Does topiramate cause weight loss?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 19, 2023.

Key Points

• Yes, topiramate (Topamax) has been shown to cause weight loss when used for both seizure control and migraine prevention.
• Anorexia (loss of appetite), which may contribute to weight loss, has also been reported in studies in both children and adults, although no correlation was made in studies
• Topiramate (used by itself) is not specifically approved by the FDA for weight loss, but some doctors may prescribe it if you have seizures or migraine and need to lose weight, too. Side effects may hinder its use for weight loss when used alone.
• Topiramate is available in an extended-release medicine approved for weight loss known as Qsymia (phentermine and topiramate). Phentermine is an appetite suppressant (anorexiant) with characteristics similar to amphetamine. Qsymia is used along with diet and exercise to treat people who are either obese, or overweight with other risk factors like high blood pressure, high cholesterol or type 2 diabetes.

What is topiramate used for?

Topiramate is classified as an anticonvulsant (seizure) medication.

• Topiramate is a prescription medication, taken alone or with other drugs to control certain types of seizures due to epilepsy. Topiramate is used for the treatment of partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut Syndrome.
• It is also used for the prevention of migraine headaches. Topiramate will not stop a migraine once it has started.

Brand names for topiramate available in the U.S. include Topamax, Trokendi XR, Topamax Sprinkle (discontinued), and Qudexy XR. Uses and dosage forms differ among products, and may not be interchangeable.

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Did weight loss occur in studies with topiramate?

Yes, weight loss was reported in studies of both children and adults. In general, weight loss was seen in 6% to 17% of patients, and tended to increase with higher doses.

Adults

Seizure control – Side effects were assessed in patients 16 years and older taking topiramate (Topamax) alone (without other seizure medicines) at two doses: 50 mg/day or 400 mg/day. Weight loss and loss of appetite (anorexia) were two of the most commonly reported side effects.

In the patients taking the lower 50 mg/day dose of topiramate, weight loss occurred in 6% of patients, and in the higher 200 mg/day dose, weight loss was reported in 17% of patients. Anorexia (loss of appetite), which may lead to weight loss, was also seen in 4% and 14% of patients, respectively.

When topiramate (Topamax) was studied in adults who used it in addition to other medicines (adjunctive treatment) for seizure control, weight loss occurred in 9% of patients receiving 200 mg/day to 400 mg/day, and 3% of those taking a placebo (an inactive pill). In children, these numbers were 9% and 1%, respectively.

Migraine prevention – In adults using doses of 50 mg/day for migraine prevention, 6% of patients experienced weight loss, while in the 100 mg/day group, 9% of patients reported weight loss. In contrast, 1% of patients in the placebo group lost weight. Anorexia occurred in 9% to 15% of those taking topiramate, but also occurred in 6% of those taking a placebo.

Children

Seizures – In children 6 to 15 years of age taking the 50 mg/day dose of topiramate (Topamax) for seizures, weight loss was seen in 7% of patients. In the higher dosage group (400 mg/day) weight loss occurred in 17% of children. Anorexia (loss of appetite) was not reported in either dose group for children 6 to 15 years old.

Migraine prevention – In adolescents 12 to 17 years of age, weight loss occurred in 7% (50 mg/day dose) and 4% (100 mg/day) compared to 2% in the placebo group. Anorexia occurred in 9% to 10% of patients taking topiramate and 4% of those taking a placebo.

Treatment discontinuation with topiramate

Weight loss is not listed in the product label as a common reason why patients discontinued treatment with topiramate (Topamax).

In studies, some patients stopped treatment due to other side effects.

• In adults 16 years and older in the high dose group (400 mg/day), 21% of patients stopped treatment due to difficulty with memory, fatigue, asthenia (weakness), insomnia (difficulty sleeping), somnolence (extreme drowsiness), and paresthesia (pins and needles or tingling feeling in extremities).
• In children 6 to 15 years of age in the high dose group (400 mg/day), 14% of patients stopped treatment due to difficulty with concentration/attention, fever, flushing, and confusion.

