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Overview: Topiramate is used to treat or prevent seizures. It is also used to prevent migraines. It may work by affecting certain signals in the brain. Common side effects include dizziness, drowsiness, numbness, loss of appetite, weight loss, and confusion or problems with memory or speech. Contact your health care provider right away if you have vision changes or eye pain, a high fever or decreased sweating, a rash, unusual changes in mood or behavior or thoughts of self-harm, or unexplained extreme tiredness, vomiting, or confusion.

Uses

What is topiramate used for?

Topiramate is commonly used in people with epilepsy to treat and prevent seizures.

Topiramate is also commonly used to help prevent migraines. A migraine is a severe, recurring type of headache that causes intense pain and other symptoms like nausea, vomiting, and sensitivity to light.

Topiramate may also be used for other conditions as determined by your health care provider.

How does topiramate work (mechanism of action)?

Seizures are caused by electrical activity in the brain that is not normal. Topiramate is though to block this abnormal electrical activity and slows down the spread of seizures. Topiramate may help prevent migraine headaches by calming down overly excited brain cells. Exactly how topiramate works to help prevent migraines isn't known. 

How is topiramate supplied (dosage forms)?

Brands and other names

  • Eprontia
  • Qudexy XR
  • Topamax
  • Trokendi XR

Dosage forms and strengths

  • 25 mg/mL oral solution 
  • 25 mg, 50 mg, 100 mg, 150 mg, 200 mg extended-release capsules
  • 25 mg, 50 mg, 100 mg, 200 mg oral tablets
  • 15 mg, 25 mg oral sprinkle capsules

How should I store topiramate?

Tablets, Sprinkle Capsules, and Extended-Release Capsules. Store at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C), for shorter periods of time, such as when transporting it. Keep tightly closed. Store in a cool, dry place.

Oral Liquid. Store at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C), for shorter periods of time, such as when transporting it. Safely throw away any unused liquid after 90 days of opening the bottle.

Side Effects

What are the most common side effects of topiramate?

The most common side effects of topiramate are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Numbness, tingling, or burning in your arms, feet, or face
  • Decreased appetite or weight loss
  • Nausea or diarrhea
  • Changes in mood, feeling nervous, or anxious
  • Concentration, memory, or speech problems (see below)
  • Feeling unusually weak or tired 
  • Changes in taste
  • Dizziness or problems with balance
  • Eye problems (see below)

There may be other side effects of topiramate that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of topiramate?

While less common, the most serious side effects of topiramate are described below, along with what to do if they happen.

Severe Allergic Reactions. Topiramate may cause allergic reactions, which can be serious. Stop taking topiramate and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Eye Problems and Glaucoma. Topiramate may make it harder to see faraway objects (short-sightedness) or cause other problems seeing. It also may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. Tell your health care provider right away if you have any of the following symptoms.

  • Trouble seeing faraway objects
  • Loss of vision, double vision, or blurred vision
  • Eye pain, discomfort, or redness
  • Severe headache or vomiting
  • Seeing flashes of light or bright, colorful circles around lights (vision halos)

Decreased Sweating and Increased Body Temperature. Tell your health care provider right away if you notice that you are sweating less or if you have a fever, especially in hot weather. Some people may need to be treated in a hospital if this happens.

Metabolic Acidosis. Topiramate can cause a condition called metabolic acidosis. This happens when there is too much acid in the blood. If this condition is not treated, it can cause kidney stones, slowed growth in children, soft or brittle bones (osteopenia, osteomalacia [rickets], or osteoporosis) or, if you are pregnant, it can harm a fetus. Tell your health care provider right away if you have any of the following symptoms of metabolic acidosis.

  • Fast breathing or heartbeat
  • Headache
  • Feeling confused, weak, or tired
  • Not feeling hungry
  • Nausea or vomiting

Suicidal Thoughts and Actions. Topiramate may increase the risk of suicidal thoughts or actions in a small number of people. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your health care provider right away if you have any of the following symptoms.

  • New or increased thoughts of suicide or death
  • Suicide attempt
  • New or increased feelings of anxiety, depression, or other unusual changes in mood or behavior

Concentration, Memory, or Speech Problems. Topiramate can cause changes to your alertness or coordination, concentration, memory, or speech. Do not drive or do other activities that require alertness or coordination until you know how topiramate affects you. Contact your health care provider right away if you have trouble concentrating, memory problems, confusion, or speaking.

Weak Bones. Using topiramate for a long time may cause the bones to become weaker, leading to reduced bone density (osteopenia). It may also cause a more serious condition called osteoporosis, which can cause bones to break (fracture) more easily. If you use topiramate, your health care provider may monitor your bone density.

Severe Skin Reactions. Topiramate can cause severe skin reactions called Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) that can lead to death if not treated. Get emergency help right away at the first sign of a rash or if you have any of the following symptoms of SJS or TEN.

  • Painful skin that looks burned and peels off
  • Flat rash or blisters on your skin, mouth, nose, or genitals
  • Red, painful, watery eyes
  • Flu-like symptoms including fever, chills, and muscle aches

High Blood Ammonia Levels. Topiramate can increase ammonia levels in your blood. You may need a blood test to check the amount of ammonia in your blood. Tell your health care provider right away if you have nausea, vomiting, unexplained tiredness, confusion, slowed thinking, or slowed reaction time. 

Kidney Stones. Topiramate may cause kidney stones. You may be more likely to get kidney stones if you are on a ketogenic diet. Drinking plenty of water can help prevent kidney stones. Tell your health care provider right away if you have severe pain in your side or back, or have blood in your urine (pee). Your pee may look pink, red, or brown.

