What not to take with topiramate?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on July 15, 2021.

Do not drink alcohol while taking topiramate (brand examples: Topamax, Qudexy XR Trokendi XR). Dangerous side effects or increased seizures may occur. Increased sleepiness or dizziness may occur if you drink alcohol while taking topiramate.

Topiramate can cause drug interactions with other medicines and cause side effects. There may be certain medications you should avoid while taking topiramate. Do not start a new prescription or over-the-counter medicine without talking with your healthcare provider first.

Tell your healthcare provider if you take:

• Valproic acid (brand name examples: Depakote). Taking topiramate when you are also taking valproic acid can cause a drop in your body temperature to less than 95 degrees F (35 degrees C), or can cause tiredness, confusion, or coma. Taking these medicines may also cause raised levels of ammonia in your blood.
• Zonisamide (brand name example: Zonegran). Using zonisamide with topiramate can cause metabolic acidosis, a condition that causes high levels of acid in your blood. Combining these medicines may increase the risk and severity of this side effect.
• Glaucoma medications, including eye drops.
• Birth control pills. Topiramate may make your birth control pills less effective. Tell your doctor if you experience any breakthrough bleeding (menstrual bleeding changes) if you are taking birth control pills and topiramate. Ask your doctor about using a non-hormonal birth control (condom, diaphragm, cervical cap, or contraceptive sponge) to prevent pregnancy.
• Any medicines that impair or decrease your thinking, concentration, or muscle coordination.

Not all possible drug interactions are listed above. This list is not complete and other medicines can affect topiramate. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter (OTC) medicines, vitamins, and herbal supplements.

Take a list of your medicines to your appointments so your doctor can review for any possible drug interactions. You can also take your medicine bottles (including OTC medications) with you and show them to your doctor if that is easier.

Learn more: Topiramate drug interactions (in more detail)

What else should I avoid while taking topiramate?

Avoid getting dehydrated. Drink plenty of fluids when taking topiramate. Also, avoid becoming overheated or dehydrated in hot weather. Topiramate can increase body temperature and decrease sweating, leading to life-threatening dehydration (especially in children).

It is also important to drink plenty of fluids when taking topiramate to decrease your chances of getting kidney stones.

Topiramate may cause drowsiness, dizziness, blurred vision or impair your thinking or reactions. Avoid driving or operating machinery until you know how topiramate will affect you.

Avoid the use of a ketogenic or “ketosis” diet (high in fat, low in carbohydrates) while you are taking topiramate.

Also avoid activities that could be dangerous if you have an unexpected seizure, such as swimming or climbing in high places.

Do not stop taking topiramate or change your dose without first talking to your doctor. Stopping suddenly or changing your dose on your own can cause serious health problems and may cause or worsen seizures.

All women of childbearing age should talk to their doctors about using other treatments instead of topiramate. Talk to your doctor before you become pregnant. If you take topiramate during pregnancy, your baby has a higher risk for birth defects called cleft lip and cleft palate. These defects can begin early in pregnancy, even before you know you are pregnant.

Also, talk to your doctor about the best form of birth control for you to use. If you are not pregnant or planning to become pregnant, use effective birth control to prevent pregnancy while taking topiramate.

It may not be safe to breastfeed a baby while you are using this medicine. Ask your doctor about any risks.

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

References

• Topamax (topiramate) Product Information. Revised 6/2020. Janssen Pharmaceuticals, Inc. Titusville, NJ. Accessed July 15, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020505s061,020844s052lbl.pdf
• Topamax (topiramate). Medication Guide. Janssen Pharmaceuticals, Inc. Titusville, NJ. Accessed July 15, 2021 at https://www.janssenlabels.com/package-insert/product-patient-information/TOPAMAX-medication-guide. pdf

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Drug information

• Topiramate Information for Consumers
• Topiramate prescribing info & package insert
  (for Health Professionals)
• Side Effects of Topiramate
  (detailed)

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Medical Disclaimer

Toperimate weight loss: Achieve sustainable weight loss

If you’re trying to lose weight, chances are you’ve traveled down the interweb’s rabbit holes researching any and all prescription medications for weight loss and over-the-counter supplements. It’s easy to get lost in Google—you’ve likely read about and tried every diet out there. You may have come across the prescription drug topiramate (or Topamax).

