Topiramate (Oral)

Topiramate is a prescripton medication taken orally that can control the severity and frequency of either partial or full epileptic seizures, as well as managing the pain and discomfort of migraine headaches.

Overview

Topiramate is in a class of medications which are known as anticonvulsants, and they work by lowering abnormal excitation in the brain. This drug can be used in a standalone mode, or in conjunction with other medications for the treatment of certain kinds of seizures, including both partial onset seizures that afflict one area of the brain, and grand mal or tonic-clonic seizures that affect the entire brain. Topiramate can also be used for the prevention of migraine headaches, although once a migraine headache is already in progress, the drug cannot effectively be used to reduce or eliminate discomfort.

Conditions Treated

  • Partial epileptic seizures
  • Full epileptic seizures
  • Migraine headaches

Type of Medicine

  • Anti-epileptic, anti-seizure

Side Effects

There are a number of side effects which might potentially be triggered by extended usage of topiramate. These can include any or some combination of the following: pain and discomfort in the legs, bones, muscles or back; missed menstrual periods or excessive menstrual bleeding; tingling or burning sensation in the hands or the feet; teary eyes or dry eyes; uncontrolled shaking of body parts, including eye movements; headaches, nosebleeds, dry mouth, persistent fatigue, weakness, nervousness or agitation, heartburn; degradation of alertness and reaction time; changes in taste; constipation, and weight loss which is not attributable to any kind of weight loss program.

Some of the potential effects of topiramate can be especially serious, and if you should experience any of these, you should immediately call your doctor and describe what you've been experiencing. In this category of special precautions, there are such side effects as blurred vision, double vision, and complete loss of vision, or pain and redness around the eyes; a noticeable increase in the severity of your seizures; a sensation of being constantly cold, or feeling low body temperature; difficulty focusing on ordinary tasks; problems with speech, often noticeable as difficulty in recalling specific words or vocabulary; confusion, disorientation and memory problems; unexplained loss of coordination; irregular heartbeat which you have no history of; problems with breathing such as shortness of breath or rapid, shallow breathing, often accompanied by chest pains; slowness to react to external stimuli; excessive and persistent fatigue; digestive problems like nausea, vomiting, stomach pain, diarrhea, severe pains in your sides or in the area of the back; frequent fevers or other indicators of infection; difficulty or discomfort when urinating; much more frequent urination than is normal for you; and urine which is either foul-smelling, cloudy, or bloody.

Topiramate can also lead to osteoporosis (the condition where bones in the body are more easily broken) for adult patients, and for child patients, rickets may develop. There is a potential for topiramate to interfere with a child's normal growth, so that he/she fails to reach the typical projected height normal for that body size and type. If you should experience any other unusual symptoms or side effects shortly after ingesting topiramate, it is highly advisable that you contact your family physician immediately, and discuss these new manifestations.

There are a number of side effects which might potentially be triggered by extended usage of topiramate. These can include any or some combination of the following: pain and discomfort in the legs, bones, muscles or back; missed menstrual periods or excessive menstrual bleeding; tingling or burning sensation in the hands or the feet; teary eyes or dry eyes; uncontrolled shaking of body parts, including eye movements; headaches, nosebleeds, dry mouth, persistent fatigue, weakness, nervousness or agitation, heartburn; degradation of alertness and reaction time; changes in taste; constipation, and weight loss which is not attributable to any kind of weight loss program.

Dosage

Topiramate comes in several different forms, one being a tablet, and another as a sprinkle capsule which includes small medicinal beads that can be sprinkled into or on top of various foods intended for ingestion. Regardless of its form, topiramate is generally taken once per day at around the same general time, and it may be taken either with food or without.

All directions included on the prescription label should be carefully adhered to, and anything which is unclear should be clarified with the family doctor who prescribed topiramate before usage. The drug should always be taken exactly as prescribed in the recommended dosage, even if you feel better or worse on a given day, and think that more or less of the medicine is appropriate for that day.

The medicine included in topiramate causes it to have a bitter taste, so the capsules or tablets are best swallowed whole to avoid tasting that bitterness and possibly triggering a gag effect. Anytime a capsule has been broken open, that capsule should be discarded, because the medicine inside will probably have lost much of its effectiveness in the open air.

