Topiramate (Topamax) | NAMI: National Alliance on Mental Illness

Download PDF

Generic name: topiramate (toe PYRE a mate)

• Tablets: 25 mg, 50 mg, 100 mg, 200 mg
• Sprinkle capsules: 15 mg, 25 mg
• Extended-release sprinkle capsules: 25 mg, 50 mg, 100 mg, 150 mg, 200 mg

Brand names:

• Epronita®
  • Oral solution: 25 mg/1 mL
• Topamax®
  • Tablets: 25 mg, 50 mg, 100 mg, 200 mg
  • Sprinkle capsules: 15 mg, 25 mg
• Trokendi XR®
  • Extended-release capsules: 25 mg, 50 mg, 100 mg, 200 mg
• Qudexy XR®
  • Extended-release sprinkle capsules: 25mg, 50mg, 100mg, 150mg, 200mg

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Topiramate And What Does It Treat?

Topiramate is a medication that works in the brain and is sometimes used in patients with bipolar disorder (also known as manic depression). It is approved for the treatment of seizures (epilepsy) in adults and children in combination with other anticonvulsants and for preventing migraine headaches in adults. Bipolar disorder involves episodes of depression and/or mania.

Symptoms of depression include:

• Depressed mood — feeling sad, empty, or tearful
• Feeling worthless, guilty, hopeless, or helpless
• Loss of interest or pleasure in normal activities
• Sleep and eat more or less than usual (for most people it is less)
• Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
• Psychomotor agitation (‘nervous energy’)
• Psychomotor retardation (feeling like you are moving in slow motion)

Symptoms of mania include:

• Feeling irritable or “high”
• Having increased self esteem
• Feeling like you don’t need to sleep
• Feeling the need to continue to talk
• Feeling like your thoughts are too quick (racing thoughts)
• Feeling distracted
• Getting involved in activities that are risky or could have bad consequences (e. g., excessive spending)

What Is The Most Important Information I Should Know About Topiramate?

Bipolar disorder requires long-term treatment. Do not stop taking topiramate even when you feel better. With input from you, your health care provider will assess how long you will need to take the medication. Missing doses of topiramate may increase your risk for a relapse in your mood symptoms.

Do not stop taking topiramate or change your dose without talking to with your health care provider first.

In order for topiramate to work properly, it should be taken every day as ordered by your health care provider.

Are There Specific Concerns About Topiramate And Pregnancy?

If you are planning on becoming pregnant, notify your health care provider so that he/she can best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Topiramate has been associated with an increased risk of oral cleft birth defects. There may be precautions to decrease the risk of this effect. Do not stop taking topiramate without first speaking to your health care provider. Discontinuing similar medications during pregnancy has been associated with a significant increase in symptom relapse.

Breastfeeding is not recommended in women who are taking topiramate.

What Should I Discuss With My Health Care Provider Before Taking Topiramate?

• Symptoms of your condition that bother you the most
• If you have thoughts of suicide or harming yourself
• Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
• If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
• Any other psychiatric or medical problems you have
• All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
• Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
• If you are pregnant, plan to become pregnant, or are breastfeeding
• If you drink alcohol or use illegal drugs

How Should I Take Topiramate?

Topiramate is usually taken one or two times a day with or without food.

Typically patients begin at a low dose of medication and the dose is increased slowly over several weeks.

The dose usually ranges from 25 mg to 400 mg. Only your health care provider can determine the correct dose for you.

Do not split or chew tablets as they have a bitter taste.

Sprinkle capsules: Swallow whole or sprinkle onto food, such as applesauce or pudding and eat immediately. Do not chew the sprinkle capsule or contents.

Extended-release capsules: Swallow whole. Do not sprinkle on food, chew, or crush capsule.

Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member a friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Topiramate?

If you miss a dose of topiramate, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your dose or take more than what is prescribed.

What Should I Avoid While Taking Topiramate?

Avoid drinking alcohol or using illegal drugs while you are taking topiramate. They may decrease the benefits (e.g., worsen your symptoms) and increase adverse effects (e.g., sedation, dizziness).

What Happens If I Overdose With Topiramate?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of topiramate does not exist.

What Are The Possible Side Effects Of Topiramate?

Common side effects

Thinking problems: slow thoughts, trouble finding the right word, confusion, trouble concentrating

Feel clumsy, unsteady, dizzy, tired, weak, or nervous

Loss of appetite, change in the way food tastes, weight loss, stomach pain

Numbness or tingling sensation in limbs and extremities

Rare/serious side effects

Mood or behavior changes, such as aggression, agitation, apathy, irritability, and depression

Hearing problems (ringing, buzzing, and decreased hearing)

Fever, sore throat, upper respiratory infection

Itching, nosebleeds, pale skin, blisters, allergy (skin rash, swelling, troubled breathing), yellow eyes or skin, easy bruising and bleeding

Topiramate may cause eye problems. Serious eye problems include a sudden decrease in vision with or without pain/redness and increased pressure in the eye. These eye problems can lead to permanent vision loss if not treated.

Serious skin reactions (Stevens-Johnson Syndrome) have been reported with use of topiramate. At the first sign of a rash, topiramate should be discontinued unless the rash is clearly not drug related.

Topiramate may cause decreased sweating and increased body temperature. People, especially children, should be watched for signs of this – especially in hot climates. Some people may need to be hospitalized for this condition.

