Generic Name: Topiramate

  • What is Topamax?

    Topamax is used alone to treat certain types of seizures in people ≥10 years of age. It is also used as add-on to other medications to treat certain types of seizures in adults and children ≥2 years of age.

    Topamax is also used to prevent migraine headaches in adults.

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

    Topamax may cause decreased sweating and fever. People, especially children, should be watched for signs of decreased sweating and fever, especially in hot temperatures.

    Topamax may increase the risk of suicidal thoughts and behavior. Contact your doctor immediately if you feel depressed, experience any unusual changes in mood or behavior, or have thoughts of harming yourself.

    Topamax has been known to cause a potentially serious condition called metabolic acidosis (an increase of acid in the blood). In children, chronic metabolic acidosis may affect growth or cause rickets (a softening or weakness of the bones that can lead to bone deformities). Contact your doctor immediately if you experience symptoms of metabolic acidosis such as rapid breathing, an irregular heartbeat, confusion, fatigue, or loss of appetite. Your doctor will decide if you should stop taking Topamax.

    Do not suddenly stop taking Topamax on your own; your doctor will slowly lower the dosage to avoid an increase in seizures.

    Topamax may cause eye problems. Serious eye problems include any sudden decrease in vision with or without eye pain and redness, or a blockage of fluid in the eye causing increased pressure in the eye. These problems can lead to permanent vision loss if not treated. Contact your doctor immediately if you have any new eye symptoms.

    Topamax may cause confusion, problems concentrating, speech problems, depression or mood swings, drowsiness, and tiredness. Do not drive or operate dangerous machinery until you know how Topamax affects you.

    Topamax may cause a condition called hyperammonemia. Contact your doctor immediately if you experience unusual exhaustion, vomiting, or changes in mental status (such as confusion, forgetfulness, and speech problems).

    Topamax may cause kidney stones to develop. Drink plenty of fluids while taking Topamax to try to prevent this from happening.

    Topamax may cause tingling in your hands and feet, which is a condition called paresthesia.

  • Who should not take Topamax?

    Do not take Topamax if you are allergic to the medication or any of its ingredients.

  • What should I tell my doctor before I take the first dose of Topamax?

    Tell your doctor about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with Topamax. Also, talk to your doctor about your complete medical history, especially if you have any eye problems, growth problems, kidney disease or a history of kidney stones, liver disease, metabolic acidosis, lung problems or breathing problems, osteoporosis (weak or brittle bones), osteomalacia (soft bones), osteopenia (decreased bone density), or paresthesia.

    Be sure to let your doctor know if you are on a high-fat diet, called a ketogenic diet, or if you have recently had surgery.

  • What is the usual dosage?

    The information below is based on the dosage guidelines your doctor uses. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's approval.

    If you have liver or kidney problems, or are undergoing hemodialysis, the doctor may need to adjust the dosages listed below.


    Adults and children: Your doctor will prescribe the appropriate dose for you or your child based on the type of seizure you are experiencing.

  • How should I take Topamax?

    Take Topamax exactly as prescribed, with or without food.

    Because of the medication's bitter taste, do not break Topamax tablets.

    You can swallow Topamax capsules whole, or you can open the capsule and sprinkle its contents on a teaspoonful of soft food. Do not chew the drug and food mixture; swallow it whole. Drink fluids right after swallowing the drug and food mixture. Do not store the mixture for future use.

    Topamax increases your risk of developing kidney stones. To prevent this problem, be sure to take Topamax with plenty of fluids.

  • What should I avoid while taking Topamax?

    Do not drive, operate heavy machinery, or participate in any activities that require your full attention until you know how Topamax affects you.

    Topamax can impair your thinking, motor skills, and/or vision. Avoid drinking alcoholic beverages with Topamax.

    Avoid becoming overheated or dehydrated during exercise and in hot weather. Drink extra fluids in these situations.

  • What are possible food and drug interactions associated with Topamax?

    If Topamax is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Topamax with the following: acetazolamide, alcohol, amitriptyline, birth control, carbamazepine, dichlorphenamide, digoxin, lithium, metformin, phenytoin, risperidone, sedatives, tranquilizers, valproic acid, zonisamide.

  • What are the possible side effects of Topamax?

    Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug.

    Side effects may include: changes in mood, depression, diarrhea, difficulty sleeping, difficulty remembering things, difficulty concentrating, dizziness, drowsiness, loss of appetite, nausea, nervousness, tingling in hands and feet, upper respiratory tract infection, weight loss

  • Can I receive Topamax if I am pregnant or breastfeeding?

    The effects of Topamax during pregnancy and breastfeeding are unknown. Tell your doctor immediately if you are pregnant, plan to become pregnant, or are breastfeeding.

  • What should I do if I miss a dose of Topamax?

    If you miss a single dose of Topamax, take it as soon as you can. However, if you are within 6 hours of taking your next scheduled dose, wait until then to take your usual dose of Topamax, and skip the missed dose. Do not take two doses at once.

  • How should I store Topamax?

    Store at room temperature in a well-closed container. Protect the tablets from moisture.

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I'm Kristen Dore, PharmD. Welcome to PDR Health!

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