The sprinkle capsules can either be swallowed whole if you're comfortable with that, or used as a kind of topping on any kind of food being eaten for a particular meal. The special extended-release capsules should only be swallowed whole, and should not be sprinkled on food, nor should they be split or chewed when ingesting.

When taking the sprinkle capsules, the following procedure should be observed:

  • First, prepare a small amount such as a teaspoonful, of any soft food like pudding, yogurt, oatmeal, applesauce, ice cream, or custard
  • Next, you should hold the sprinkle capsule upright over your chosen soft food
  • Now twist off the capsule's covering, and pour all the contents of the capsule onto the yogurt or other soft food
  • Swallow the entire contents of the spoon, both yogurt and medication sprinkles, all at once without chewing
  • Drink a full glass of water immediately after ingestion, so as to ensure that all medicine is washed down and swallowed.

For the management of seizures, children between the ages of two and nine will generally have dosages calculated in accordance with their weight. For adults and for children aged 10 and above, a typical dosage of topiramate is 400 mg per day, divided into two equal dosages. When topiramate is used in the treatment of migraine headaches, a dosage of 100 mg per day is commonly prescribed and will be divided into two equal doses, to be taken at two different times of the day.

In most cases, your doctor will prescribe an initial low dosage of topiramate, to be followed up by gradually increasing dosages as needed. It should be borne in mind that topiramate will not cure the underlying cause of seizures, but will only help to manage the symptoms thereof.

Interactions

Topiramate can have an impact on other medications which are used to treat epilepsy, for instance phenytoin, carbamazepine, and valproic acid, so these kinds of medications should not be used in tandem with any treatment program including topiramate.

Birth control medicines can be weakened by taking topiramate, and can even be rendered wholly ineffective, depending on the type of birth control being used. In most cases, your family doctor will recommend that you do not become pregnant while taking topiramate, and will therefore recommend the usage of oral contraceptives for the duration of your treatment program. However, the specific birth control medication used will be one that is not degraded or weakened when taken in conjunction with topiramate.

Other medications which have known interactions with topiramate are Metformin, lithium, many kinds of medication for anxiety, insomnia medications, pain medications, and alcohol. In addition to this, any kind of medications which impair your thinking, coordination, or ability to focus can have significant interaction with topiramate, and should not be taken during any treatment program which includes topiramate.

Warnings

Make sure to tell your doctor if you think you are allergic to topiramate or any of the ingredients listed on the label, regardless of the form that your topiramate medication is in. If you don't have a list of the ingredients included in the manufacture of topiramate, ask your local pharmacist for such a list, and it can be provided.

Let your doctor know if you have a history of metabolic acidosis, which is a noticeable disturbance in the body's acid-base balance, which causes the blood to have excess acid in its composition. You should also let your doctor know if you are taking metformin to manage metabolic acidosis, because it has the potential to negatively interact with topiramate.

You should make a list of all medications, vitamins, and supplements you're currently taking, and let your doctor and pharmacist know about all of these. You should be especially conscientious in informing your doctor about acetazolamide, amitriptyline, any kind of antihistamines or antidepressants, metformin, any kind of hormonal contraceptives such as birth control pills or patches, seizure medications such as carbamazepine, phenytoin, valproic acid, zonisamide, or pioglitazone. If you are currently taking any of these medications, your doctor may want to reduce the dosage, or eliminate them entirely while you are taking topiramate.

Let your doctor know, as well as your family members, if you've ever had kidney stones, or if you've ever had suicidal thoughts, especially when they resulted in some kind of action.

If you have any history of osteoporosis, osteomalacia, osteopenia, diabetes, com/health/coma/">glaucoma, respiratory disease, chronic obstructive pulmonary disease, depression, liver disease, kidney disease, or physical growth issues, these are all issues which should be reported to your doctor.

If you have had recurring diarrhea, or if diarrhea develops during your program of treatment with topiramate, it should be discussed with your doctor on your next visit. Tell your doctor if you are now pregnant or plan to become pregnant in the near future, or if you are considering breastfeeding your infant. It may be necessary to alter your medication dosage or choose an alternative medication entirely, because topiramate may have a negative impact on your fetus.