Topiramate can increase the level of acid in your blood (metabolic acidosis). If left untreated, metabolic acidosis can cause brittle or soft bones, kidney stones, can slow the rate of growth in children, and may possibly harm your baby if you are pregnant. Metabolic acidosis can happen with or without symptoms. Sometimes people with metabolic acidosis will feel tired, not feel hungry, feel changes in heartbeat, or have trouble thinking clearly.

Studies have found that individuals who take antiepileptic medications, including topiramate, have suicidal thoughts or behaviors up to twice as often as individuals who take placebo (inactive medication). These thoughts or behaviors occurred in approximately 1 in 500 patients taking the antiepileptic class of medications.

Are There Any Risks For Taking Topiramate For Long Periods Of Time?

To date, there are no known problems associated with long term use of topiramate. It is a safe and effective medication when used as directed.

What Other Medications May Interact With Topiramate?

Topiramate may decrease the levels and effects of oral contraceptives (birth control pills).

The following medications may decrease levels and effects of topiramate: carbamazepine (Tegretol®), phenytoin (Dilantin®), valproate (Depakote®) and phenobarbital

Combining valproate (Depakote®) with topiramate may increase ammonia levels in your blood. If this happens, you may get confused, disoriented, or have difficulty thinking.

Carbonic anhydrase inhibitors, including acetazolamide, dichlorphenamide, methazolamide, and dorzolamide, increase the risk of kidney stones when taken with topiramate.

How Long Does It Take For Topiramate To Work?

It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking topiramate. It will probably take several weeks to see big enough changes in your symptoms to decide if topiramate is the right medication for you.

Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder. Your doctor can best discuss the duration of treatment you need based on your symptoms and course of illness.

Summary of FDA Black Box Warnings

There are no FDA Black Box Warnings for topiramate.

Provided by

(January 2023)

©2022 The American Association of Psychiatric Pharmacists (AAPP) and the National Alliance on Mental Illness (NAMI). AAPP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the American Association of Psychiatric Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The American Association of Psychiatric Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

Topamax side effects and how to avoid them

Topamax side effects | Warnings | Interactions | How to avoid side effects

Topamax (topiramate) is a brand-name anticonvulsant drug that works in the brain to prevent seizures. It has been FDA-approved since 1996 for the treatment of epilepsy in both children and adults. Topamax is also commonly used to prevent migraine headaches in adults. It’s also used off-label to treat patients with bipolar disorder (also called manic depression) and assist with weight loss. The drug is usually prescribed in 25 mg to 400 mg doses.

Topamax is safe for long-term use when taken as prescribed. However, several common and potentially severe side effects have been reported by a small number of patients. There are also quite a few drugs that can cause harmful interactions or become ineffective when taken in conjunction with Topamax. Here’s everything you should know about safely taking Topamax, including what you can do to minimize the risk of developing severe side effects.

RELATED: What is Topamax? | Get Topamax coupons

Common side effects of Topamax

Most of the side effects associated with Topamax are considered mild to moderate. Many will disappear or subside as you adjust to the medication. If you experience any of these symptoms, notify your doctor immediately because they might indicate more severe side effects.  These are the most common Topamax side effects, according to the manufacturer:

• Loss of appetite, changes in taste, weight loss, stomach pain, and even anorexia
• GI side effects (nausea, diarrhea, indigestion)
• Tiredness
• Paresthesia (tingling or prickling sensations)
• Speech problems
• Cognitive dysfunction (trouble with memory and thinking)
• Upper respiratory tract infection
• Dizziness
• Nervousness
• Slow reactions
• Visual changes (blurred, cloudy vision, involuntary eye movements)
• Fever
• Decreased sensitivity or numbness

Does Topamax make you sleepy?

Taking Topamax can make you very drowsy and even dizzy. You should avoid driving, using heavy machinery, or doing other tasks that require alertness until you know how this medication affects you. Because it can cause drowsiness, Topamax is often taken at night.

Does Topamax cause brain fog?

Patients often experience brain fog, or a decrease in cognition, when beginning Topamax. Some report an inability to quickly process information, language problems, or think clearly. For some, this symptom resolves as the body acclimates to dosing. Others may need to look for Topamax alternatives.

Does Topamax make your hair fall out?

According to the National Institutes of Health, hair loss is a possible side effect of topiramate, but the manufacturer of Topamax does not list it as a common. Hair usually grows back quickly if you stop treatment. 

Serious side effects of Topamax

There are also serious side effects to be aware of when taking Topamax. These side effects usually require hospitalization or medical help, and may result in permanent injury or be life-threatening. 

• Metabolic acidosis (tiredness, loss of appetite, irregular heartbeat, brain fog)
• Excess ammonia in the blood (when Topamax is taken with medicine containing valproic acid)
• New or worsening depression, anxiety, or suicidal thoughts/behaviors (occurring in 1 in 500 patients)
• Decreased sweating but increased body temperature
• Glaucoma
• Stevens-Johnson syndrome (severe skin rash, blisters, peeling skin)
• Stunted growth in children
• Sudden withdrawal seizures (if Topamax is stopped suddenly)

Can Topamax change your personality?

Anticonvulsants like Topamax, can also profoundly affect mood, contributing to mental illnesses like anxiety, depression, or mania. Topamax can have several neurocognitive and neuropsychiatric side effects, including this case of Topamax-induced dissociative disorder. Patients should be aware of drastic changes in mood or emotion and seek medical attention if they experience significant personality changes.

Can Topamax cause permanent memory loss?

Topamax may be associated with dementia and should be used with caution in older patients. Still, it has not been well established that Topamax can cause permanent memory loss.

