Key takeaways

  • Topamax is a brand-name drug that’s used to prevent migraine attacks and treat epilepsy. It’s available as an oral tablet and a sprinkle capsule.
  • Topamax is not approved for weight loss or bipolar disorder, but it may be prescribed off-label for these uses. With off-label use, doctors may prescribe a medication for a condition it’s not approved to treat.
  • Topamax’s dosage depends on several factors, including your age and the specific condition being treated. However, the typical dose of Topamax is 200 mg twice per day (400 mg total).

The Food and Drug Administration (FDA) has approved Topamax for the following purposes in certain situations:

To learn more about the conditions Topamax is prescribed for, see the “Topamax uses” section.

Drug details

You’ll find key information about Topamax here:

  • Drug class: anticonvulsants
  • Drug forms: oral tablet, sprinkle capsule
  • Active ingredient: topiramate
  • Generic available? yes
  • Prescription required? yes
  • Controlled substance? no

Topamax can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Topamax. These lists do not include all possible side effects.

For more information about the possible side effects of Topamax, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be bothersome.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medications safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking Topamax and want to tell the FDA about it, visit MedWatch or call 800-332-1088.

Mild side effects

Mild side effects of Topamax can include:

  • feeling of pins and needles or tingling
  • sleepiness
  • fatigue
  • speech problems, such as slurred speech
  • slow reactions or dizziness, which could affect your ability to drive or use machines safely
  • difficulty remembering or concentrating
  • change in the way things taste
  • nausea
  • abdominal pain
  • insomnia
  • fever
  • hair loss
  • loss of appetite
  • weight loss

This is a partial list of mild side effects from Topamax. To learn about other mild side effects, talk with your doctor or pharmacist, or read Topamax’s prescribing information.

For more information on weight loss, see the “Topamax for weight loss” section.

These side effects may go away within a few days to a couple of weeks. However, if they become more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Topamax aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

For more information about kidney stones and allergic reaction, see the “Side effect details” section.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

Side effects in children

Topamax is approved for treating certain types of seizures in children ages 2 years and older. It’s also approved for preventing migraine attacks in children ages 12 years and older. (To learn more about the conditions Topamax is approved for, see the “Topamax uses” section.)

Side effects of Topamax in children are similar to those in adults. These side effects are described in the preceding sections.

One clinical trial looked at children ages 6 years and older who took Topamax alone for epilepsy. The more common side effects were:

  • fever
  • weight loss
  • respiratory infections, such as colds

In other clinical trials, children ages 2 to 15 years took Topamax with other medications for epilepsy. The more common side effects in these studies were:

  • fatigue
  • sleepiness

In clinical trials involving children ages 12 years and older who took Topamax for migraine, the more common side effects were:

Children who take Topamax are less likely than adults to have speech problems, slow reactions, and difficulty concentrating.

Serious side effects in children

Children taking Topamax are more likely than adults to have fever and reduced sweating. These problems can lead to hyperthermia (high body temperature), which may need treatment in a hospital.

It’s important to monitor your child in hot weather. If they sweat less than usual or develop a high temperature, call your doctor for advice. A high temperature for children ages 2 years and older is one that’s above 99.5°F (37.5°C) when taken orally.

Additionally, children taking Topamax may have reduced bone mineral density (BMD). This is a measure of bone strength. Decreased BMD could indicate weakened bones.

Children taking Topamax may also have reduced growth, affecting their weight and height. Doctors will monitor growth in children who take Topamax.

Side effect details

You may wonder how often certain side effects occur with this drug or whether certain side effects pertain to it. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Topamax. However, it isn’t known how often this side effect may have occurred in clinical trials.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • difficulty breathing

Call your doctor right away if you have an allergic reaction to Topamax, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Kidney stones

Topamax can raise the risk of developing kidney stones. There were reports of kidney stones occurring in adults who took Topamax for epilepsy in clinical trials.

It’s not known how many people who took Topamax for migraine may have had kidney stones during clinical trials.

Kidney stones were also reported in children taking Topamax for epilepsy or migraine.

Symptoms of kidney stones

Symptoms of kidney stones can include:

If you have any of these symptoms while taking Topamax, call your doctor right away. You may need treatment to help your body get rid of any kidney stones.

