Common use

Topamax (Topiramate) prevents and controls seizures in people with epilepsy. It may also be used to prevent migraine headaches. It works by calming overactive nerves in your body.

Dosage and direction

Take this medication by mouth with water. Take it as directed on the prescription label at the same time every day. Do not cut, crush or chew this medicine. Swallow the tablets whole. You can take it with or without food. If it upsets your stomach, take it with food. Keep taking it unless your care team tells you to stop.

Precautions

Do not suddenly stop taking this medication. You may develop a severe reaction. Your care team will tell you how much medication to take. If your care team wants you to stop the medication, the dose may be slowly lowered over time to avoid any side effects.
You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medication affects you. Do not stand up or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effects of this medication. Avoid alcoholic drinks.
Watch for new or worsening thoughts of suicide or depression. This includes sudden changes in mood, behaviors, or thoughts. These changes can happen at any time but are more common in the beginning of treatment or after a change in dose. Call your care team right away if you experience these thoughts or worsening depression.
Using this medication for a long time may weaken your bones. The risk of bone fractures may be increased. Talk to your care team about your bone health.
Do not become pregnant while taking this medication. Hormone forms of birth control may not work as well with this medication. Talk to your care team about other forms of birth control. There is potential for serious harm to an unborn child. Tell your care team right away if you think you might be pregnant.

Contraindications

Bleeding disorder.
Kidney disease.
Lung disease.
Suicidal thoughts, plans or attempt.
An unusual or allergic reaction to topiramate, other medications, foods, dyes, or preservatives.
Pregnant or trying to get pregnant.
Breast-feeding.

Possible side effect

Side effects that you should report to your care team as soon as possible:
Allergic reactions - skin rash, itching, hives, swelling of the face, lips, tongue, or throat.
High acid level - trouble breathing, unusual weakness or fatigue, confusion, headache, fast or irregular heartbeat, nausea, vomiting.
High ammonia level - unusual weakness or fatigue, confusion, loss of appetite, nausea, vomiting, seizures.
Fever that does not go away, decrease in sweat.
Kidney stones - blood in the urine, pain or trouble passing urine, pain in the lower back or sides.
Redness, blistering, peeling or loosening of the skin, including inside the mouth.
Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss.
Thoughts of suicide or self-harm, worsening mood, feelings of depression.

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Burning or tingling sensation in hands or feet.
Difficulty with paying attention, memory, or speech.
Dizziness.
Drowsiness.
Fatigue.
Loss of appetite with weight loss.
Slow or sluggish movements of the body.

Drug interaction

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use.
Acetazolamide; Alcohol; Antihistamines for allergy, cough, and cold; Aspirin and aspirin-like medications; Atropine; Birth control pills; Certain medications for anxiety or sleep; Certain medications for bladder problems like oxybutynin, tolterodine; Certain medications for depression like amitriptyline, fluoxetine, sertraline; Certain medications for Parkinson's disease like benztropine, trihexyphenidyl; Certain medications for seizures like carbamazepine, lamotrigine, phenobarbital, phenytoin, primidone, valproic acid, zonisamide; Certain medications for stomach problems like dicyclomine, hyoscyamine; Certain medications for travel sickness like scopolamine; Certain medications that treat or prevent blood clots like warfarin, enoxaparin, dalteparin, apixaban, dabigatran, and rivaroxaban; Digoxin; Diltiazem; General anesthetics like halothane, isoflurane, methoxyflurane, propofol; Glyburide; Hydrochlorothiazide; Ipratropium; Lithium; Medications that relax muscles; Metformin; Narcotic medications for pain; NSAIDs, medications for pain and inflammation, like ibuprofen or naproxen; Phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine; Pioglitazone.

Missed dose

If you miss a dose, take it as soon as you can unless it is within 6 hours of the next dose. If it is within 6 hours of the next dose, skip the missed dose. Take the next dose at the normal time. Do not take double or extra doses.

Overdose

If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

Storage

Keep out of the reach of children and pets.
Store between 15 and 30 degrees C (59 and 86 degrees F). Protect from moisture. Keep the container tightly closed. Get rid of any unused medication after the expiration date.