Topamax and metabolic acidosis

Topamax may cause an excessive amount of acid in the bloodstream, called metabolic acidosis. When this occurs, the body produces acid too quickly, and the kidneys cannot keep up with filtering it out. For this reason, patients with impaired kidney function or kidney disease should be monitored closely when taking Topamax.

In extreme cases, metabolic acidosis can lead to kidney damage, shock, or even death. This condition can also cause soft or brittle bones and kidney stones, slow the growth rate in children, and harm a baby during pregnancy. Common metabolic acidosis symptoms include rapid breathing, low blood pressure, lethargy and confusion, and loss of appetite. 

Topamax and eye problems

Topamax can cause severe eye conditions that may result in blindness. Acute myopia, which causes nearsightedness, can cause headaches or blurred vision because of increased pressure in the eye. Patients also reported several instances of secondary angle closure glaucoma, which, if left untreated, can lead to vision loss. Patients taking Topamax should seek medical advice if they ever experience eye pain or discomfort. 

Topamax warnings

Do not take Topamax if you:

• are allergic to it or any of the ingredients in it
• consume alcohol within 6 hours of taking Topamax
• have or have had any of these conditions: 
  • Glaucoma or other eye problems
  • Kidney disease
  • Metabolic acidosis
  • Lung disease or breathing problems
  • Mood problems, depression, suicidal thoughts or actions
  • Growth disorders
  • Soft or brittle bones (osteoporosis, osteomalacia)
• are planning to become pregnant or if you are breastfeeding

Suicidal behavior and ideations

As an anticonvulsant, Topamax has a direct influence on brain activity. About 1 in 500 patients taking antiepileptic drugs like Topamax have reported that they experienced suicidal thoughts and tendencies, especially when starting treatment or changing dosage levels. 

Due to these predispositions, patients should be continually monitored and seek medical attention if they experience anxiety, panic attacks, onset of or increased depression. Though rare, Topamax can also cause mood or behavior changes, like aggression or violence, agitation, apathy, mania, or irritability. Tell a healthcare professional about any of these changes.

Topamax and pregnancy

If you are pregnant or planning to become pregnant, you should inform your doctor as soon as possible. Topamax increases the risk of oral cleft birth defects like cleft lip and cleft palate by 16 times. Using Topamax during pregnancy can also cause heart, lung, skull, and skeletal abnormalities like malformed limbs. Other birth defects may include persistent pulmonary hypertension of the newborn (PPHN), spina bifida, and other neural tube defects, which can be life-threatening.

Consequently, it’s necessary to take certain precautions to decrease the risk of these potential complications by managing Topamax doses with other medications during pregnancy. Suddenly discontinuing medications like Topamax during pregnancy is not recommended, so don’t adjust your dosage or stop taking it without talking to your doctor. Topamax should only be used to treat conditions that could be life-threatening in pregnant patients.

Topamax interactions

There are many over-the-counter and prescription drugs that interact with Topamax. The side effects of those drug interactions range from mild to severe, rendering one or the other more or less effective. Ask a doctor before taking Topamax if you’re on one of the following medications:

• Birth control pills: Topamax may reduce the potency and effects of oral contraceptives or menopause drugs containing estrogen. A barrier form of birth control like a condom or diaphragm with spermicide a better form of protection while taking Topamax.
• Seizure drugs: Tegretol (carbamazepine), Dilantin (phenytoin), Depakote (valproate), lamotrigine, and phenobarbital may decrease the levels and effects of the Topamax in your body. Taking Depakote (valproate) in conjunction with Topamax can raise the levels of ammonia in your blood. If this occurs, you may experience confusion, disorientation, or have difficulty thinking.  
• Carbonic anhydrase inhibitors: Drugs like acetazolamide, dichlorphenamide, methazolamide, and dorzolamide can increase the risk of kidney stones when they are taken with Topamax.
• Allergy medicine: Certain allergy drugs like diphenhydramine, chlorpheniramine, hydroxyzine may increase the risk of side effects like dizziness, sleepiness, or trouble concentrating.
• Pain relievers: Patients taking Topamax may experience increased drowsiness, dizziness, or trouble thinking when prescribed in conjunction with pain drugs like hydrocodone, oxycodone, morphine, or hydromorphone.  
• Bipolar medication: Topamax may increase levels of lithium in the body when taken together.
• Diabetes drugs: Glyburide or pioglitazone may be less effective in controlling blood sugar to treat diabetes. Taking metformin with Topamax can also be risky, especially if the patient has metabolic acidosis. 

Can you drink caffeine with Topamax?

Topamax can increase caffeine’s excretion rate, which may reduce its efficacy in the body, but it’s generally a safe combination.

What should I eat while taking Topamax?

You can take Topamax with or without food. Since one of the most severe side effects of taking Topamax is metabolic acidosis, avoid eating a ketogenic (low carbohydrate, increased protein) diet. Eating foods that promote ketosis may increase the risk of kidney stones, which can further tax your kidneys.

How to avoid Topamax side effects

For more drug information, read the Topamax medication guide before starting your treatment.