Topiramate is an anticonvulsant medication used to treat certain seizures, epilepsy, and migraines. Ongoing research is also being done on its efficacy in treating alcoholism, post-traumatic stress disorder (PTSD), and binge-eating disorder. The drug was first synthesized in 1979 and received approval from the Food and Drug Administration (FDA) in 1996 as an antiepileptic drug.

As more and more patients started taking topiramate, the medical community began noticing weight loss as a side effect of topiramate. They were intrigued by the idea it might help treat conditions like overweight and obesity, and asked: Could topiramate help reverse this growing epidemic?

In 2012, after years of clinical trials, the FDA approved Qsymia—a controlled-release combo of topiramate and phentermine—for weight management. Phentermine (another medication that you may be familiar with) helps activate the sympathetic nervous system and can suppress appetite. Combined with topiramate, the duo may also increase energy expenditure—meaning the number of calories your body burns. 

We’re here to answer your questions if you’re curious about topiramate weight loss and its possible side effects. Let’s get to it. 

Topiramate weight loss and obesity

Obesity has almost tripled since 1975, according to the World Health Organization, and excess weight has been linked to an estimated 3 million deaths annually worldwide. It’s one of the leading contributors to preventable deaths in the United States. These numbers are one of the reasons drugs like topiramate are being prescribed off-label to support weight loss—in addition to diet and exercise.

Topiramate by itself can be prescribed off-label as a weight loss drug. A paper on the first clinical trial for use of the drug for obesity, published in 2003,  found that topiramate produced significant weight loss in participants. Among 385 healthy obese participants, those on topiramate lost an average of 6.3 percent of their body weight over 24 weeks, compared to a placebo group that dropped only 2.6 percent. 

Perhaps even more intriguing: The people in the study taking topiramate didn’t plateau during the study, which suggests that the weight management benefits would continue (though it may mean taking the medication for an extended period of time to get the maximum results). 

Topiramate weight loss: possible side effects

With any medication you take, there are risks of side effects. Truth be told, weight loss is a side effect of the topiramate in and of itself. So when taking this medication, if you suffer from overweight or obesity, losing weight is the most common side effect you’ll experience while on it. 

But, although rare, there are other serious side effects we want you to be aware of when taking topiramate for weight loss. Contact your health care provider immediately if they do happen: 

• Blurred vision

• Paresthesia (burning, prickling, or tingling sensations)

• Dizziness

• Drowsiness

• Eye redness or pain

• Generalized slowing of mental and physical activity

• Increased eye pressure

• Memory problems

• Menstrual changes or pain

• Nervousness

• Kidney stones

• Speech or language problems

• Trouble concentrating or paying attention

• Unusual tiredness or weakness

• Dry mouth

What not to take and what to avoid with topiramate

We totally get it; after reading the side effects, you may be thinking ehhhh is this drug right for me? The best person to consult may be your Found health care provider. They’ll be able to cover the side effects of using topiramate for weight loss in-depth. They’ll also be able to talk about what other medications and supplements you shouldn’t take when on topiramate. In addition, here are some lifestyle guidelines to keep in mind: 

Don’t get dehydrated. The FDA cautions that in some cases during clinical trials, patients didn’t sweat normally, and their base temperature increased. Drink plenty of water. Also, if you feel warmer than normal, tell your doctor right away.

Steer clear of ketogenic (keto) diets. A keto plan is essentially high in fat and low in carbohydrates. Taking topiramate can cause metabolic acidosis—in other words, too much acid in the body, while a keto diet can cause ketoacidosis, leading to even more acid. And too much acid can cause kidney stones, kidney disease, or even kidney failure. Taking topiramate while following a keto diet could compound the problem and increase the risk of acid overload. 

Reduce salt intake. The National Institute of Diabetes and Digestive and Kidney Diseases warns that sodium can increase the risk of developing kidney stones. (Check out the keto info above.) So it’s best to watch how much salt you’re getting in your diet to avoid upping your risk of kidney stones. The Dietary Guidelines for Americans recommends less than 2,300 mg of salt daily—that’s about one teaspoon a day.

Watch out for certain birth control pills. A small study published in 1997 in the journal of the International League Against Epilepsy, Epilepsia, looked at the efficacy of oral contraceptives among women taking topiramate. Researchers found that while the birth control pill was still just as effective, they did see some breakthrough bleeding between periods. However, more recent studies suggest that topiramate may reduce the effectiveness of estrogen-containing contraceptives. You may want to consider progestin-only birth control. Similarly, if you’re pregnant or planning on becoming pregnant, in 2011 the FDA issued a warning that data showed an increased risk of cleft lip or palate with women treated with topiramate.  