If you are not thinking of becoming pregnant, it would be advisable to take birth control pills while you are on a treatment program including topiramate, so you can avoid the possibility of becoming pregnant. However, in taking birth control pills, you should discuss with your doctor exactly which kind you are taking, because interaction with topiramate is possible, and that may reduce the effectiveness of the birth control pills.

Whenever you have any kind of surgery planned for the near future, even if it's oral surgery, you should discuss this with both your doctor and your dentist, and let them know you're taking topiramate.

This drug can make you feel disoriented, confused, dizzy, and sleepy, so it is highly inadvisable for you to be driving or operating any kind of heavy machinery after taking topiramate.

While you are taking topiramate, it is still possible for you to experience seizures of almost any severity, so you should be cautious about engaging in activities such as climbing, driving, swimming, or any other activity which would place you in danger if you were to lose consciousness as a result of a seizure.

You should not drink alcohol either six hours before or six hours after taking topiramate. In fact, it's advisable that you don't drink alcohol at all while you are on a treatment program which includes the drug.

Topiramate has the characteristic of inhibiting your body's cooling system, and it can prevent you from sweating. This would make it much more difficult for your body to cool down when you are exposed to high temperatures, so whenever possible, you should avoid going out into hot weather, and when it is necessary, you should make sure to plenty of fluids to give your body as much cooling help as possible. If you notice that you are experiencing headaches, muscle cramps, fevers, upset stomach, or total lack of sweating, you should discuss this immediately with your physician.

It is much more likely that you can develop kidney stones while on a treatment program including topiramate, and to reduce the likelihood of that, try to include at least six to eight glasses of drinking water every day in your routine.

Your emotional and mental health can be affected when you are taking topiramate, and this can take some extreme forms which will cause you to entertain suicidal thoughts. Clinical studies have documented that approximately one in 500 adults and children who have been taking topiramate for the treatment of epilepsy, mental illness or other conditions have become at least mildly suicidal during treatment.

However, there is also a risk that your mental health can be degraded by not treating it properly, so it is worthwhile having a thorough discussion with your family doctor about the risks and benefits of taking an anticonvulsant medication such as topiramate.

It's very important that changes in your behavior which are observed either by yourself or by your family should be discussed at the earliest opportunity with your family doctor. Potential changes of behavior include the following: panic attacks, increasing irritability, anxiety, depression, restlessness, insomnia or other sleeping problems, unusual aggression, violent behavior, suicidal thoughts or actions, acting out impulsively, withdrawal from family, friends or both, an unhealthy preoccupation with death, and giving away important personal assets or possessions.

When any of these kinds of behavior emerge, it can happen as soon as one week after treatment, so close observation is necessary for anyone taking topiramate. For this reason, your doctor will probably recommend frequent visits early in your treatment program, and if no adverse mental behaviors develop, those visits can then be spaced out more.

Topiramate has been associated with a much higher risk for some types of birth defects, especially those where a cleft lip or cleft palate appear in the fetus. These kinds of defects can be generated very early during a pregnancy, in some cases even before you are aware of being pregnant. This makes it extremely important that you discuss with your physician the risks versus benefits of taking topiramate during pregnancy.

Generally speaking, any woman of childbearing age should consider using other anticonvulsant medications rather than topiramate, because of the potential for birth defects. If you have decided to use topiramate as your anticonvulsant medication of choice, you would be well advised to take some kind of birth control for the duration of your treatment program, and the specific type of birth control should be recommended by your family doctor.

If you should become pregnant during a treatment program which includes topiramate, you should immediately discuss the situation with your family doctor, and a decision should be made on whether or not to continue with your topiramate treatment. If you become pregnant, your baby may be harmed if you have metabolic acidosis, which is one of the conditions which can be triggered by taking topiramate.

You should also be aware that topiramate may be present in human breast milk, although the precise effects on infants are not fully known or understood. If you plan to breastfeed after delivery of your infant, you should discuss this thoroughly with your family doctor, so as to find out any information he/she may be aware of which would affect your decision to breastfeed.