1. If you experience any side effects, consult your healthcare provider. Consistent serum tests to routinely check kidney and liver function, for example, can also reduce the risk of severe complications.  
2. Be aware of all drug interactions. Some drugs like oral contraceptives aren’t as effective when taken with Topamax, and others, like allergy medicine, can exacerbate Topamax side effects.
3. Don’t take Topamax within six hours of consuming alcohol. 
4. Avoid operating heavy machinery, driving, or performing other dangerous tasks if Topamax makes you drowsy or dizzy. 
5. Drink lots of fluids and make an effort to avoid dehydration and constipation. This can help to reduce the risk of kidney stone formation, which can help prevent metabolic acidosis. 
6. Avoid following a ketogenic diet to prevent kidney stone development and potential metabolic acidosis. 
7. Seek urgent medical attention if you notice any sudden changes in mood or the development of depression or suicidal thoughts. 
8. If you are a woman on oral contraceptives, consider using an additional barrier form of protection to prevent pregnancy. That is one of the most effective ways to avoid the risk of severe birth defects associated with taking Topamax.
9. If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip it and take the upcoming dose. Don’t take a double amount to make up for a missed dose.
10. Don’t stop taking Topamax suddenly, as that may cause seizures, even if you haven’t had them in the past. If you need to stop taking Topamax, your doctor will gradually decrease your dose to safely wean you off the medication.

When to see a doctor for Topamax side effects

Many Topamax side effects can be severe and life-threatening. Inform your healthcare professional and seek medical attention right away if you begin to experience any of them, especially those considered serious.

Memorial Sloan Kettering Cancer Center

Adult Medication

Share

Provided by Lexicomp ^® , this document contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Eprontia; QudexyXR; Topamax; Topamax Sprinkle; Trokendi XR

Trade names: Canada

ACH-Topiramate; AG-Topiramate; APO Topiramate; Auro Topiramate; DOM Topiramate; GLN Topiramate; JAMP Topiramate; Mar-Topiramate [DSC]; MINT Topiramate; MYLAN-Topiramate; PMS Topiramate; PRO Topiramate; RAN-Topiramate [DSC]; SANDOZ Topiramate [DSC]; TEVA Topiramate; Topamax; Topamax Sprinkle

What is this drug used for?

• Used to treat seizures.
• It is used to prevent migraine.
• This drug may also be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.

Combining this drug with certain drugs and conditions may be unfavorable.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

What do I need to know or do while taking this drug?

• Avoid driving and other activities that require increased attention until you see how this drug affects you.
• This drug has been associated with less sweating and a significant increase in body temperature. In some cases, patients required hospital treatment. Caution should be exercised in hot weather and during physical exertion. If you develop body temperature or do not sweat during exercise or in hot weather, contact your doctor immediately.
• Like other seizure medicines, this medicine can rarely increase the risk of suicidal ideation or behavior. This risk may be higher in people who have tried or had suicidal thoughts in the past. Call your doctor right away if you develop or worsen symptoms such as depression, nervousness, anxiety, irritability, panic attacks, or other mood or behavioral disturbances. If you have suicidal thoughts or attempted suicide, contact your doctor immediately.
• This drug can cause an acid disorder in the blood (metabolic acidosis). This effect is more likely to occur in children and in people with kidney, respiratory or diarrhea problems. The chance also increases if you are taking certain other medications, if you have had surgery, or are on a ketogenic diet. Over time, metabolic acidosis can cause kidney stones, bone problems, and growth problems in children.
• This drug may increase the risk of bleeding. Sometimes bleeding can be life-threatening. Consult your doctor.
• This drug can cause very serious eye problems. If left untreated, these problems can lead to long-term vision loss. Call your doctor right away if you have new symptoms of eye problems, such as blurry or other visual disturbances, or redness of the eyes.
• Possible severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis). This can lead to severe health problems, which can be permanent, and sometimes death. Seek immediate medical attention if you experience symptoms such as redness, swelling of the skin with blistering or peeling (with or without fever), redness or irritation of the eyes, and sores in the mouth, throat, nose, or eyes.
• If the patient is a child, use this drug with caution. Children may have a higher risk of some side effects.
• In some cases, the drug may affect the growth rate in children and adolescents. They may need regular growth rate checks. Consult your doctor.
• The effectiveness of birth control pills and other hormonal birth control may decrease. Use other types of birth control, such as a condom, in addition to taking this drug.
• If you are using a hormonal contraceptive and you experience any changes in the frequency of your periods, talk to your doctor.
• When used during pregnancy, the drug may have a harmful effect on the fetus. If you are pregnant or become pregnant while taking this drug, call your doctor right away.
• If you can get pregnant but don’t want to, use birth control that you can trust while taking this drug.
• Tell your doctor if you are breastfeeding. It is necessary to consult whether the drug poses any risk to the child.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that could be associated with serious side effects:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• Symptoms of increased acidity in the blood (acidosis), such as confusion, rapid breathing, tachycardia, irregular heartbeat, very severe abdominal pain, nausea or vomiting, severe drowsiness, shortness of breath, increased fatigue or weakness.
• Signs of infection, such as fever, chills, very bad pain in the throat, ear, or sinuses, cough, more sputum or change in color, pain when urinating, mouth sores, or a sore that doesn’t heal.
• Signs of high ammonia levels such as irregular heartbeat, trouble breathing, confusion, pale skin, bradycardia, seizures, sweating, vomiting, or muscle twitches.
• Any unexplained bruising or bleeding.
• Feelings of confusion, inability to concentrate, or changes in behavior.
• Impairment or loss of memory.
• Difficult speech.
• Sleep disorders.
• Balance change.
• Severe dizziness or fainting.
• If you can’t eat.
• Pain in the back, abdomen, or blood in the urine. Perhaps these are signs of kidney stones.
• Unusual sensations of burning, numbness, or tingling.
• Bone pain.
• Chest pain.
• Muscle pain or weakness.
• Shiver.
• Difficulties with walking.
• Loss of control over eye movements.
• Liver problems have rarely been reported with this drug. In some cases, this has led to death. Call your doctor right away if you develop signs of liver problems such as dark urine, fatigue, lack of appetite, nausea or abdominal pain, light-colored stools, vomiting, yellowing of the skin or eyes.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

• Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
• Change in the ability to perceive taste.
• Weight loss.
• Nervous tension and agitation.
• Feeling dizzy, drowsy, tired or weak.
• Headache.
• Hyperemia (blush).
• Cold symptoms.
• Joint pain.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

All forms:

• Take this drug with or without food.
• Keep taking this drug as instructed by your doctor or other health care professional, even if you feel well.
• Do not stop taking this drug abruptly without consulting your doctor. This can increase the risk of seizures. If necessary, taking this drug should be stopped gradually, in accordance with the doctor’s instructions.
• Drink plenty of non-caffeinated fluids, unless your doctor tells you to drink less fluids.
• Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Perform blood tests as directed by your doctor. Consult with your doctor.
• Check with your doctor before using marijuana, other forms of cannabis, or prescription or over-the-counter drugs that can slow you down.
• Taking this drug with valproic acid may cause a decrease in body temperature. It can also cause fatigue, confusion, or coma. Consult your doctor.

Tablets:

• Swallow whole. Do not chew, break or crush.
• Avoid drinking alcohol while taking this drug.

Regular-release and slow-release openable capsules:

• You can swallow it whole or scoop the contents into a tablespoon with a soft food like applesauce. Do not crush or chew the drug.
• If taken in a mixed form, swallow the mixture immediately. Do not store for future use.
• To make sure you have swallowed the drug, drink the liquid immediately after you eat the food with the added drug.
• Avoid drinking alcohol while taking this drug.

Sustained release capsules:

• Swallow whole. Do not chew, open or crumble.
• Do not add this drug to food.
• Avoid drinking alcohol while taking this drug. It is especially important not to drink alcohol within 6 hours before or 6 hours after taking this drug.

Oral solution:

• Liquid doses should be measured with caution. Use the dispenser that comes with the medicine. If the dispenser is not provided in the package, ask the pharmacist for a dosing agent for this drug.
• This drug can not be measured with an ordinary teaspoon or tablespoon. This may lead to an overdose of the drug.
• Avoid drinking alcohol while taking this drug.

What if I miss a dose of a drug?

Sustained release capsules:

• See your doctor for further instructions.

Delayed release capsules:

• Take the missed dose as soon as you can.
• If it’s time for your next dose, don’t take the missed dose and then go back to your regular dosing schedule.
• Do not take 2 doses or an additional dose at the same time.
• If you miss 2 doses, contact your doctor.

All other dosage forms:

• Take the missed dose as soon as you can.
• If your next dose is less than 6 hours away, do not take the missed dose and go back to your regular dosing schedule.
• Do not take 2 doses or an additional dose at the same time.
• If you miss 2 doses, contact your doctor.

How do I store and/or discard this drug?

All forms:

• Store at room temperature in a dry place. Do not store in the bathroom.
• The lid must be tightly closed.
• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

Oral solution:

• Once opened, discard any unused servings after 60 days.

Sustained release capsules:

• Protect from light.

General information about medicines

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone and do not take other people’s medicines.
• Some medicines may come with other patient information leaflets. If you have any questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• A separate instruction for patients is attached to the drug. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient’s specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications. This information is not a guarantee that a treatment or drug is safe, effective, or approved for a particular patient. UpToDate, Inc. and its subsidiaries disclaim any warranties or liabilities related to this information or its use. The use of this information is subject to the Terms of Use found at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

Last revision date

2022-05-18

Copyright

© UpToDate, Inc. and its affiliates and/or licensors, 2023. All rights reserved.

Date last updated

Monday, December 12, 2022

Topamax – instructions for filling, buy Topamax capsules in Ukraine | Price from 423.60 UAH.

Dosage

• Topiramate: 25 mg/capsule (1)
• Topiramate: 50 mg/capsule (1)

Who can

• Seniors (2)
• Children (2)
• Allergics (2)
• Diabetics m (2)

• Product list
• Instructions

• Prices in pharmacies

• Analogues

Product: 2

Sorting:
Behind the ratingVid cheapVid expensive

Go to box

Go to box

Analogs

Show all

Go to

Go to

Go to

Buying goods

• Type 8. 40 UAH

• Type 150.00 UAH

• Type 206.40 UAH

• Vіd 132.40 UAH

• Type 75. 20 UAH

• Vіd 93.40 UAH

• Type 102.00 UAH

Editorial team

Creation date: 04/27/2021
Date updated: 11.06.2023

Stock and release form

Stock

• 1 capsule to topiramate 15 mg, 25 mg or 50 mg;
• Additional words: sucrose, povidone, cellulose acetate.

Release form

Capsules (28 and 60 capsules per bottle in a carton pack).