Again, be sure to tell your health care provider your entire medical history and any medication or supplements you’re on for guidance on what not to take with topiramate.

Topiramate dosage for weight loss

Studies indicate that topiramate can be taken in low doses—typically 25 mg—to begin with to see how well your body tolerates it. It can be bumped up to 50 mg daily. The doses are taken evenly, twice a day, and are typically increased weekly.

A study in the International Journal of Obesity found that 60 weeks of treatment led to an average of more than 9 percent loss in body weight while taking 192 mg of topiramate daily. Researchers concluded that lower doses of topiramate for weight loss may have a beneficial result over a longer period of time. As a note, this study looked at topiramate taken alone, finding people can lose weight on lower doses and in combination with behavior change. But of course, the effective dose varies in individuals.

The medication is also offered in an extended-release form called topiramate XR. It comes in the same daily dose as the original medication but only needs to be taken once a day. So, like all of us, if life gets busy, it may be easier for you to remember to take that one dose daily instead of two times a day for topiramate weight loss.

Topiramate weight loss: what’s the verdict?

It’s clear topiramate weight loss is real and is worth considering when choosing what weight loss medication is right for you. 

To start your journey with Found, take our quiz.

GLP-1 Note

GLP-1s are now available as one of Found’s medical weight-loss options. Found’s providers work with you to determine a safe, effective treatment for your unique biology. While GLP-1s are effective for weight loss, they are not clinically appropriate for everyone. Other medications may be more appropriate for you. Prescriptions are based on a clinician’s evaluation of your medical history, lifestyle, lab results, and, for GLP-1s, insurance coverage.

About Found

Found is among the largest medically-supported weight care clinics in the country, serving nearly 200,000 members to date. To start your journey with Found, take our quiz.

SOURCES

Blanco JC, Khatri A, Kifayat A, Cho R, Aronow WS. Starvation Ketoacidosis due to the Ketogenic Diet and Prolonged Fasting – A Possibly Dangerous Diet Trend. Am J Case Rep. 2019 Nov 22;20:1728-1731.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883983/

Bray, G.A., Hollander, P., Klein, S., Kushner, R., Levy, B., Fitchet, M. and Perry, B.H. (2003), A 6-Month Randomized, Placebo-Controlled, Dose-Ranging Trial of Topiramate for Weight Loss in Obesity. Obesity Research, 11: 722-733. https://onlinelibrary.wiley.com/doi/10.1038/oby.2003.102

The U.S. Food and Drug Administration. 4 Mar. 2011. FDA Drug Safety Communication: Risk of oral clefts in children born to mothers taking Topamax (topiramate). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-risk-oral-clefts-children-born-mothers-taking-topamax-topiramate

Hoy SM. TopiramateExtended Release: A Review in Epilepsy. CNS Drugs. 2016 Jun;30(6):559-66.https://pubmed.ncbi.nlm.nih.gov/27224993/

Moradi S, Kerman SR, Mollabashi M. The effect of topiramate on weight loss in patients with type 2 diabetes. J Res Med Sci. 2013 Apr;18(4):297-302.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793374/

National Library of Medicine. 2022. TOPAMAX – topiramate. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=21628112-0c47-11df-95b3-498d55d89593

National Institute of Diabetes and Digestive and Kidney Disease. 2017. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/eating-diet-nutrition

Rosenfeld WE, Doose DR, Walker SA, Nayak RK. Effect of topiramate on the pharmacokinetics of an oral contraceptive containing norethindrone and ethinyl estradiol in patients with epilepsy. Epilepsia. 1997 Mar;38(3):317-23. https://pubmed.ncbi.nlm.nih.gov/9070594/

Singh J, Kumar R. Phentermine-topiramate: First combination drug for obesity. Int J Appl Basic Med Res. 2015 May-Aug;5(2):157-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456896/

World Health Organization. 2021. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Pharmacy on Moskovskaya

Trade name: Topamax (Topamax)
International name: Topiramate (Topiramate)

