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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