Basic FIZIKO -KIMICHNI POWER

STRIDIL DED CAPSULI with the BILOLLALL CALOR I PRESSED CREARY KRISHKA, WITHDPOVIMI, VMIST capsules – granules of the BASIA MAIZH BILOLOURA:

• 15 mg – capsules No. 2 with the inscription “Top” on the cap and “15” – on the body;
• 25 mg – capsules No. 1 with the inscription “Top” on the cap and “25” – on the body;
• 50 mg – capsules No. 0 with the inscription “Top” on the cap and “50” – on the body;

Pharmacological action

Pharmacodynamics

Topiramate, which is the intoxicating agent of Topamax capsules, is a new antiepileptic drug, which belongs to the class of sulfamat-substituting monosaccharides. Topiramate blocking sodium channels and reducing repetitive potentials against the background of trivalo depolarization of the neuron membrane. Topiramate enhances the activity of g-aminobutyric acid (GABA) of prominent GABA receptor subtypes (and GABA itself _A receptors), as well as modulating the activity of the GABA _A receptors themselves, transversally activating kainat / AMPK (α-amino-3 hydroxy-5-methylisoxazole-4-propionic acid) – glutamate receptor, does not affect activity N-methyl-D-aspartate (NMDA) is consistent with the NMDA receptor subtype. The effect of topiramate is dose dependent at drug concentrations in plasma from 1 µmol to 200 µmol, with minimal activity between 1 and 10 µmol. Topiramate also inhibits the activity of certain isoenzymes of carbonic anhydrase. Because of its pharmacological effect, topiramate is significantly affected by acetazolamide, a known carbonic anhydrase inhibitor, so the activity of topiramate cannot be considered the main component of its proteepileptic activity.

Pharmacokinetics

Pharmacokinetic profile of topiramat, correlated with other antiepileptic drugs, is characterized by three periods of administration in blood plasma, pharmacokinetics lineage, importantly nirkovym clearance, the number of daily association with proteins and the number of clinically significant active metabolites.

If taken internally, approximately 20% of the dose taken is metabolized. Ale in ailments, as they enjoy protiepileptic drugs, as they induce enzymes, as they are responsible for the metabolism of drugs, the metabolism of topiramate increased up to 50%. From plasma, sections and feces of humans, we have found and identified six practically inactive metabolites. The main route for the introduction of the invariable topiromat (70%) and yoga metabolites is nirka. After oral administration, the value of plasma clearance becomes 20-30 ml / min. Pharmacokinetics of topiramat is not linear, plasma clearance remains constant, and the area under the “concentration / hour” (AUC) curve in the dose range of 100 to 400 mg increases in a proportional dose. to reach plasma concentrations may be needed in 4 to 8 days.The value of the maximum concentration (Cmax) after bagatorases oral ingestion of 100 mg dvіchі per day becomes 6.76 mcg/ml. nuє about 21 years old .After a single dose of 100 to 1200 mg, the value of the average apparent volume of the dose becomes 0.80-0.55 l / kg. iv , due to the presence of adipose tissue in the body of women, such a difference is not clinically important.0003

Children (up to 12 years old). Pharmacokinetics of topiramate in children, as well as in adults, how to use Topamax as adjunctive therapy, or linear; clearance does not depend on dose, equal plasma concentrations move proportionally to dose. However, in children, the clearance is high, and the period of drinking is short. Also, the concentration of topiramate in the blood plasma at the same doses in a rozrachunka per kilogram of body weight can be lower in children compared to those in adults. Like in adults, protiepileptic drugs, which induce liver enzymes, change equally the concentration of topiramate in the blood plasma of children.

Indication before congestion

epilepsy

As monotherapy in patients with previously diagnosed epilepsy or for switching to monotherapy in patients with epilepsy.

As adjunctive therapy for the treatment of adults and children over 2 years of age with partial or generalized tonic-clonic attacks.

Treatment of adults and children as adjunctive therapy for attacks associated with Lennox-Gastaut syndrome.

migraine

For the prevention of migraine attacks in adults.

Topamax application for exaltation of hostile migraine attacks not cured.

Contraindications

Increased sensitivity to drug components.

Dosing method

For optimal control in both adults and children, it is recommended to start treatment with a negligible dose with a distant incremental effective dose.

Topamax can be taken directly from the receptionist. Topamax capsules can be taken as a whole. Patients who have problems with forging capsules (for example, children or ailments of the summer age), can take Topamax on the offensive:

Capsules carefully open, hang instead of capsules into a small amount (about 1 teaspoon) of soft tissue. Otrimanu sumish slid negaly rolled without rotting, and it is possible to drink a sufficient amount of rind. No way to take the drug, bov zmishany z їzhey, before the onset of taking.

epilepsy

Supplemental therapy

The growth of jubilation is based on the selection of doses by way of taking 25-50 mg for the first day of the week. In the longer term or in two intervals, the dose can be increased by 25-50 mg and taken in two doses. When choosing a dose, it is necessary to have a therapeutic effect. In some ailments, the effect can be reached when taking the drug 1 time per day.

The minimum effective dose is 200 mg. The usual incremental dose should be 200-400 mg/dose and should be taken in two doses. In general, patients tolerate the dose better than 1600 mg/day.

Appointed dosing may be recommended for all mature ailments, including people of a frail age, if they are sick, they become ill.

Children older than 2 years of age

The recommended total daily dose of Topamax (Topiramate) for adjunctive therapy is to become an average of 5 – 9mg/kg body weight per day, divided into two doses. Likuvannya starts with the selection of doses with a dose of 25 mg (or less, primed dosing 1 – 3 mg / kg of body weight per day) for the first 1 day. In the longer term or in two intervals, the dose can be increased by 1-3 mg/kg body weight per day and stopped in two doses until a therapeutic effect is reached. When choosing a dose, there is a keruvate with a therapeutic effect.

In clinical studies, a dose of up to 30 mg/kg body weight per day has been well established.

monotherapy

The introduction of topiramate monotherapy was based on warning signs of sudominal attacks during concomitant therapy with antiepileptic diseases.