Pharmacological group: antiepileptic agent
Pharmacological group according to ATC: N03AX11. Topiramate
Pharmacological action: antiepileptic
Pharmacodynamics: Antiepileptic agent. Reduces the frequency of occurrence of action potentials characteristic of a neuron in a state of persistent depolarization, which indicates the dependence of the blocking action of topiramate on Na + channels on the state of the neuron. It increases the activity of GABA against certain subtypes of GABA receptors (including GABA a receptors), and also modulates the activity of the GABA a receptors themselves, prevents the activation of kainate / AMPK receptor sensitivity (alpha-amino-3-hydroxy- 5 methylisoxazole-4-propionic acid) to glutamate does not affect the activity of N-methyl-D-aspartate against NMDA receptors. These effects are dose-dependent at plasma topiramate concentrations of 1-200 μM, with minimal activity in the range of 1-10 μM.
Inhibits the activity of some isoenzymes of carbonic anhydrase (II-IV), but this effect is weaker than that of acetazolamide, and probably is not the main anticonvulsant activity of topiramate.
Pharmacokinetics: Absorption – high, bioavailability – 80%. Eating does not have a clinically significant effect on bioavailability. TCmax – 2 hours after oral administration at a dose of 400 mg. Cmax after repeated oral administration of 100 mg 2 times a day – 6.76 mcg / ml.
Communication with plasma proteins – 13-17%. The volume of distribution (after taking 1.2 g) – 0.55-0.8 l / kg, depends on gender (in women – 50% of the values ​​observed in men). Css is achieved in 4-8 days, with renal failure – 10-15 days. Penetrates into breast milk.
Metabolized in the liver by hydroxylation, hydrolysis and glucuronidation to form 6 pharmacologically inactive metabolites. Pharmacokinetics after a single oral administration is linear, plasma clearance remains constant – 20-30 ml / min, AUC in the dose range of 100-400 mg increases in proportion to the dose. T1 / 2 after repeated administration of 50 and 100 mg 2 times a day – 21 hours
In severe hepatic and renal (CC less than 60 ml / min) insufficiency, plasma and renal clearance are reduced. Excreted by the kidneys unchanged (70%) and as metabolites. Removed from plasma by hemodialysis.
Indications for use: As monotherapy – newly diagnosed epilepsy.
As an auxiliary drug in adults and children over 2 years of age – partial or generalized tonic-clonic seizures, epileptic seizures against the background of Lennox-Gastaut syndrome.
Contraindications: Hypersensitivity, pregnancy, lactation, children’s age (up to 2 years).
Dosage regimen: Inside, regardless of the meal. Tablets should not be divided. Capsules are intended for patients who have difficulty swallowing tablets (children, elderly patients). The capsules should be carefully opened, the contents of the capsules mixed with a small amount (1 teaspoon) of soft food and swallowed immediately without chewing. Capsules can also be swallowed whole.
When used as monotherapy, consideration should be given to the possible impact of discontinuing concomitant anticonvulsant therapy (CST) on the frequency of seizures. In cases where it is undesirable to abruptly cancel concomitant PST, the doses of drugs are reduced gradually, reducing the dose by 1/3 every 2 weeks. With the abolition of drugs that are inducers of microsomal “liver” enzymes, the concentration of topiramate in plasma will increase. In such situations, if clinically indicated, the dose can be reduced.

Adults at the beginning of monotherapy – 25 mg once a day at bedtime for 1 week. Then the dose is increased at intervals of 1-2 weeks by 25-50 mg / day (the daily dose is divided into 2 doses). If this regimen is not tolerated, the dose is increased by a smaller amount or at longer intervals. The dose is selected depending on the effect. The recommended dose is 100 mg/day, the maximum daily dose is 500 mg. In some cases, with monotherapy for refractory epilepsy, the dose of topiramate is 1 g / day.