Topiramate is linked with many other side effects, including nausea, stomach pain, and taste perversion, which may impact weight loss or anorexia.

This is not all the information you need to know about topiramate for safe and effective use. Review the full topiramate (Topamax) information here, and discuss this and any questions you have with your doctor or other health care provider.

References

• Kramer CK, Leitão CB, Pinto LC, et al. Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials. Obes Rev. 2011 May;12(5):e338-47. PMID: 21438989
• Topiramate. Drugs@FDA: FDA-Approved Drugs. Accessed Jan. 29, 2021 at https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
• Topamax [product monograph]. Drugs.com. Accessed Jan. 28, 2021 at https://www.drugs.com/pro/topamax.html
• Qysmia [product monograph]. Drugs.com. Accessed Jan 29, 2021 at https://www.drugs.com/pro/qsymia.html

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Medical Disclaimer

Topamax for Weight Loss: Uses, Dosage, Side Effects

1. Does Topamax work for losing weight?
2. What is Topamax?
3. Topamax uses
4. Topamax side effects
5. Topamax dosage
6. Topamax warnings
7. Topamax interactions 

It may sound strange, but one of the drugs most commonly prescribed for weight loss is not FDA-approved for that purpose. It’s a seizure medication called Topamax (topiramate), that happens to come with a welcome side effect for many people: weight loss. Studies have shown that Topamax can help you lose weight by reducing appetite, so many healthcare providers prescribe it off-label for that purpose. It’s not a magic pill, though. This drug can have several side effects, some of them serious. Find out more below.

Studies have found that about 6–17% of people who take Topamax will lose body weight (National Library, 2021). One review of studies found that people with obesity who took Topamax for at least four months lost an average of about 12 pounds more than the placebo group (Kramer, 2011).

Topamax (topiramate) is FDA-approved to treat seizure disorders (like epilepsy) and migraines. Because one of the side effects is decreasing appetite, some providers prescribe Topamax off-label as a weight loss medication. Other common brand names for this drug are: Qudexy XR, Topiragen, and Trokendi XR. 

Topamax is approved by the FDA for the treatment of (National Library, 2021; FDA, 2012): 

• Epilepsy, a neurological disorder in which brain activity becomes abnormal, causing seizures or other types of unusual behavior
• Migraine headaches, which are recurrent, throbbing headaches that typically affect one side of the head

Topamax can also be used “off-label” to treat other conditions, meaning it wasn’t specifically approved by the FDA for those uses. Drugs can be prescribed by a healthcare provider for an unapproved use if they decide that it’s the right treatment for their patient. 

Off-label uses for Topamax include:

• Weight loss
• Alcohol dependence (MedlinePlus, 2021)

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Common side effects of Topamax include (Fariba, 2021; National Library, 2021):

• Paresthesia (tingling or prickling sensations)
• Altered sense of taste

Topamax can have serious side effects:

• Myopia (nearsightedness) and glaucoma
• Vision defects
• Metabolic acidosis
• High blood ammonia levels
• Trouble with thinking or concentration
• Nausea
• Confusion
• Memory problems
• Trouble speaking
• Depression or mood problems
• Suicidal tendencies
• Tiredness or sleepiness
• Serious skin reactions, including rash or blisters
• Kidney stones
• Low body temperature
• Hair loss

Topamax comes in the following forms (National Library, 2021; Medline Plus, 2021):

• Tablets: 25 mg, 50 mg, 100 mg, and 200 mg
• Sprinkle capsules: 15 mg and 25 mg

Because Topamax hasn’t been approved by the FDA for weight loss, no specific dosage is recommended for that use. Your healthcare provider will recommend a dose based on your health history, physical condition, and other factors.

