Topamax



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Generic Name: topiramate
(toe PYRE a mate)

What is Topamax?

Topamax is a seizure medication, also called an anticonvulsant.

Topamax is used alone or in combination with other medications to prevent seizures in adults and children who are at least 2 years old.

Topamax is also used to prevent migraine headaches. Topiramate will only preventmigraine headaches or reduce the number of attacks. It will not treat a headache that has already begun.

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

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

Seek emergency medical attention if you have a sudden change in vision and pain around or behind the eyes. These may be early signs of a serious side effect of Topamax.

Do not stop taking Topamax without first talking to your doctor, even if you feel better. You may have increased seizures if you stop taking topiramate suddenly. You will need to use less and less before you stop the medication completely.

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

You may have thoughts about suicide while taking this medication. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Carry an ID card or wear a medical alert bracelet stating that you are taking Topamax, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking a seizure medication.

Topamax can cause side effects that may impair your vision or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Avoid drinking alcohol. It can increase some of the side effects of Topamax, and can also increase the risk of a seizure.

Ketogenic or "ketosis" diets that are high in protein and low in carbohydrates can increase the risk of kidney stones. Avoid the use of such diets while you are taking Topamax.

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

Do not use this medication if you are allergic to Topamax.

Before taking Topamax, tell your doctor if you are allergic to any drugs, or if you have:

  • kidney disease or a history of kidney stones
  • liver disease
  • glaucoma
  • asthma, emphysema, or bronchitis; or
  • if you have recently had surgery.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

You may have thoughts about suicide while taking this medication. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several months of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

Topamax can make birth control pills less effective. Talk with your doctor about other forms of birth control if you are trying to prevent pregnancy while taking topiramate.

It is not known whether Topamax passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Topamax?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Topamax can be taken with or without food.

Take the medicine with a full glass of water.

The Topamax tabletshould be swallowed whole. It has a bitter taste when chewed or broken.

To make the Topamax capsuleeasier to swallow, you may open the capsule and sprinkle the medicine into a spoonful of applesauce, custard, ice cream, oatmeal, pudding, or yogurt. Swallow this mixture right away without chewing. Do not save the mixture for later use.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using Topamax. You may need to stop using the medicine for a short time.

Do not stop taking Topamax without first talking to your doctor, even if you feel better. You may have increased seizures if you stop taking topiramate suddenly. You will need to use less and less before you stop the medication completely.

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

Carry an ID card or wear a medical alert bracelet stating that you are taking Topamax, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking a seizure medication.

Drink extra fluids each day while you are taking Topamax. This will lower your risk of having kidney stones or an electrolyte imbalance. Vomiting or diarrhea can lead to dehydration and cause an electrolyte imbalance. Call your doctor if you have ongoing vomiting or diarrhea while taking topiramate.

Store Topamax at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical treatment if you think you have used too much of this medicine.

Overdose symptoms may include drowsiness, dizziness, agitation or depression, blurred vision, problems with speech or balance, stomach pain, chest pain, fast or pounding heartbeats, feeling light-headed, fainting, and seizure (convulsions).

What should I avoid while taking Topamax?

Topamax can cause side effects that may impair your vision or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Avoid drinking alcohol. It can increase some of the side effects of Topamax, and can also increase the risk of a seizure.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Topamax. Tell your doctor if you regularly use any of these other medicines.

Ketogenic or "ketosis" diets that are high in protein and low in carbohydrates can increase the risk of kidney stones. Avoid the use of such diets while you are taking Topamax.

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

What are the possible side effects of Topamax?

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

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Stop taking Topamax and call your doctor at once if you have any of these serious side effects:

  • sudden vision loss, pain around or behind your eyes
  • dry mouth, increased thirst, confusion, drowsiness, decreased sweating, increased body temperature, and hot, dry skin,
  • nausea, vomiting, increased urination, muscle pain or weakness, fast heart rate, feeling light-headed, fainting, or seizure (convulsions); or
  • severe pain in your side or lower back, painful or difficult urination.

Less serious side effects may include:

  • slowed thinking, memory problems, trouble concentrating
  • problems with speech or balance
  • numbness or tingling
  • sleep problems (insomnia)
  • tired feeling
  • headache, dizziness; or
  • loss of appetite, weight loss.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Topamax?

Before taking Topamax, tell your doctor if you are taking any of the following medicines:

  • amitriptyline (Elavil, Etrafon)
  • atropine (Donnatal, and others)
  • benztropine (Cogentin)
  • glycopyrrolate (Robinul)
  • hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic)
  • methscopolamine (Pamine) or scopolamine (Transderm-Scop)
  • risperidone (Risperdal)
  • bladder or urinary medications such as darifenacin (Enablex), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare)
  • bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva)
  • diabetes medicine you take by mouth, such as pioglitazone (Actos) or metformin (Actoplus Met, Avandamet, Glucophage, Fortamet);
  • glaucoma medications such as acetazolamide (Diamox), methazolamide (Neptazane), or dichlorphenamide (Daranide)
  • irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), propantheline (Pro-Banthine); or
  • other seizure medications such as carbamazepine (Carbatrol, Tegretol), lamotrigine (Lamictal), phenytoin (Dilantin), or valproic acid (Depakote, Depakene).

This list is not complete and there may be other drugs that can interact with Topamax. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about Topamax.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.