As a precautionary measure, it is not necessary to take a negative dose of concomitant antiepileptic drugs, it is recommended that the next dose be reduced by approximately one third of the anterior dose for a duration of 2 days.

Due to the application of drug benefits, because of the power of enzyme inducers, which is indicative of the metabolism of drug benefits, topiramate increases. The health camp of a sick person may need to change doses of topiramat.

Mature. Start taking the next dose of 25 mg for the first day on the 1st day. Nadalі dose can be increased by 25-50 mg at the same or two intervals and stop in two doses. If the patient does not reach the dose increase, it is possible to take a smaller increase in the dose, or more three intervals between the increase. When choosing a dose, follow the therapeutic effect.

The recommended dose of topamax on cobs as monotherapy in mature adults is 100 mg/dobu, and the maximum recommended dose is 500 mg/dobu. Patients with refractory forms of epilepsy are well tolerated by Topamax monotherapy at a dose of 1000 mg/day. Appointed dosing may be recommended for all mature patients, including people of a frail age, if they are sick, they get sick.

Children.

Treatment of children over 2 years of age and more should start taking 0.5-1 mg/kg for the first day of the week. Nadal dose can be increased by 0.5 – 1 mg / kg / doba with a daily or double interval; a given dose can be taken in two doses. If a child cannot be included in the dose selection regimen, a smaller increase in the dose can be achieved, or more intervals between dose increases. When choosing a dose, follow the therapeutic effect.

Recommendations for the cob dose of Topamax in monotherapy in children older than 2 years of age should be 3-6 mg/kg body weight per doba. In cases where the diagnosis of “Partial epileptic seizures” has recently been established, children can take a dose up to 500 mg / day.

migraine

The recommended additional dose of topiramate for the prevention of migraine attacks is 100 mg in two doses. Start taking doses of 25 mg in the evening for one day. The dose was increased by 25 mg/dose at 1-month intervals following cutaneous elevation of the dose. If it is bad for the patient to endure the dose dosing regimen, it is possible to stop by a smaller increase in the dose, or more three intervals between the increase. In some patients, a positive result is achieved with an additional dose of topiramate 50 mg. In clinical studies, patients were treated with additional doses of topiramate up to 200 mg/dobu. When choosing a dose, follow the therapeutic effect.

You can buy Topomax at the additional website of the MIS Pharmacy 9-1-1 for a good price. The current price for the drug Topamax is listed in the catalog on the MIS Pharmacy 9-1-1 website.

Overdose

Signs and symptoms of topamax overdose: sudomi, drowsiness, impaired movement and vision, diplopia, impaired mentality, impaired coordination, lethargy, stupor, arterial tension hypotension, pain in the stomach, confusion, arousal or depression. Most of the clinical manifestations of the depressions were not severe, but there were registered fatal depressions after overdosing with various combinations of decilic drugs, including topiramate. An overdose of topiramate can cause important metabolic acidosis.

likuvannya

In case of acute overdose of Topamax, as if you had taken a hedgehog not too long ago, it is necessary to immediately flush the tube or vomit. From the data of in vitro studies, it was established that activated vugilla adsorbs topiramate. If necessary, carry out symptomatic therapy. An effective way of introducing topiramat from the body is hemodialysis. Patients are recommended to adequately increase the volume of the patient’s heart.

Side effects

More often than not Topamax is used together with other antiepileptic drugs;

The most common adverse reactions with an incidence of > 5% and a higher frequency, lower in the placebo group, in the course of treatment with topiramate boules: anorexia, decreased appetite, bradyphrenia, depression, impaired ex presive movement, disturbed sleep – sleeplessness, impaired coordination of movements, impaired concentration, confusion, dysarthria, relish, hypesthesia, lethargy, impaired memory, nystagmus, paresthesia, drowsiness, tremor, diplopia, dizziness, diarrhea, tedium, volatility, irritability and change nya masi tila.

From the side of the central nervous system (CNS) – nervousness, confusion, headache, impaired movement of the eyes, psychomotor confusion, ataxia, fatigue, impaired concentration of respect, difficulty in remembering, confusion homelessness, drowsiness, mental disorder, anorexia, nystagmus, diplopia, paresthesia, dodatkovo depression in children – derangement of special features, slinothea, hyperkinesia; Significantly more likely – changes in the taste, arousal, cognitive disorders, emotional lability (problems with mood), glaucoma, impaired coordination of the hand and foot, apathy, psychosis-psychotic symptoms, aggressive reactions ї; more rarely – suicidal thoughts and try, amnesia, in children dodatkovo – hallucinations.

On the side of the duct-intestinal tract and herbal system – dyspeptic manifestations, nausea, pain in the abdomen, apparent discomfort in the duct, diarrhea, dry lips and mouth odor, rarely – elevation of “liver” transaminases, hepatitis, liver failure none.

Other – changes in body mass, asthenia, nephrolithiasis, oligohidrosis (mainly in children), metabolic acidosis, pasture, as well as reactions from the side of the skin and mucous membranes (erythema multiforme, pemphigus, ST syndrome ivens-Johnson, toxic epidermal necrolysis, alopecia) in sick people, they took off Topamax at the same time with other drugs, which caused skin reactions and mucous membranes. Rarely – leukopenia, rarely – neutropenia. It is possible to blame the syndrome (as a rule, in a month after the beginning of therapy), which is characterized by myopia of the eyes against the background of an increased internal pressure.