• Pregnant women shouldn’t take Topamax because it can increase the risk of congenital anomalies (especially cleft lip and cleft palate) in the infant.
• Acute myopia and glaucoma—rare but possible side effects of Topamax—can lead to permanent vision loss.  
• Metabolic acidosis, in which too much acid is produced in the body, can lead to shock or death when severe.
• Antiepileptic drugs, including Topamax, can increase suicidal thoughts or behavior.

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Topamax can interact with the following drugs (National Library, 2021):

• Antiepileptic drugs—Taking phenytoin and carbamazepine with Topamax can decrease blood levels of Topamax. Taking valproic acid with Topamax may cause low body temperature and high levels of ammonia.
• Carbonic anhydrase inhibitors—Topamax is a carbonic anhydrase inhibitor. Taking it with other such medications (like zonisamide and acetazolamide) can increase the risk of metabolic acidosis and kidney stones.
• Central nervous system (CNS) depressants—Topamax alone may cause CNS depression, so it should be used with extreme caution with other CNS depressants, like alcohol.
• Combination oral contraceptives (birth control pills)—Topamax may cause combination oral contraceptives to be less effective.
• Hydrochlorothiazide (HCTZ)—HCTZ is a diuretic (water pill). Taking it together with Topamax can cause concentrations of Topamax to rise, which could be dangerous.
• Lithium—Lithium is used to treat bipolar disorder and other mental illnesses. Taking it together with Topamax can increase the blood levels and effects of lithium.
• Amitriptyline—Amitriptyline is used to combat depression. Taking it together with Topamax can cause a large increase in the concentration of amitriptyline.

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

1. Fariba, K. & Saadabadi, A. (2021). Topiramate. [Updated 2021 Aug 6]. In: StatPearls [Internet]. Retrieved on Nov. 3, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK554530/
2. Food and Drug Administration. (2012). Topamax (topiramate) Prescribing Information. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020844s041lbl.pdf
3. Kramer, C. K., Leitão, C. B., Pinto, L. C., Canani, L. H., Azevedo, M. J., & Gross, J. L. (2011). Efficacy and safety of topiramate on weight loss: A meta-analysis of randomized controlled trials. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 12(5), e338–e347. doi: 10.1111/j.1467-789X.2010.00846.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21438989/
4. Medline Plus. (2021). Topiramate. U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/druginfo/meds/a697012.html
5. National Institutes of Health. (2021). TOPAMAX- topiramate capsule, coated pellets. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=21628112-0c47-11df-95b3-498d55d89593
6. U.S. National Library of Medicine. (2021). DailyMed. Label: TOPAMAX- topiramate tablet, coated. TOPAMAX- topiramate capsule, coated pellets. National Institutes of Health. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=21628112-0c47-11df-95b3-498d55d89593

Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.

Topamax for weight loss: safety and effectiveness | SingleCare – Product Information

Home >> Product Information >> Topamax Slimming: see Safety and Efficacy Information.

Product Information

Topamax is the brand name for a generic drug called topiramate. It is technically classified as an anticonvulsant, which is used to treat conditions such as epilepsy, but is also used to treat other conditions such as migraine and bipolar disorder. Topamax is great for treating these conditions, but many people taking it will experience weight loss as a major side effect. Let’s take a closer look at how safe and effective Topamax is and how it affects weight loss.

Topamax slimming

Topamax is approved by the Food and Drug Administration (FDA) for the treatment and prevention of epilepsy. migraine, but the prescription drug is also well known for causing weight loss. While weight loss may be a positive benefit of taking Topamax, the FDA has not approved it for weight loss alone.

Topamax causes weight loss because it affects appetite. People who take it and have a reduced appetite may feel less hungry and eat less because of it. Studies have shown that Topamax can also speed up metabolism, which means that the body burns calories faster.

Clinical trials have shown that approximately 6%-17% of people taking Topamax experience weight loss, and while many people may see this as an added benefit, too much weight loss is not good. “Most people will experience moderate weight loss from Topamax,” says Kuldip Singh, MD, a Baltimore-based weight loss surgeon and director of the Maryland Bariatric Center at Mercy Medical Center. Rapid weight loss can be unhealthy – it might be time to see a doctor if you’re taking Topamax and this is happening to you. Maintaining a healthy weight is important, and the best way to find out what target weight is best for you is to ask your doctor. Decreasing body weight below your target due to Topamax will be another sign that it’s time to talk to your doctor.