What might help

It’s important to drink plenty of fluids while you take Topamax. This can reduce your risk of developing kidney stones.

While taking Topamax, you’ll also have tests to check the level of acid in your blood. Kidney stones can be a sign that you have metabolic acidosis (a high level of acid in your blood).

If you have metabolic acidosis, your doctor may lower your Topamax dose. If this doesn’t help, you may need to switch to a different treatment.

The Food and Drug Administration (FDA) approves prescription drugs such as Topamax to treat certain conditions. Topamax may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what the FDA has approved it for.

Topamax to prevent migraine attacks

Topamax is FDA approved to help prevent migraine attacks in adults and children ages 12 years and older. Migraine attacks are also referred to as migraine episodes.

Migraine is a condition that can cause intense, throbbing, and long-lasting headaches. Many people also experience nausea, vomiting, and increased sensitivity to light and sound with a migraine attack.

Some people have sensory symptoms, called an aura, before or during the migraine attack. The aura may cause you to see flashing lights or zigzag lines or have blind spots in your vision. The aura can also cause tingling feelings or problems with speech. After a migraine attack, many people feel tired or irritable for up to 2 days.

Migraine attacks can be treated with medications that help relieve the symptoms. These episodes can often affect your ability to perform your usual activities.

If you have migraine attacks that happen more than once per week or are severe, talk with your doctor. They’ll likely recommend medication to help prevent migraine attacks. Your doctor may also suggest medication to help prevent migraine attacks if drugs for treating migraine aren’t suitable or don’t work for you.

Effectiveness for preventing migraine attacks

Topamax was found to be safe and effective in preventing migraine attacks in clinical trials. For details about these trials, see the Topamax prescribing information.

Topamax to treat seizures

Topamax is FDA approved to treat epilepsy involving certain types of seizures in adults as well as children ages 2 years and older. It’s used as initial monotherapy. This means it’s prescribed before any other medications are included in a person’s treatment regimen. Topamax is used to treat:

  • Focal onset seizures: For the purpose of treating focal onset seizures (also referred to as partial onset seizures), Topamax may be used alone or with other anticonvulsant drugs (medications to treat seizures).
  • Generalized tonic-clonic seizures: For the purpose of treating generalized tonic-clonic seizures, Topamax may be used alone or with other anticonvulsant drugs.
  • Seizures linked to Lennox-Gastaut syndrome: For this purpose, Topamax is used with other anticonvulsant drugs. (Lennox-Gastaut syndrome is a type of epilepsy.)

Topamax is taken to help treat seizures. It is a type of drug called an anticonvulsant, also known as an antiepileptic drug.

Epilepsy is a condition that causes repeated seizures (excessive electrical activity in certain parts of your brain). The type of seizure you have depends on the part of your brain that’s affected.

Focal onset seizures

With focal onset seizures, excessive electrical activity starts in only one part of your brain. Focal onset seizures don’t make you lose consciousness.

Focal seizures are referred to as simple or complex. With simple focal seizures, you may have muscle twitching in one part of your body or a change in your senses. This could be a tingling feeling or a change in taste, smell, or vision. You may have difficulty communicating but still be aware of your surroundings.

With complex focal seizures, you may feel confused or dazed and may be unaware of your surroundings. You may also have muscle twitching or a change in your senses, as mentioned previously.

Generalized tonic-clonic seizures

With generalized tonic-clonic seizures, excessive electrical activity affects both sides of your brain. This type of seizure makes you lose consciousness, so you may fall. It also causes convulsions, which means your muscles become stiff (tonic) and jerk, shake, or spasm (clonic).

Seizures associated with Lennox-Gastaut syndrome

Lennox-Gastaut syndrome (LGS) is a rare form of childhood epilepsy that causes several different types of seizures. The seizures can be hard to manage with medications. Children with LGS may also have learning difficulties and behavior problems, such as hyperactivity or autism.

Effectiveness of Topamax for managing seizures

Clinical trials have found Topamax to be safe and effective for managing focal onset and generalized tonic-clonic seizures when taken alone. Clinical trials have also found Topamax to be safe and effective in managing focal onset and generalized tonic-clonic seizures, and seizures associated with LGS when taken with certain other drugs.

For details about these trials, see the Topamax prescribing information.