Jamming peculiarities

In patients with impaired function (CLCR ≤ 70 ml / min), topiramate should be considered for protection because plasma and nirk clearance of topiramate is reduced in such patients. Recommendations on how to dose in patients with impaired function of the nirok are given in the instructions.

Impaired liver function. Patients with impaired liver function Topamax should be considered for protection due to the possibility of a decrease in topiramate clearance.

Metabolic acidosis. If topiramate is ingested, it may cause hyperchloremia, not cause anion deficiency, metabolic acidosis (therefore, a decrease in the concentration of bicarbonates in plasma below the norm due to the presence of respiratory alkalosis). Decreased concentrations of bicarbonates in blood syrovans and, last but not least, carbonangidrazy topiramate in nirkah. In most cases, a decrease in the concentration of bicarbonates is observed on the cob of the drug taken, although the effect may be manifested at any hour with the exhalation of topiramate.

Conservation in the period of pregnancy and breastfeeding

An investigation, in which bi-topamax was consummated for the confinement of pregnant women of the reproductive age, was not carried out. Therefore, during the period of pregnancy, Topamax should only be stagnant in that period, if its potential positive effect outweighs the potential risk for the fetus. Topiramat was not seen in breast milk in controlled studies. Studies on patients have shown the presence of topiramate in breast milk. Oskіlki more medicinal benefits are seen with milk, it is necessary to virishite nutrition about dotsіlnіst pripinennia breastfeeding or zastosuvannya zastosuvannya drug, vrahovoyuchi steps of yoga importance for the mother.

Children

The drug can be administered to children from 2 years of age.

Responsiveness to swiftness of the reaction when treated by motor transport or other mechanisms

i, confusion and other similar symptoms. Assigned side effects are mostly weak or peacefully pronounced, but they can be potentially unsafe for the sick, like driving a car, or for the quiet, who works with technology, especially in that case, if you still don’t have ailments the individual approval of the drug.

Interaction with other drugs and other forms of interaction

Addition of other antiepileptic drugs to topamax reduce plasma concentrations of Topamax. Adding either phenytoin or carbamazepine to topamax may require changing the remaining doses. The dose should be carefully selected, focusing on the achievement of the necessary therapeutic effect.

Other drug interactions

Digoxin %. The therapeutic significance of this caution is not stated. If you are recognized or treated with Topamax ill, if you take digoxin, special attention should be given to routine monitoring of the concentration of digoxin in serum.

Oral contraceptives. In previous drug interactions with oral contraceptives, in some combinations, a drug that eliminates norethindrone (1 mg) and etinilestradiol (35 mg), topamax in doses of 50 – 800 mg / day, has not been shown to be effective, but retindrone i in doses of 50 – 200 mg / day – on the effectiveness of etinilestradiol. A significant dose-related decrease in the efficacy of ethinilestradiol has been reported with dosing of Topamax 200-800 mg/day. The clinical significance of the changes made is not known. The risk of reducing the effectiveness of contraceptives and exacerbation of bleeding is due to patients who take oral contraceptives at the same time as Topamax. Patients who have taken oral contraceptive methods should be asked to report whether there are any changes in the lines and characteristics of menstruation.

Lithium preparations. In healthy volunteers, there was a decrease (up to 18%) in the AUC of lithium per hour of one-hour ingestion of topiramate at a dose of 200 mg per doba. In patients with bipolar disorder, the pharmacokinetics of lithium was permanently depleted of a one-hour dosing of topiramate at doses of 200 mg per doba, while ingestion of topiramate at doses of 600 mg per doba resulted in an increase in AUC lithium to 26%. It is recommended to control the concentration of lithium in plasma during one-hour ingestion with topiramate.

Risperidone. Follow-up trials conducted on healthy volunteers and patients with bipolar disorders with one or more doses of the drug showed similar results. With one-hour congestion with topiramate at increasing doses of 100, 250 and 400 mg/dobu, there was a decrease in the area under the concentration curve of risperidone, prescribed at doses of 16 mg/dobu, to 16 and 33% for dosing 250 and 400 mg/dobu vіdpovіdno. Minimal changes in the pharmacokinetics of active metabolites (risperidone + 9-hydroxy) and no changes were observed for 9-hydroxyrisperidone. Also, clinically significant changes in the pharmacokinetics of active metabolites, both risperidone and topiramate, have been considered.

Hydrochlorothiazide. The results of the study showed that with one-hour administration of topiramate and hydrochlorothiazide, the Cmax and AUC of topiramate increased by 27% and 29% apparently. The clinical significance of these changes is unknown. Administration of hydrochlorothiazide to patients who are taking topiramate may require dose adjustment of topiramate. The pharmacokinetic parameters of hydrochlorothiazide did not change significantly during concomitant topiramate therapy. Clinical laboratory studies have shown a decrease in potassium levels in blood syrometry with ingestion of topiramate or hydrochlorothiazide, which was more significant with ingestion of topiramate and hydrochlorothiazide in combination.

Metformin. The clinical relevance of metformin to the pharmacokinetics of topiramate is not known. In case of recognition of either Topamax patients, such as Metformin prescriptions, it is necessary to give special consideration to their relevant diabetic status. At the time of recognition or administration of Topamax to patients who enjoy metformin, they should regularly monitor their diabetic status.

Pioglitazone. In the case of one-hour admission of topamax and pioglitazone to patients, it is necessary to give special consideration to the diabetic status of these patients.

Glyburide. In case of one-hour recognition of topamax and glibenclamide to patients, it is necessary to give special consideration to the diabetic status of these patients.