CHILDREN:
Children over 2 years of age with monotherapy in the first week of treatment – 0.5-1 mg / kg / day (daily dose is divided into 2 doses). The magnitude of the dose and the rate of its increase are determined by the clinical efficacy and tolerability of therapy. The recommended dose range for monotherapy with topiramate in children older than 2 years is 3-6 mg/kg/day. With newly diagnosed partial seizures – up to 500 mg / day.
When administered in combination with other anticonvulsant drugs in adults, the initial dose is 50 mg once a day at night for 1 week. Further, the dose is increased by 25-50 mg every week until an effective dose is reached. The average daily dose is 200-400 mg, the frequency of administration is 2 times a day. If necessary, it is possible to increase the daily dose to a maximum of 1600 mg. The criterion for dose selection is the clinical effect, in some patients it can be achieved when taking the drug 1 time per day.
When conducting combined anticonvulsant therapy in children older than 2 years, the recommended total daily dose is 5-9 mg / kg for 2 doses. Dose selection begins with 25 mg / day (or less, at the rate of 1-3 mg / kg / day) at night for 1 week. In the future, the dose can be increased by 1-3 mg / kg in 1-2 weeks and taken in 2 divided doses. A daily dose of 30 mg/kg is generally well tolerated.
On days of hemodialysis, topiramate should be administered additionally at a dose equal to 1/2 of the daily dose, in 2 divided doses (before and after the procedure).
The drug should be discontinued gradually to minimize the possibility of an increase in the frequency of seizures (by 100 mg / week).
Side effects: Ataxia, reduced ability to concentrate, confusion, dizziness, increased fatigue, paresthesia, drowsiness, impaired thinking, rarely – agitation, amnesia, decreased appetite, aphasia, depression, emotional lability, speech impairment, nystagmus, visual impairment (including diplopia), taste perversion, nausea, nephrourolithiasis, weight loss.
A syndrome may occur (usually 1 month after the start of therapy), characterized by myopia against the background of increased intraocular hypertension. At the same time, an acute decrease in visual acuity and / or pain in the eye area was also noted. Ophthalmic manifestations included: myopia, a decrease in the depth of the anterior chamber of the eye, hyperemia of the mucous membrane of the eye and an increase in intraocular pressure. In some cases – mydriasis. A possible mechanism for this syndrome is an increase in supraciliary effusion, which leads to anterior displacement of the lens and iris and, as a result, to the development of secondary angle-closure glaucoma. Treatment includes discontinuation of the drug and measures to reduce intraocular pressure.

Overdose
Symptoms: increased side effects.
Treatment: gastric lavage, symptomatic therapy. The use of activated carbon is inefficient, because. it has been shown in in vitro experiments that it does not adsorb topiramate. An effective way to remove topiramate from the body is hemodialysis.
Interaction: Reduces the effectiveness of oral estrogen-containing contraceptives.
Decreases AUC of digoxin by 12%.
The concomitant use of ethanol or other drugs that depress the central nervous system is not recommended.
When taken simultaneously with carbamazepine, the AUC of carbamazepine remains unchanged or changes slightly (less than 10%), while the AUC of topiramate decreases by 40%.
When co-administered, the AUC of phenytoin remains unchanged or increases by 25%, while the AUC of topiramate decreases by 48%, a correction of the dosing regimen of the latter may be required.
When used simultaneously with valproic acid, the AUC of valproic acid is reduced by 11%, topiramate – by 14%.
Carbonic anhydrase inhibitors (acetazolamide) increase the risk of kidney stones.
Special instructions: In patients with a predisposition to nephrourolithiasis, the risk of kidney stones is increased, to prevent which an adequate increase in the amount of fluid consumed is necessary.
During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Precautions
Renal/liver failure, nephrourolithiasis (history, including familial), hypercalciuria.

Producer: Janssen Ortho LLC, Puerto Rico
Marketing authorization holder: Janssen Pharmaceutica N.V., Belgium
Presentation: capsules 50 mg (polyethylene vials)
Ingredients: topiramate 50 mg
Belongs to Vital and Essential Drugs
Expiry date : 2 years
Data on registration: LSR-005288/08 dated 04.07.2008
Registration certificate status: valid
HS codes: 3004 90 190 9

Manufacturer: Janssen Ortho LLC, Puerto Rico
Registration certificate holder: Janssen Pharmaceut ica N.V., Belgium
Forms of production: capsules 15 mg, 25 mg (polyethylene bottles)
Composition: topiramate 15/25 mg
Belongs to Vital and Essential Drugs
Expiration date: 2 years
Registration data: P No. 011415/02 of 01/18/2008 : current
TN VED codes: 3004 90 190 9

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. The main use of Topamax is to combat epilepsy, however there are several off-label uses including migraine prevention, treatment of bipolar disorder and weight loss.

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• Diet Methods for 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 for 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
• Coordination problems
• Nausea
• Memory loss – especially a word access disorder that 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.