Topiramate is an anticonvulsant that can be prescribed to adults and children for the treatment of epilepsy and seizures associated with Lennox-Gastaut Syndrome, as well as migraine prevention. It works in the brain by reducing nerve cell stimulation that can trigger epileptic seizures or migraines.

This medication can be purchased in pharmacies with a prescription under its generic name topiramate, or commercial name Topamax.

Topiramate should be used in the doses and for the duration of treatment prescribed by your doctor, and requires ongoing monitoring to assess effectiveness.

What it's used for

Topiramate is indicated for the treatment of:

Epilepsy
Focal seizures
Primary generalized tonic-clonic seizures
Seizures caused by Lennox-Gastaut Syndrome.

Topiramate can also be prescribed by a neurologist for the prevention of migraines in adults.

Does topiramate help with anxiety?

Topiramate is not used for anxiety and is not indicated for the treatment of anxiety disorders. Learn more about anxiety medication and what your doctor can prescribe instead.

How to take

Topiramate should be taken orally with a glass of water, at the doses and times indicated by your doctor. Generally, treatment starts at a low dose which can be gradually increased until a therapeutic effect is achieved.

1. Adjunctive therapy for epilepsy

The minimum therapeutic dose for adults is 200 mg per day, up to a maximum of 1600 mg per day. Treatment should start at 25 to 50 mg, administered at night, for one week. Then, every 1 to 2 weeks, the dose should be increased by 25 to 50 mg per day, and then divided into two doses.

For children over 2 years of age, the dose is calculated using the child's body weight.

2. Primary treatment of epilepsy

The normally recommended starting dose for adults is one 25mg tablet, taken at night for 1 week. After this time, the doctor may increase by 25 to 50 mg per day every 1 to 2 weeks, which can be further divided into 2 doses per day.

When other antiepileptic drugs are removed from the treatment plan to swap in topiramate as the primary treatment, the other medications should be gradually discontinued. These adjustments should be closely monitored and frequent reassessments are needed.

For children over 2 years of age, the dose is calculated using the child's body weight.

3. Migraine prophylaxis

The recommended starting dose of topiramate for adults is 25 mg at night for one week. This dose is then increased by the doctor by 25 mg per day every week for up to a maximum of 100 mg per day, which can be divided into two daily doses.

Possible side effects

The most common side effects of topiramate are drowsiness, dizziness, tiredness, irritability, weight loss, slower thinking, tingling in the arms or legs, abnormal coordination, double vision, nausea, diarrhea, changes in taste, decreased appetite, fever, difficulty speaking, blurred vision, speech or memory problems.

Topiramate may also cause side effects similar to a cold, like a stuffy nose, sneezing, or a sore throat.

You should inform your doctor if you experience any mood swings, depression, anxiety, panic attacks, insomnia, difficulty sleeping, impulsivity, irritation, agitation, aggression or suicidal ideation after starting topiramate.

Can topiramate lead to weight loss?

Topiramate may lead to mild weight loss as it may cause a loss of appetite.

This medication can also alter taste, which can contribute to the less eating and eventually weight loss.

Nonetheless, it is important to emphasize that topiramate is not indicated for weight loss.

Contraindications for use

Topiramate should not be used by women who are pregnant or may be pregnant, nor should it be taken by anyone who is allergic to topiramate or to any component in the formula.