Any woman who becomes pregnant while taking topiramate should discuss with the family doctor the possibility of registering in the North American Anti-Drug Pregnancy Registry, so that as much information as possible can be collected about the safe use of antiepileptic drugs during pregnancy.

If you notice that you are losing weight while taking topiramate, you should discuss this with your doctor - he may recommend that you increase your food intake temporarily to compensate for the weight loss. Make sure to discuss it with your doctor if you are considering any significant changes to your diet, or if you plan to embark on some kind of weight loss program.

Do not start any kind of high-fat, low-carbohydrate diet such as those used to manage seizures, without first consulting with your doctor. If you should neglect to take a scheduled dosage of topiramate, just take it as soon as you do think of it, unless you remember it at a time very near your next regularly scheduled dosage.

In that case, you can just skip the missed dosage and take the next regularly scheduled dose as planned. You should not double up your doses because you've missed one, since the much higher dosage at one time could trigger undesirable effects. In situations where you miss more than a single dose, it's advisable to contact your doctor and explain the situation, and ask for instructions on how to proceed.

Storage

Topiramate should be kept sealed in the same container issued by your pharmacist, well out of the reach of any curious children in the household. Both tablets and extended-release capsules should be kept in an environment not to exceed room temperature, and where there is no persistent high humidity condition.

Topiramate should not be stored in the bathroom medicine cabinet because bathrooms can become notoriously hot and humid during showering or bathing times, and this will degrade the medicine included in topiramate. Broken tablets of topiramate should be discarded without using them, and food which has been sprinkled with topiramate should never be stored or preserved in a refrigerator or anywhere else - if it is not consumed as regularly scheduled, it should be discarded.

Any topiramate medication whose expiration date has passed should be disposed of according to directions given by your family doctor or pharmacist. It is not advisable to keep topiramate in weekly pill reminders, as these are the subject of fascination for children, and most of them lack any kind of safety features which prevent unwanted tampering. To make sure household children don't accidentally ingest topiramate capsules or tablets, make sure your medications are stored in a location where children cannot reach them, even by climbing.

Summary

It's very important that you keep all regularly scheduled appointments with your doctor when you are being treated with topiramate, especially so that the appearance of any new side effects can be observed and evaluated. Your doctor also may want to schedule specific laboratory tests to determine what your body's responses are to taking topiramate.

You should never let anyone else take your topiramate medication, even if you think they may benefit by its anticonvulsant properties. It's impossible to predict how anyone else but yourself will react to taking topiramate, because they will have an entirely different medical history, and everyone's body reacts differently to medications.

It is highly advisable that you keep a list handy of all the current prescriptions, over-the-counter medications, vitamins, supplements and any herbals you may be using. If it should become necessary for you to visit an emergency health care clinic at some point, this list will be invaluable in making medical personnel there aware of what you are taking, and what dosages you are taking. Doctors will be very reluctant to prescribe any kind of medication in an emergency unit without first being aware of medications you are already using, because there is always a danger of drug interactions.

If you suspect you have taken an overdose of topiramate, you should immediately alert a family member or contact your doctor. Some of the most common symptoms of an overdose include the following: increased severity and frequency of seizures, drowsiness, blurred vision or double vision, loss of coordination or loss of consciousness, dizziness and disorientation, stomach pain, nausea, or vomiting, total loss of appetite, an irregular heartbeat which seems to be pounding in your chest, fast shallow breathing, often accompanied by chest pain, difficulty in talking or formulating sentences, or problems with thinking clearly.

Even when you have not had any seizures for a period of time and you're feeling quite well, you should continue to take the medication as prescribed by your doctor. You should not discontinue taking topiramate without consulting your doctor, even if you become aware of specific changes in your mood or behavior. There is a danger associated with the abrupt discontinuance of taking topiramate, since it can trigger the onset of severe seizures, even if you haven't had a history of such seizures in the past.

Whenever your doctor prescribes topiramate as part of your treatment program, you will also receive a medication guide which will provide specific instructions about how the drug is to be taken. All these instructions should be carefully followed, and the medication guide should be re-read every time you refill your prescription, because there's a possibility that something may have changed.

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Last Reviewed:
December 24, 2017
Last Updated:
April 05, 2018
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