Generic Name: Topamax Brand Name(s): Generics only. No brands available.


What is Topamax® (topiramate) used for?

Topamax® is a seizure medicine, also called an anticonvulsant. Topamax® is used to treat seizures in adults and children who are at least 2 years old.

Topamax® is also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. This medicine will only prevent migraine headaches or reduce the number of attacks. It will not treat a headache that has already begun.

Topamax® may also be used for purposes not listed in this medication guide.

How should I take Topamax® (topiramate)?

Take Topamax® exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Topamax® can be taken with or without food.

Do not chew, crush, or break a tablet. Swallow the tablet whole.

Topamax® Sprinkle Capsule can be swallowed whole. Or you may open the capsule and sprinkle the medicine into a spoonful of applesauce or other soft food. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

Carefully follow the swallowing instructions for your medicine.

While using Topamax®, you may need frequent blood tests. If you need surgery, tell the surgeon ahead of time that you are using Topamax®. Any medical care provider who treats you should know that you take seizure medication.

Drink plenty of liquids while you are taking this medicine, to prevent kidney stones or an electrolyte imbalance.

Do not stop using Topamax® suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.

Call your doctor if your seizures get worse or you have them more often while taking Topamax®.

How do I store Topamax® (topiramate)?

Topamax® is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Topamax® in the bathroom or the freezer. There may be different brands of Topamax® that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Topamax® down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Topamax® (topiramate)?

Before using this drug, tell your doctor if:

  • You are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only take medicines on the recommendation of a doctor.
  • You are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • You have allergy with any of active or inactive ingredients of Topamax® or other medications.
  • You have any other illnesses, disorders, or medical conditions.

Some people have thoughts about suicide while taking an anticonvulsant. Your doctor will need to check your progress at regular visits while you are using Topamax®. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Topamax® can increase the level of acid in your blood (metabolic acidosis). This can weaken your bones, cause kidney stones, or cause growth problems in children or harm to an unborn baby. You may need blood tests to make sure you do not have metabolic acidosis, especially if you are pregnant.

Do not start or stop taking Topamax® during pregnancy without your doctor’s advice.

Taking Topamax® during pregnancy may increase the risk of low birth weight and cleft lip and/or cleft palate in the newborn. But having a seizure during pregnancy could harm both mother and baby. There may be other seizure medicine that can be more safely used during pregnancy.

Topamax® can make birth control pills less effective. Use a barrier form of birth control (such as a condom or diaphragm with spermicide) to prevent pregnancy while taking Topamax®. Tell your doctor right away if you become pregnant during treatment.

Topamax® can pass into breast milk, but effects on the nursing baby are not known. Tell your doctor if you are breastfeeding a baby.

Is it safe during pregnancy or breastfeeding?

There are no adequate studies in women for determining risk when using Topamax® during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Topamax®. Topamax® is pregnancy risk category D, according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk
  • B=No risk in some studies
  • C=There may be some risk
  • D=Positive evidence of risk
  • X=Contraindicated
  • N=Unknown

Side effects

What side effects can occur from Topamax® (topiramate)?

Common side effects may include:

  • Numbness or tingling in your arms and legs
  • Flushing (warmth, redness, or tingly feeling)
  • Headache
  • Dizziness
  • Drowsiness
  • Tired feeling
  • Mood problems
  • Confusion
  • Feeling nervous
  • Problems with thinking or memory
  • Slow reactions
  • Problems with speech or vision
  • Nausea
  • Diarrhea
  • Stomach pain
  • Loss of appetite
  • Indigestion
  • Weight loss
  • Cold symptoms such as stuffy nose, sneezing, sore throat
  • Changes in your sense of taste

Call your doctor at once if you have:

  • Vision problems, eye pain or redness, sudden vision loss (can be permanent if not treated quickly)
  • Confusion, slowed thinking, memory problems, trouble concentrating, problems with speech
  • Dehydration symptoms – decreased sweating, high fever, hot and dry skin
  • Signs of a kidney stone – severe pain in your side or lower back, painful or difficult urination
  • Signs of too much acid in your blood – irregular heartbeats, feeling tired, loss of appetite, trouble thinking, feeling short of breath
  • Signs of too much ammonia in your blood – vomiting, unexplained weakness, feeling like you might pass out

Get emergency medical help if you have any signs of an allergic reaction to Topamax®: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening mood symptoms to your doctor, such as mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.


