to prevent migraines in adults and children over 12.

How does topiramate work?

Topiramate is an anticonvulsant drug. This diverse group of medications treats epileptic seizures by suppressing rapid-firing neurons in the brain. These neurons fire at the outset of a seizure and can quickly spread throughout the brain. Topiramate works by stopping this reaction and preventing a seizure from occurring.

How do I take topiramate?

Topiramate is available in the following forms:

  • Oral tablets
  • Sprinkle capsules
  • Oral suspension (liquid)

The dosage and frequency of use depend on the condition being treated, its severity, and how you respond to the medication.

Follow your healthcare provider's instructions regarding dosage and schedule. Do not exceed the prescribed dose or frequency of use without consulting your provider.

How long until I feel better?

Topiramate is used to manage and prevent seizures and to prevent migraine headaches, not to cure these conditions. It may take several days or weeks before you notice the effects of this medication, especially for migraine prevention.

Continue using topiramate as prescribed, even if you start feeling better. Regular use according to your prescription plan is crucial for the effective management of symptoms.

Are there any other uses for topiramate?

While topiramate is primarily used for epilepsy and migraine prevention, healthcare providers may prescribe it off-label for other conditions, such as weight loss or bipolar disorder.

Discuss any alternative uses of topiramate with your healthcare provider.

Dosage forms of topiramate

Topiramate is available in the following dosage forms:

  • Oral tablets
  • Sprinkle capsules
  • Oral suspension (liquid)

Topiramate is a prescription medication. You will need a valid prescription from a licensed healthcare provider to obtain this medication.

Side Effects and Precautions for Topiramate


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What are the side effects of topiramate?

The use of topiramate can lead to various side effects in some individuals.

Common mild side effects of topiramate use include:

  • Headaches
  • Drowsiness
  • Weakness
  • Uncontrollable shaking
  • Stomach pain
  • Nausea
  • Constipation
  • Musculoskeletal pain
  • Nosebleeds
  • Dry mouth
  • Dizziness
  • Pins and needles sensation or numbness
  • Impaired coordination
  • Changes in menstrual bleeding
  • Missed menstrual periods

More severe side effects of topiramate use can include:

  • Skin rash
  • Loss of vision/ vision changes
  • Worsening of seizures
  • Confusion/ slowed reactions/ difficulty concentrating
  • Difficulty with speech
  • Memory impairment
  • Coma
  • Difficulty breathing
  • Vomiting
  • Decreased sweating
  • Intense back pain
  • Kidney stones
  • Bloody or cloudy urine
  • Pain or difficulty during urination
  • Fever
  • Unusual bleeding or bruising
  • Worsening of eating disorders

If you experience any severe or concerning side effects while taking topiramate, contact your healthcare provider right away.

What should I tell my healthcare provider before using topiramate?

Tell your healthcare provider about any existing medical conditions, allergies, or other medications you are taking before starting treatment with topiramate. This includes prescription drugs, over-the-counter medications, and dietary supplements, as they may interact with topiramate.

Tell your provider if you are taking these medications or supplements:

  • Anticonvulsants: Carbamazepine, phenobarbital, phenytoin
  • Antipsychotics: Clozapine, olanzapine
  • Oral Contraceptives: May decrease the effectiveness of birth control pills
  • CNS Depressants: Alcohol, benzodiazepines, sedatives
  • Diuretics: Hydrochlorothiazide, furosemide (especially important due to the potential for decreased potassium levels)
  • Other mood stabilizers or anticonvulsants for conditions such as bipolar disorder or neuropathic pain
  • Medications for heart failure
  • Medications for glaucoma

You should also mention medical conditions such as:

  • Respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD)
  • Glaucoma
  • Kidney or liver disease
  • Metabolic acidosis
  • Mood problems, depression, or suicidal thoughts and behaviors
  • Osteopenia or osteoporosis
  • Recent dietary changes (especially a high-fat, low-carbohydrate diet which can affect how topiramate works)

If you are pregnant, planning to become pregnant, or breastfeeding, consult your healthcare provider before using topiramate to assess potential risks and benefits.

Are there any other special instructions I should follow?

Take topiramate exactly as prescribed by your healthcare provider. Do not exceed the recommended dose or duration of treatment.

Topiramate can be taken with or without food, but taking it with food may help reduce stomach upset. It's important to complete the full course of treatment, even if you start feeling better, to ensure the medication's effectiveness in managing your condition.

While taking topiramate, you should avoid alcohol. Alcohol can increase the effect of topiramate and worsen side effects.

What should I do in case of an overdose?

In case of a topiramate overdose, seek medical attention immediately. Symptoms of overdose may include severe drowsiness, confusion, speech problems, blurred vision, or seizures. If you suspect an overdose, contact the poison control helpline at 1-800-222-1222 or call emergency services.

Proper Use & Dosage Information for Topiramate


Drug Information | Side Effects | Use & Dosage | Request an Online Prescription

What is the typical starting dose for topiramate?

Topiramate is available in the following forms:

  • Oral tablets
  • Oral sprinkle capsules

The typical starting dose of topiramate varies depending on the condition being treated, the severity of symptoms, and individual patient factors. It is crucial to follow your healthcare provider's instructions regarding dosage and administration.

For epilepsy:

  • Adults: Typically, 25-50 mg once daily
  • Children: Dosage is based on body weight and must be determined by your doctor

For migraine prevention:

  • Adults: Typically, 25 mg once daily in the evening

The dosage may be adjusted based on the response and tolerance to the medication. Your healthcare provider will determine the most appropriate dose based on your medical history and your response to the medication.

Topiramate should be taken exactly as prescribed by your healthcare provider. Do not exceed the recommended dose or duration of treatment without consulting your provider.

If you have any questions about your dosage or need adjustments, contact your healthcare provider for guidance. If you want to talk to a provider right away, consider scheduling an online doctor appointment through a telehealth platform like Sesame.

What should I do if I miss a dose of topiramate?

If you miss a dose of topiramate, take it as soon as you remember unless it is close to the time for your next scheduled dose. In that case, skip the missed dose and continue your regular dosing schedule. Do not double the dose to make up for a missed one.

Take topiramate around the same time every day to maintain an even level of medication in your body.

What should I do if I'm feeling better while taking topiramate?

Continue taking topiramate as prescribed by your healthcare provider, even if you start feeling better. It's important to keep taking the medication as directed to maintain control over your condition, whether it's for epilepsy or migraine prevention.

If you have any concerns or questions about your medication, discuss them with your healthcare provider for medical advice and recommendations.

How should I store topiramate?

Store topiramate according to the instructions provided by your healthcare provider or pharmacist. Keep it at room temperature, away from light and moisture. Ensure the container is tightly closed and out of reach of children.

Do not use expired medication or medications that appear damaged or discolored. If you have any questions about storage, consult your healthcare provider or pharmacist for guidance.

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