Off-label uses for Topamax

In addition to the uses listed in the preceding section, Topamax may be used off-label for other purposes. Off-label drug use means using a drug for a purpose other than what the FDA has approved it for. (For more information on conditions Topamax is approved for, see the “Topamax to prevent migraine attacks” and “Topamax to treat seizures” sections.)

Here are examples of off-label uses for Topamax.

Topamax for bipolar disorder

Topamax isn’t approved to treat bipolar disorder. There’s not much evidence that the drug works to treat this condition. Despite this, Topamax may sometimes be used off-label to treat bipolar disorder. People with bipolar disorder have episodes of depression and mania.

Research shows that Topamax isn’t effective for treating episodes of mania in bipolar disorder. In addition, there’s a lack of firm evidence from clinical trials to show whether Topamax works for stabilizing mood in bipolar disorder. For this reason, your doctor will likely recommend trying Topamax only if other medications haven’t worked for you.

If you have bipolar disorder and are interested in taking Topamax, talk with your doctor.

Topamax for anxiety

Topamax isn’t approved to treat anxiety. The drug may sometimes be used off-label to treat people with certain anxiety disorders, such as obsessive-compulsive disorder (OCD). However, it’s not known for sure whether Topamax is effective for this purpose.

A review of studies suggests that topiramate, the active ingredient in Topamax, may help treat OCD. However, more studies are needed to determine whether Topamax can be a safe and effective treatment for this condition. If you’re interested in taking Topamax for an anxiety disorder, talk with your doctor.

Topamax for pain

Topamax isn’t approved to treat pain. However, the drug may be used off-label to treat certain types of chronic pain. (Chronic pain is pain that lasts at least 12 weeks.)

For example, studies have found Topamax to be effective in relieving chronic low back pain. Topamax has also been found to be effective in treating various forms of nerve pain. For more information, see the “Topamax for nerve pain” section.

If you’re interested in taking Topamax to treat pain, talk with your doctor.

Topamax for nerve pain

Topamax isn’t approved to treat nerve pain. However, Topamax may be used off-label to treat certain types of nerve pain.

For example, studies have found Topamax to be effective in relieving painful diabetic neuropathy. This is a type of nerve damage that occurs in people with diabetes.

One small study found Topamax to be similar to gabapentin (Neurontin) in its ability to treat nerve pain. Gabapentin is widely used for nerve pain. Topamax could be a useful alternative if you’ve tried gabapentin and had side effects that you couldn’t tolerate.

If you’re interested in taking Topamax to treat nerve pain, talk with your doctor.

For more information on conditions Topamax is approved for, see the “Topamax to prevent migraine attacks” and “Topamax to treat seizures” sections.

Topamax and children

Topamax is FDA approved in certain situations to:

  • Prevent migraine attacks in children ages 12 years and older.
  • Treat epilepsy in children ages 2 years and older with:
    • focal onset seizures
    • generalized tonic-clonic seizures
    • seizures linked to Lennox-Gastaut syndrome (a rare form of childhood epilepsy that causes several different types of seizures)

For details on these conditions and uses, see the “Topamax to prevent migraine attacks” and “Topamax to treat seizures” sections.

Topamax isn’t approved by the Food and Drug Administration (FDA) for weight loss. However, the drug may reduce your appetite, which may cause you to lose weight.

In clinical trials, there were reports of weight loss in people who took Topamax. This depended on the dosage and condition the drug was being used for.

Research suggests that topiramate, the active ingredient in Topamax, may be effective for weight loss and weight management.

Topamax isn’t usually prescribed solely for weight loss. However, your doctor might recommend Topamax for seizures or migraine if you might also benefit from weight loss. For example, if you have an increased risk of health problems because of excess weight, Topamax might benefit you. The drug might also be useful if you’re taking other seizure or migraine treatments that can cause weight gain.

There isn’t a particular dosage or best time of day to take Topamax for weight loss. You should take it as prescribed by your doctor.

If you’re interested in taking Topamax for weight loss, it’s important to discuss the possible risks and benefits of this treatment with your doctor.

Note: Weight loss is an approved use for the brand-name medication Qsymia, which contains topiramate and another drug called phentermine.

