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Topamax® (topiramate)

Brand name:

Topamax®

  • Tablets: 25 mg, 50 mg, 100 mg, 200 mg

  • Capsule: sprinkle: 15 mg, 25 mg

Generic name: topiramate (toe PYRE a mate)

Medication Class: anticonvulsant

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

What is Topamax® 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 Topamax®?

Bipolar disorder requires long-term treatment. Do not stop taking topiramate even when you feel better.

Only your healthcare provider can determine the length of topiramate treatment that is right for you.

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 healthcare provider first.

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

Are there specific concerns about Topamax® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions. This is a complex decision since untreated bipolar disorder has risks for the fetus as well as the mother. It is important to discuss with your doctor and caregivers.

Exposure to topiramate during pregnancy is associated with increased risk of oral clefts.

Breastfeeding is not recommended in women who are taking topiramate.

What should I discuss with my healthcare provider before taking Topamax®?

  • Symptoms that are most bothersome to you about your condition

  • If you have thoughts of suicide

  • Medications you have taken in the past to treat bipolar disorder, whether they were effective or caused any adverse effects

  • Any psychiatric or medical problems you may 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 psychotherapy (i.e., 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 breast-feeding

  • If you smoke, drink alcohol, or use illegal drugs

How should I take Topamax®?

Topiramate is usually taken 2 times per day with or without food.

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

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

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

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 Topamax®?

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 healthcare provider. Do not double your dose or take more than what is prescribed.

What should I avoid while taking Topamax®?

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 Topamax®?

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 possible side effects of Topamax®?

Common Side Effects

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

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

Rare Side Effects

  • Mood or behavior changes: aggression, agitation, apathy, irritability, and depression

  • Increased eye pressure, abnormal eye movements, hearing problems (ringing, buzzing and decreased hearing)

  • Stomach pain, loss of appetite, change in the way food tastes, weight loss

  • Fever, chills, sore throat, and menstrual changes. Sexual problems, painful urination, kidney stones and bladder control problems

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

Are there any risks for taking Topamax® 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 Topamax®?

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 Topamax® to work?

It is very important to tell your doctor how you feel 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.

Provided by

College of Psychiatric and Neurologic Pharmacists

(January 2013)

There are no FDA Black Box Warnings for topiramate.

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