Is it safe to take Topamax for weight loss?

Topamax can sometimes be prescribed off label to help you lose weight. Off-label prescription occurs when a doctor writes someone a prescription for an FDA-approved drug to treat a condition other than the one their patient has. This is legal and often occurs in the medical industry, with an estimated 1 in 5 prescriptions being misused.

A doctor can give someone a prescription for Topamax to help with weight loss or to treat eating disorders such as overeating and purging that lead to weight gain. According to Dr. Singh, in order to be prescribed any weight loss medications, including Topamax, someone must have a body mass index (BMI) of 30 or higher.

Studies have shown that people taking Topamax for weight loss lose approximately 11 pounds compared to placebo groups if they take the drug for at least four months, and that the weight loss effect of Topamax increases with both treatment duration and dosage. Studies have also shown that treatment with topiramate can increase the likelihood of statistically significant weight loss by more than sixfold.

Although Topamax can be very effective for weight loss, it is not safe for everyone. The following groups of people should talk to their doctor before taking Topamax because they may have an increased risk of serious side effects if they take it:

• People with kidney disease
• People with lung or breathing problems.
• People with liver disease
• People with vision problems such as glaucoma
• People with depression
• People with suicidal thoughts or behavior
• People with osteoporosis
• People with bolic ketoacidosis

It may be safe for pregnant women to take Topamax if the benefits of taking the medicine outweigh the potential risks. It is unlikely that Topamax will or should be given during pregnancy for weight loss purposes. Topamax can cause fetal harm and oral birth defects if taken by pregnant women, so it should be used with caution and only if medically necessary. It is also excreted in breast milk, but it is not known if it will adversely affect breastfeeding. Topamax may reduce the effectiveness of birth control pills, so it is important to discuss the use of non-hormonal methods of contraception with your doctor if you do not want to become pregnant while taking Topamax.

People who are not pregnant and who do not have any of the conditions listed above can safely take Topamax, but they may still experience side effects from taking it. Here are some of the most common side effects of Topamax, other than weight loss:

• Dizziness
• Fatigue
• Numbness
• Diarrhea
• Loss of appetite
• Loss of coordination

90 036 Paresthesia (burning)

Although rare, Topamax can cause more serious side effects that may require medical attention, such as confusion, memory problems, trouble concentrating, and speech problems. Some people will also experience mental health side effects such as depression, panic attacks, mood changes, and suicidal thoughts or behavior. If you have any of these symptoms, you should seek medical attention as soon as possible.

Another rare side effect of Topamax is vision problems, which can lead to vision changes and blindness, so it’s important to call your doctor if your vision starts to change. This list of side effects is not exhaustive; If you need a complete list of Topamax side effects, ask your doctor or pharmacist for a medication guide.

If Topamax causes too many side effects, know that you have other options. Topamax’s active ingredient, topiramate, is also the main ingredient in the weight loss drug. Qsymia, which is a combination containing phentermine. According to Dr. Singh, Qsymia is one of the best medicines for long-term use in combination with diet and lifestyle changes for weight loss, especially for grade 1 or 2 obese patients. Therefore, if you are unable to take Topamax due to an underlying health problem or because you are experiencing too many side effects, you may want to try asking your healthcare provider about Qsymia or other ways to lose weight.

How to take Topamax to lose weight

Topamax can be taken to promote weight loss and control overeating and detoxification, but it is important to remember that it is not a substitute for visiting a doctor and putting together a comprehensive weight loss plan. If you are interested in taking Topamax, it is best to make an appointment with your doctor to see if it is right for you. Your doctor will perform a complete physical exam and ask about your medical history. If you and your doctor decide that Topamax can safely help you lose weight, you may be able to get a prescription for it.