Growth Problems in Children. Topiramate can slow down how fast your child grows. This risk may be increased in children who get metabolic acidosis (see above). Your health care provider may change your child’s dose of topiramate or stop treatment if they are not growing as expected.

Warnings & Precautions

Who should not use topiramate?

Allergies to Ingredients. People who are allergic to any of the following should not use topiramate.

  • Topiramate
  • Topamax
  • Eprontia
  • Qudexy
  • Trokendi XR
  • Any of the ingredients in the specific product dispensed

Your pharmacy can tell you all the ingredients in the specific topiramate products they stock.

What should I know about topiramate before using it?

Do not take topiramate unless it has been prescribed to you by a health care provider. Take it as prescribed.

Do not stop taking topiramate without talking to your provider. Stopping topiramate suddenly can cause seizures even if you have never had a seizure. If you need to stop taking topiramate, your health care provider will give you instructions on how to stop the medicine.

Do not share topiramate with other people, even if they have the same condition as you. It may harm them.

Keep topiramate out of the reach of children.

Topiramate can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how topiramate affects you.

Do not chew, cut, or crush topiramate. Swallow the sprinkle capsules, extended-release capsules, and tablets whole with water. Some topiramate capsules may be opened and sprinkled on soft food such as applesauce. Ask your pharmacist or health care provider about the best way to take your medicine. If you are told that it is okay to open a topiramate capsule and sprinkle on soft food, swallow the soft food right away without chewing. Do not save the soft food to swallow at a later time. 

If you are taking topiramate oral liquid, use an accurate measuring device to measure your dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist what measuring device to use.

If you can become pregnant, use effective birth control while you are taking topiramate. Talk to your health care provider about your birth control options. 

What should I tell my health care provider before using topiramate?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. Also tell your health care provider if you will be having surgery. This will help them know if topiramate is right for you.

Mental Health Problems. Tell your health care provider about your recent and current mental health problems, especially if you have had thoughts of suicide or dying or have ever attempted suicide.

Other Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • History of seizures or epilepsy
  • Kidney problems or kidney stones
  • Liver problems
  • Too much acid in your blood (metabolic acidosis)
  • On a low-carbohydrate and high-fat diet, such as a ketogenic diet
  • Eye problems, especially glaucoma
  • Lung or breathing problems
  • Diarrhea 
  • Growth problems
  • Bleeding problems
  • Weak, brittle, or soft bones such as osteopenia, osteoporosis, or osteomalacia (rickets)

Pregnancy. Topiramate can cause harm to a fetus. Tell your health care provider if you are or plan to become pregnant. Your health care provider will let you know if you should take topiramate while you are pregnant or planning to become pregnant. If you get pregnant while taking topiramate, you can sign up for a special registry called the North American Antiepileptic Drug Pregnancy Registry by calling 888-233-2334. This registry collects safety information about the use of antiepileptic medicines during pregnancy. 

Breastfeeding. Topiramate passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should take topiramate while breastfeeding. If you take topiramate and breastfeed, monitor your baby for increased sleepiness or diarrhea, and get medical help right away if this happens. 

Other Medicines and Supplements. Topiramate may interact with other medicines and supplements. Before taking topiramate, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Interactions

Does topiramate interact with foods or drinks?

There are no known interactions between topiramate and food or drinks. 

Do not drink alcohol within 6 hours before or after taking topiramate extended-release capsules. Alcohol affects how the medicine is released in your body.

It is unknown if drinking alcohol will affect other topiramate products, but both topiramate and alcohol can increase your risk of bleeding, dizziness, and drowsiness. It is best to limit the amount of alcohol you drink.

Does topiramate interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking topiramate.

  • A birth control medicine that contains hormones (such as pills, implants, patches, or injections) 
  • Carbamazepine (Tegretol, Carbatrol, and others), which is a medicine commonly used to treat seizures or nerve pain
  • Phenytoin (Dilantin, Phenytek, and others), which is a medicine to control seizures
  • Valproic acid, divalproex sodium, or valproate sodium (Depakote and others), which is a medicine used for seizures and other conditions
  • A carbonic anhydrase inhibitor, such as zonisamide (Zonegran and others), acetazolamide (Diamox), or methazolamide
  • Any other medicine that causes dizziness and sleepiness (e.g., prescription pain medicines, sleep medicines, and medicines for anxiety)
  • A non-steroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen, naproxen, and others, which are in many prescription and OTC products for pain, swelling, and fever
  • A blood thinner, which is a medicine used to treat or prevent blood clots
  • Lithium, which is a medicine commonly used for mental health conditions
  • Amitriptyline, which is a medicine that is used for depression and other conditions 
  • A selective serotonin reuptake inhibitor (SSRI), which is a medicine commonly used for anxiety and depression
  • Pioglitazone (Actos), which is a medicine for diabetes

This may not be a complete list of medicines that can interact with topiramate. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much topiramate?

If you or someone else has used too much topiramate, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of topiramate?

If you miss a dose of topiramate and it is still more than 6 hours until your next scheduled dose, take your missed dose right away. Take your next dose at the regular time.

If you miss a dose of topiramate and it is less than 6 hours until your next scheduled dose, do not take your missed dose. Just take your next dose at the regular time. Do not take double or extra doses.

Ask your health care provider about what you should do if you miss a dose if you feel unsure about when you took your last dose or if you missed more than one dose of topiramate.