Qsymia is approved by the FDA for weight loss in adults and children ages 12 years and older who have obesity. The drug is also approved for use in adults with overweight who have one or more weight-related health problems, such as high blood pressure, high cholesterol, or type 2 diabetes.

Topamax contains the active ingredient topiramate, which belongs to the anticonvulsant drug class.

Topamax is approved to help prevent migraine attacks and treat certain types of epilepsy seizures in adults and some children. To learn about Topamax’s mechanism of action (how it works) for these conditions, see this article on how Topamax works.

Topamax is a brand-name drug that contains the active ingredient topiramate. This active ingredient is also available as a generic medication. A generic drug contains the same active ingredient as its brand-name version.

The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

If you’re interested in using the generic form of Topamax, talk with your doctor. They can tell you whether it comes in forms and strengths that can be used for your condition.

Here’s some information on the use of Topamax with other drugs.

Use with other drugs for epilepsy

If you have epilepsy and anticonvulsant drugs aren’t helping manage your seizures, your doctor may prescribe Topamax. (Anticonvulsant drugs are medications that treat seizures, and Topamax is a type of anticonvulsant drug.) Topamax is approved to be taken alone or with other drugs. For details on the use of Topamax in treating epilepsy, see the “Topamax uses” section.

Examples of other anticonvulsant drugs that you may take with Topamax include:

Use with other drugs for migraine

If you’re taking Topamax for migraine, you’ll typically take Topamax alone to help prevent migraine symptoms such as headaches. However, if you have a migraine attack while you’re using Topamax, you can take fast-acting medications for your migraine symptoms. (For details on the use of Topamax in helping to prevent migraine attacks, see the “Topamax uses” section.)

Examples of fast-acting medications used to relieve migraine symptoms include:

  • over-the-counter pain relievers, such as:
  • prescription pain relievers, such as:
    • acetaminophen/butalbital/caffeine (Fioricet)
    • aspirin/butalbital/caffeine (Fiorinal)
    • acetaminophen/caffeine/dihydrocodeine
    • acetaminophen/codeine (Tylenol with codeine)
  • triptans, such as:
    • almotriptan
    • eletriptan (Relpax)
    • frovatriptan (Frova)
    • naratriptan
    • rizatriptan (Maxalt)
    • sumatriptan (Imitrex, Tosymra, Onzetra Xsail, Zembrace Symtouch)
    • sumatriptan/naproxen (Treximet)
    • zolmitriptan (Zomig)

The Topamax dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Topamax to treat
  • your age
  • your body weight
  • your kidney function
  • other medical conditions you may have

Typically, your doctor will start you on a low dose. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dose that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Topamax comes in two different forms:

  • An oral tablet: The tablet is available in strengths of 25 milligrams (mg), 50 mg, 100 mg, and 200 mg.
  • A sprinkle capsule: The capsule can be swallowed whole or opened to sprinkle on a teaspoonful of soft food and swallowed. The capsule is available in strengths of 15 mg and 25 mg.

If you have difficulty swallowing Topamax tablets, talk with your doctor about using Topamax sprinkle capsules instead.

Dosage for preventing migraine attacks

Topamax is recommended for preventing migraine attacks in adults and children ages 12 years and older. The usual recommended dosage is 50 mg taken once in the morning and once in the evening. For details on the use of Topamax in helping to prevent migraine attacks, see the “Topamax uses” section.

Your doctor will gradually increase your dosage to this level over the first 4 weeks of treatment. This allows your body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section.)

The dosage is usually increased as described here, but it may be raised more slowly if needed:

  • Week 1: 25 mg every evening
  • Week 2: 25 mg every morning and 25 mg every evening
  • Week 3: 25 mg every morning and 50 mg every evening
  • Week 4: 50 mg every morning and 50 mg every evening

Dosage for treating seizures

Topamax is used to treat epilepsy (a condition that causes repeated seizures) in certain situations. For details on the use of Topamax in treating epilepsy, see the “Topamax uses” section.

The recommended dosage depends on whether you’re taking Topamax alone or with other medications for your seizures.

The dosage of Topamax is gradually increased over the first few weeks of treatment. This allows your body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section.)

Topamax dosage when used alone

Topamax can be used on its own to treat focal onset seizures and generalized tonic-clonic seizures.