If you do get a prescription from your doctor, it is important to know how to take Topamax to get the best results. The starting dose of Topamax for weight loss is a low dose of 25mg per day, but this dosage can be increased on a case-by-case basis based on each person’s medical history and how much weight they need to lose.

In a study conducted by Journal of Clinical Psychiatry, patients with bipolar disorder and schizophrenia were given an average of 195mg of topiramate a day lost about 22 pounds over time. This shows that the dosage range of Topamax can vary from low to high, and that doctors can increase or decrease the amount of Topamax someone takes depending on their individual results over time.

It may take some time to see weight loss results from taking Topamax. Some people may not notice a difference until they have been taking the drug for at least four months, while other people may start to lose weight in the first month of taking it. Weight loss results from topiramate have been proven to increase over time.

Topamax can be taken with or without food, usually at the same time each day. It should not be taken at the same time as certain other medicines due to the potential for drug interactions. Here is a list of drugs that Topamax should not be taken with:

• Antiepileptics
• Carbonic anhydrase inhibitors
• CNS depressants
• Oral contraceptives
• Hydrochlorothiazide (HCTZ) 9003 7
• Pioglitazone
• Lithium
• Amitriptyline

In addition to these medicines, Topamax should not be taken with alcohol because it may cause drowsiness, increase the risk of kidney stones and cause metabolic acidosis. Metabolic acidosis is a condition in which too much acid builds up in body fluids and can become life-threatening if left untreated. If you begin to experience rapid breathing, confusion, extreme fatigue, and a rapid heart rate while taking Topamax, you should seek medical attention as soon as possible, as these are signs that you may have metabolic acidosis.

Weight gain after Topamax

When someone stops taking Topamax, they may gain weight over time, especially if they did not combine Topamax with healthy lifestyle changes. In an observational study by the National Library of Medicine, discontinuing Topamax for at least six months showed a trend towards a return to baseline weight. Thus, people are more likely to return to what they weighed before they started taking Topamax, but this may take some time.

This return to original weight can occur because the body no longer experiences decreased appetite and accelerated metabolism. The best way to maintain weight after stopping Topamax is to make healthy lifestyle changes that will support you on your weight loss journey.

5 Safe Ways to Lose Weight

Topamax may be helpful in your weight loss journey if approved by your doctor, but it is not the only way to lose weight. Lifestyle changes can help you lose weight and keep it off so you can enjoy the benefits of weight loss without taking Topamax, during or after taking it. Here are some of the safest ways to lose weight.

1. Improve your eating habits.

Eating healthy is one of the safest and best ways to lose weight. Being mindful of what and how much you eat will help you lose weight if you do it right. For the best advice on what to eat to lose weight, you should talk to your doctor, but making some small changes, like eating more fruits and vegetables, can be a great start.

Processed foods, refined carbohydrates, sugar, and alcohol are all examples of foods that can cause weight gain. Fresh fruits, vegetables, and high-quality proteins like salmon, beans, and eggs are all great examples of foods that the body can easily process for vital nutrients.

2. Exercise regularly.

According to the Centers for Disease Control and Prevention (CDC), exercise not only helps control weight, it also lowers high blood pressure, reduces the risk of type 2 diabetes, and may even reduce symptoms of depression and anxiety. People vary in how much exercise they need to lose weight, so it’s a good idea to talk to your doctor about how often you should exercise. Some great weight loss exercises include walking, cycling, swimming, and strength training.

3. Reduce stress.

Stress is associated with many health problems such as anxiety and depression. Feeling stressed can lead to emotional overeating, which can lead to weight gain over time. Finding ways to reduce stress can help you lose weight. You can do meditation, yoga, take a walk, or call a friend or family member. You can also ask your doctor or psychologist about proven ways to reduce stress that will fit into your lifestyle.

4. Get enough sleep.

According to the Sleep Foundation, lack of sleep can increase appetite and lead to metabolic disorders. Getting enough sleep can help your body function properly and give you more energy for things like exercise to help you lose weight. Getting enough sleep can also reduce your stress levels, which will help you control any overeating urges.