What drugs may interact with Topamax® (topiramate)?

Topamax® may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Products that may interact with this drug are:

  • Birth control pills
  • Metformin
  • Glaucoma medicine – acetazolamide, dichlorphenamide
  • Other seizure medicines – carbamazepine, divalproex sodium, phenytoin, valproic acid, or zonisamide

Does food or alcohol interact with Topamax® (topiramate)?

Topamax® may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Topamax® (topiramate)?

Topamax® may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Health conditions that may interact with this drug are:

  • Glaucoma or other eye problems
  • Diabetes, or a history of metabolic acidosis
  • Kidney disease, a history of kidney stones, or if you are on dialysis
  • Severe breathing problems
  • A history of mood problems, depression, or suicidal thoughts or actions
  • Liver disease
  • Soft or brittle bones (osteoporosis, osteomalacia)
  • A growth disorder
  • You are sick with diarrhea


The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using Topamax® (topiramate).

What is the dose of Topamax® (topiramate) for an adult?

Monotherapy Use

Adults and Pediatric Patients 10 Years and Older:

  • The recommended dose for Topamax® monotherapy in adults and pediatric patients 10 years of age and older is 400 mg/day in two divided doses.

Children Ages 2 to <10 Years

  • Dosing in patients 2 to <10 years is based on weight.
  • During the titration period, the initial dose of Topamax® should be 25 mg/day administered nightly for the first week.
  • Based upon tolerability, the dosage can be increased to 50 mg/day (25 mg twice daily) in the second week.
  • Dosage can be increased by 25–50 mg/day each subsequent week as tolerated.
  • Titration to the minimum maintenance dose should be attempted over 5–7 weeks of the total titration period.
  • Based upon tolerability and clinical response, additional titration to a higher dose (up to the maximum maintenance dose) can be attempted at 25–50 mg/day weekly increments.
  • The total daily dose should not exceed the maximum maintenance dose for each range of body weight.

Adjunctive Therapy Use

Adults 17 Years of Age and Over – Partial Onset Seizures, Primary Generalized Tonic-Clonic Seizures, or Lennox-Gastaut Syndrome

  • The recommended total daily dose of Topamax® as adjunctive therapy in adults with partial onset seizures is 200 to 400 mg/day in two divided doses, and 400 mg/day in two divided doses as adjunctive treatment in adults with primary generalized tonic-clonic seizures.
  • It is recommended that therapy be initiated at 25 to 50 mg/day followed by titration to an effective dose in increments of 25 to 50 mg/day every week.
  • Titrating in increments of 25 mg/day every week may delay the time to reach an effective dose.
  • Doses above 400 mg/day (600, 800 or 1,000 mg/day) have not been shown to improve responses in dose-response studies in adults with partial onset seizures. Daily doses above 1,600 mg have not been studied.

Pediatric Patients Ages 2 – 16 Years – Partial Onset Seizures, Primary Generalized Tonic-Clonic Seizures, or Lennox-Gastaut Syndrome

  • The recommended total daily dose of Topamax® as adjunctive therapy for pediatric patients with partial onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome is approximately 5 to 9 mg/kg/day in two divided doses.
  • Titration should begin at 25 mg/day (or less, based on a range of 1 to 3 mg/kg/day) nightly for the first week.
  • The dosage should then be increased at 1- or 2-week intervals by increments of 1 to 3 mg/kg/day (administered in two divided doses), to achieve optimal clinical response.
  • Dose titration should be guided by clinical outcome.


The recommended total daily dose of Topamax® as treatment for adults and adolescents 12 years of age and older for prophylaxis of migraine headache is 100 mg/day administered in two divided doses.

What is the dose of Topamax® (topiramate) for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Topamax® (topiramate) available?

Topamax® is available in the following dosage forms and strengths:

  • Tablet, coated; capsule, coated pellets topiramate 25mg

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Topamax®, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.


Review Date: July 14, 2017 | Last Modified: July 19, 2017

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