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Topiramate (Topamax®)

Topiramate (Topamax® and generic forms) belong to a group of medications called “anticonvulsants.”

What is this medication used for?

Topiramate is approved by Health Canada for the treatment of seizure disorders (epilepsy) in children and adults.

Research shows topiramate may also be used for migraine headache prevention, aggressive or impulsive behaviour management, and alcohol dependence treatment.

When potential benefits outweigh potential risks, topiramate may be prescribed “off-label.” Learn more about off- label medication use:

Tell your doctor or pharmacist if you:

  • Have allergies or bad reactions to a medication
  • Take (or plan to take) other prescription or non- prescription medications, including natural medicines. Some medications interact with topiramate. Your doctor may adjust medication doses or monitor for side effects
  • Have a history (or family history) of kidney or liver disease, kidney stones or seizures
  • Miss a menstrual period, are pregnant, breast-feeding or planning a pregnancy
  • Have a growth problem, biochemical disease, glaucoma, depression, bipolar disorder or other psychiatric conditions, or if you follow a ketogenic diet
  • Use alcohol or drugs. Taking topiramate together with certain substances may cause a bad reaction. Learn more at

When will the medication start to work?

Topiramate usually needs to be taken for at least 2 weeks before you notice an improvement in your symptoms.

A delay in response is normal. Topiramate is usually prescribed to be taken regularly.

Do not increase, decrease or stop taking the medication unless directed by your doctor. Topiramate may not work for everyone. If you find this medication has not helped you after a month of treatment or if side effects are too bothersome, your doctor may recommend switching you to another medication.

This medication is not addictive. Do not stop taking it before talking to your doctor.

How do I take this medication?

Topiramate is usually taken with food once or twice a day, at the same time(s) each day. Usually, you will start with a low dose and slowly increase this dose over several days to weeks, based on how you tolerate it. Do not stop taking the medication unless directed by your physician.

Topiramate tablets should be swallowed whole with fluid. Do not crush or chew tablets. Capsules may be swallowed whole, or alternatively you may sprinkle the entire contents of the capsule(s) on a small amount of soft food and swallow immediately without chewing. While taking topiramate, drink plenty of fluids, avoid ketogenic diets and do not drink alcohol.

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

  • Dizziness, drowsiness, slowed movement or unsteadiness
  • Vision problems (such as double vision) or altered taste of certain foods
  • Upset stomach, nausea, vomiting or diarrhea
  • Decreased appetite or weight loss
  • Difficulty concentrating, slowed thinking, confusion or nervousness
  • Tingling sensation in hands/feet, tremors, decreased sweating

Contact your doctor immediately if you experience:

  • Blood in urine, lower back pain or pain in genital area
  • Decreased alertness, fatigue, tiredness, vomiting
  • Aggressive behavior or seizures
  • Abnormal changes in mood or behavior or thoughts of self- harm or suicide
  • Speech or memory problems, confusion, difficulty concentrating
  • Worsening of vision or blurred vision with pain and/or red eyes
  • Unexplained tiredness, loss of appetite, irregular heartbeat, loss of consciousness

What precautions should my doctor and I be aware of when taking this medication?

  • Many medications may interact with topiramate, including birth control pills, antihistamines, anti-anxiety medications, some antidepressants, some anticonvulsants and several other medications. If you are (or begin) taking any other prescription, over-the counter medication, natural health product or supplement, check with your doctor or pharmacist to see if they are safe to use.
  • While taking this medication, you may feel dizzy, drowsy or slowed down. Do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking topiramate.

How do I store this medication?

Keep this medication in the original container, stored at room temperature away from moisture and heat and protected from light. Keep this medication out of reach and sight of children.

What special instructions should I follow while using this medication?

  • Keep all appointments with your doctor and the lab.
  • Your doctor may want to meet with you over time to make sure topiramate is working well for you and monitor for side effects.
  • Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you forget to take a dose of topiramate, take the missed dose as soon as you remember. However, if it is within 4 hours of your next scheduled dose, skip the missed dose and continue with your regular schedule. DO NOT double your next dose to try to ‘catch-up.’

How does this medication work?

Topiramate affects levels of the brain chemicals GABA and glutamate. Topiramate has a “stabilizing” effect on nerves, which helps to reduce the spread of seizure activity in the brain and prevent migraine episodes. The exact way topiramate treats alcohol dependence is not fully known.

How well does the medication work in children and adolescents?

Topiramate is helpful in treating newly diagnosed epilepsy, and epilepsy that is not controlled with therapy in children and adolescents. Topiramate may be particularly helpful for those who experience aggressive behaviour and alcohol dependence. When used to prevent recurring migraine headaches, topiramate may reduce the frequency of migraines. In addition, this medication may counteract the side effect of weight gain caused by other medications.

How long should I take the medication for?

This depends on the symptoms you have, how frequently they occur and how long you have had them. Most people who have recurring migraine headaches need to take topiramate for at least 6 months. When topiramate is used to treat alcohol dependence, 3-6 months or longer is usually needed. This allows time for symptoms to stabilize and for function to improve.

After this time you and your doctor can discuss the benefits and risks of continuing treatment. If you have had several episodes of aggression, or if you are taking this medication for epilepsy and you tolerate it well, you may be asked to take this medication on an ongoing basis.

Continuing treatment will significantly decrease the chances that you may have another episode. Do not increase, decrease or stop taking topiramate without discussing it with your doctor. If you stop taking topiramate suddenly, it is possible that your symptoms may return or that you may experience a seizure.

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