5. Try safe diet pills and dietary supplements.

There are countless diet pills and supplements on the market that claim to cause weight loss, such as Hydroxycut and glucomannan, but they should not be used as a substitute for healthy lifestyle changes. According to Dr. Singh, when people go for weight loss drugs, most of them do it because it’s easy to do. If someone first seriously changes their lifestyle and eating habits, they will indeed see a significant improvement with Topamax or other weight loss medications. Mood is the most important thing. Medicines cannot replace proper nutrition and exercise.

Dosage of Topamax for weight loss – Diet

What is the correct dosage of Topamax for weight loss? The answer is not simple – it depends on a number of factors. When considering the dosage of Topamax for weight loss, one must consider the risks associated with taking the medication versus its benefits.

What is Topamax?

Topamax (drug name topimirate) is a prescription anticonvulsant drug that acts on the frontal cortex of the brain. Topamax is primarily used to treat epilepsy, however there are several off-label uses including migraine prevention, treatment of bipolar disorder, and weight loss.

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While scientists aren’t entirely sure how Topamax works, it’s believed that it can actually rewire the part of the brain that controls addiction and also calms excitable nerves, among other things.

How does Topamax promote weight loss?

During clinical trials of Topamax for the treatment of epileptic seizures, many patients in the trial were found to lose weight. This side effect occurs due to several different properties of the drug.

• Patients often find that the taste of food has changed in such a way that it is much less palatable. This is especially noticeable in high-fat foods, sugary foods, and carbonated drinks.
• In many patients, even small doses of Topamax significantly reduce or completely eliminate appetite. Topamax patients often need to be reminded to eat or plan meals so they don’t forget to eat right.
• Topamax seems to act on the addictive centers of the brain, removing the addictive motives. Because many overweight people are addicted to food, Topamax can eliminate this addictive craving.

Side effects of Topamax

While all of the above may sound like a dream come true to people desperate to lose weight, Topamax is a powerful drug and weight loss can come at a cost. Some side effects of Topamax include:

• Brain fog and loss of mental alertness/intelligence (Topamax is sometimes referred to as “dopamax” due to the prevalence of this side effect).
• Dizziness
• Kidney stones
• Paresthesia (tingling) of the extremities, especially the hands and feet, although it can also occur on the face and other parts of the body.
• Fatigue
• Confusion
• Inability to pay attention
• Problems with coordination
• Nausea
• Loss of memory – especially word access disorder, which makes it difficult to find the right word at the right time.
• Dry mouth
• Back pain
• Hair loss

What is the correct dosage of Topamax for weight loss

The dosage of Topamax for weight loss can be from 25 mg per day or up to 800 mg per day – usually divided into two doses. Due to side effects, most physicians (and drug manufacturers) recommend gradually increasing the dose, starting with a minimum dose of 25 mg and gradually increasing the dose over several weeks. Your doctor will work with you to determine the most effective dose.

Other factors to consider

When choosing Topamax for weight loss, you can take into account the following:

• The use of Topamax for weight loss is not for its intended purpose. Clinical trials to identify Topamax as a weight loss drug were actually completed prematurely as it was determined that the side effects of Topamax were not well tolerated by patients using it for weight loss.
• Many insurers do not cover prescription drugs.
• Patients taking doses greater than 200 mg per day should reduce the dose of the drug if they decide to stop taking it. Abrupt discontinuation of Topamax at doses above this level may cause seizures even in patients who have never had seizures.
• When you stop taking Topamax, your appetite and food cravings return. It is important to learn proper nutrition and exercise strategies to support weight loss.
• Many patients report weight loss/appetite loss only during the first course of treatment. If you stop taking Topamax and then restart it, the results will not necessarily be the same.
• According to the Topamax package insert, only 16 percent of those who take it lose weight; however, some side effects occur in more than 50 percent of patients.