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What is Topamax?

Topamax (topiramate)

Topamax is an anticonvulsant drug approved for the treatment of seizures (epilepsy) in adults and children. It can be used alone, or in combination with other anticonvulsants. It is also approved for use in preventing migraine headaches in adults.

While not approved by the FDA for other illnesses, Topamax has been tried and studied in the treatment of tremors, nerve pain, cluster headaches, eating disorders, alcohol dependence, and bipolar disorder (also known as manic-depression).

A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

A depressive episode, or depression, is when a person experiences several of the following symptoms at the same time: "low" or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating, and thoughts of death (suicidal thinking).

Bipolar disorder is a brain disorder (mental illness) that exposes people to these mood changes over the course of time. Bipolar disorder affects more than two million American each year, but patients with this disorder can lead fulfilling lives when they receive proper treatment. Unfortunately, many people with this illness do not receive treatment

What is the most important information I should know about Topamax?

Bipolar disorder requires long-term treatment. Do not stop taking Topamax even when you feel better. Only your healthcare provider can determine the length of Topamax treatment that is right for you. Not taking Topamax on a daily basis may increase your risk for a relapse in your mood symptoms, and it may also increase the possibilities of troublesome side effects such as seizures.

Unlike other drugs used to treat bipolar disorder (e.g., lithium, valproic acid, Topamax does not have blood levels that we try to achieve. However, from time to time, your doctor may ask that you give blood samples to check for specific kinds of side effects.   Also unlike many other drugs used to treat bipolar disorder, Topamax does not generally cause weight gain. In fact, most people taking Topamax will experience some weight loss.

Topamax has been associated with some cognitive-related problems. This difficulty with memory may include impaired concentration, attention, and language problems.

Topamax may be prescribed by itself or along with other medications to help manage your bipolar mood symptoms. Do not stop taking Topamax or change your dose without talking to your healthcare provider first. In order for Topamax to work properly, it should be taken every day as ordered by your healthcare provider. This is to maintain a steady level of medication in your body.

Are there specific concerns about Topamax and pregnancy?

Topamax has not been studied in pregnant women. Studies in pregnant animals using doses much larger (by weight) than humans indicate that Topamax may cause birth defects in unborn babies, as well as causing problems in pregnant patients. If you are pregnant or planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions about the risks and benefits of the medications as they relate to the illness, and to the fetus. This is a complex decision as untreated bipolar disorder has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.

Breast-feeding is not recommended, since Topamax does pass into breast milk.

What should I discuss with my healthcare provider before taking Topamax?

You should tell your doctor if you have taken Topamax before and if you are allergic to it, tell your doctor and pharmacist exactly what the medication did to you before taking even one dose. In addition, you should discuss the following:

How should I take Topamax?

Do not stop taking Topamax unless you first talk to your doctor or pharmacist. This drug does not cure you so it only helps you as long as you keep taking it.

Topamax is generally taken twice a day with or without food. Don’t crush, or chew the tablets. You may notice a bitter taste, this is normal. If you are taking capsules they may be opened and the contents (little beads) sprinkled on a small amount (teaspoonful) of soft food (such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt) and swallowed immediately without chewing.

While the dose usually ranges from 25mg to 200 mg in bipolar disorder, your healthcare provider will determine the dose that is right for you based upon your response.

What happens if I miss a dose?

If you miss a dose of Topamax, take it as soon as you remember unless it is close to when your next dose is due.  If it is close to your next dose, wait until then to take the medication and skip the missed dose.  Do not double your next dose or take more than your prescribed dose.

If you miss more than one or two days of the medication, start taking your medication as directed, but also call your doctor’s office and tell them.

What should I avoid while taking Topamax?

Avoid drinking alcohol or using illegal drugs while you are taking mood stabilizing medications because the beneficial effects of the medication may be decreased and adverse effects may be increased (e.g. sedation).

Topamax can make you sweat less making it easier for you to become overheated. Be careful when you are in hot places not to let yourself get overheated.

You should avoid becoming dehydrated; in other words drink plenty of water every day. This will help prevent kidney stones and help you keep from becoming overheated.

Do not suddenly stop taking Topamax without talking to your doctor first. Your doctor may want to gradually lower your dose rather than stopping it abruptly. 

What happens if I overdose?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary.  Call your doctor or emergency medical service (911).  You may also contact the poison control center (1-800-222-1222).

If you take too much Topamax, you will feel sleepy, have slow thinking, loss of appetite, problems seeing clearly, and you may have an abnormal heart rate.

A specific antidote for Topamax does not exist.

What are the possible side effects of Topamax?

Like all medications, Topamax has side effects. Most of these will get better or even go away completely as your body gets used to the medicine. Everyone responds differently so let your doctor, pharmacist, and other healthcare professionals know how the medication is affecting you.

Remember the lists of side effects below are only possible problems. Nobody gets them all and very few people get the more serious side effects. This list is to help you know when to contact your doctor or pharmacist. It is not meant to scare you. Talk with your healthcare provider if you experience side effects that are bothersome to you.

More common side effects are:

Clumsiness or unsteadiness, confusion, tingling sensations, dizziness, drowsiness, generalized slowing of mental and physical activity, memory problems, nervousness, speech or language problems, trouble in concentrating or paying attention, unusual tiredness or weakness. 

Less common side effects are:

Mood or mental changes, including aggression, agitation, apathy, irritability, and mental depression. increased eye pressure, continuous, uncontrolled back-and-forth or rolling eye movements, stomach pain, fever, chills, or sore throat, loss of appetite, changes in the way food tastes, weight loss, menstrual changes. Topamax can also cause kidney stones, so drink plenty of water to minimize this risk.

Topamax makes some people feel clumsy, or dizzy, or drowsy, or have trouble in thinking. Be careful about doing things that take good concentration until you find out how Topamax affects you. Alcohol and any other medicine that can cause drowsiness may make this worse.

Rare side effects are:

Sexual problems, painful urination, eye pain, hearing loss, itching, loss of bladder control, nosebleeds, pale skin, red or irritated eyes, ringing or buzzing in ears, blisters, allergy (skin rash, swelling, troubled breathing), yellow eyes or skin, easy bruising. 

This medicine may cause some people to have pain around the eye, blurred vision, or double vision. If you have this problem while on Topamax, call your doctor right away.

Are there any risks for taking this medication for long periods of time?

To date, there are no known problems associated with long term use of Topamax. This medicine is meant to be taken for a long time.

What other drugs interact with this medication?

Oral contraceptives (birth control pills) may not work properly if you take them while you are taking Topamax. Unplanned pregnancies may occur. You should use a different or additional means of birth control while you are using Topamax. If you have any questions about this, check with your doctor or pharmacist.

Other drugs that may interact with Topamax include:

How long does it take for Topamax to work?

It is very important to tell your doctor, pharmacist, and other health care professionals how you feel things are going during the first two months after you start taking Topamax or after your dose has been changed. It will take several weeks for you and your doctor to see enough changes to decide if Topamax is helpful for you.

Mood stabilizer treatment is generally needed lifelong for persons with bipolar illness. Your doctor can best discuss the duration of treatment you need based on your symptoms and course ofillness.

Brand and Generic Names

Tablets:  25mg, 50mg, 100mg , 200 mg

Sprinkle capsules: 15 mg, 25 mg

Updated by W. Klugh Kennedy, Pharm.D., BCPP
(June 2007)