The usual recommended dosage for treating these types of seizures is 200 mg twice per day. The drug should be taken once in the morning and once in the evening for a total of 400 mg per day. This is the dosage for both adults and children ages 10 years and older.

Your doctor will gradually increase your dose to this level as follows:

  • Week 1: 25 mg twice per day
  • Week 2: 50 mg twice per day
  • Week 3: 75 mg twice per day
  • Week 4: 100 mg twice per day
  • Week 5: 150 mg twice per day
  • Week 6: 200 mg twice per day

Topamax dosage when used with other seizure medications

Topamax can be used with other seizure medications to treat focal onset seizures, generalized tonic-clonic seizures, and seizures linked to Lennox-Gastaut syndrome (LGS). (LGS is a rare form of childhood epilepsy that causes several different types of seizures.)

For the first week of treatment, the starting dosage is usually 25 mg to 50 mg per day. After this, your doctor may increase your daily dosage by 25 mg to 50 mg each week until the recommended dosage is reached.

The usual recommended dosages for treating these types of seizures in people ages 17 years and older are:

  • For focal onset seizures: 200 mg to 400 mg per day
  • For seizures linked to LGS: 200 mg to 400 mg per day
  • For generalized tonic-clonic seizures: 400 mg per day

The recommended dose per day is split into two equal doses. One dose is taken in the morning, and the other is taken in the evening.

Children’s dosage

Topamax is used to treat certain seizures in children ages 2 years and older. The drug is also used to prevent migraine attacks in children ages 12 years and older. The recommended children’s dosage for these conditions is described here.

For migraine prevention

The usual recommended dosage of Topamax in children ages 12 years and older is the same as it is for adults. For details, see the “Dosage for preventing migraine attacks” section.

For treating seizures when used alone

Topamax can be used on its own to treat focal onset seizures and generalized tonic-clonic seizures.

For children ages 10 years and older, the usual recommended dosage of Topamax is the same as it is for adults. For details, see the “Dosage for treating seizures” section. The following text provides information for treating children ages 2 to 9 years.

Starting treatment

For the first week of treatment, the starting dosage is 25 milligrams (mg) taken every evening. If your child tolerates this well, for the second week of treatment, their doctor may increase the dosage to 25 mg twice per day. (This is a total of 50 mg daily.)

When starting treatment, your child’s doctor will likely increase your child’s dose gradually. This will take place over the first few weeks until the recommended dose is reached. This allows your child’s body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section.)

Increasing dosage

After this, their doctor may increase their daily dosage by 25 mg to 50 mg each week. This is done until your child is at the minimum recommended dose for their body weight. If your child’s seizures aren’t managed with this dose, their doctor may gradually raise the dose. This increase will continue until your child is at the maximum dose for their body weight.

Recommended dosage

For children ages 2 to 9 years, the usual recommended dosage of Topamax is based on body weight in kilograms (kg) as shown in the table. Note that 1 kg is about 2.2 pounds (lb).

WeightDose per day
Up to 11 kg150 to 250 mg
12 to 22 kg200 to 300 mg
23 to 31 kg200 to 350 mg
32 to 38 kg250 to 350 mg
more than 38 kg250 to 400 mg

The recommended dose per day is split into two equal doses. One dose is taken in the morning and the other is taken in the evening.

For treating seizures when used with other seizure medications

Topamax can be used with other seizure medications to treat:

  • focal onset seizures
  • generalized tonic-clonic seizures
  • seizures in Lennox-Gastaut syndrome

Children ages 17 years and older typically take the same dosage of Topamax as adults. The following sections discuss the dosages for children ages 2 to 16 years.

Starting treatment

For the first week of treatment, the starting dose per day is usually about 1 to 3 mg per kg of body weight. Topamax is typically taken as a single dose every evening.

When starting treatment, your child’s doctor will gradually increase their dose over the first few weeks until the recommended dose is reached. This allows your child’s body to get used to the medication and helps reduce the frequency and severity of side effects. (For more about side effects, see the “Topamax side effects” section.)

After the first week, your child’s doctor may increase their daily dose by 1 to 3 mg per kg of body weight every 1 to 2 weeks. The medication is split into two equal doses. One dose is taken in the morning and the other is taken in the evening.

The daily dose is increased until your child is at the minimum recommended dose for their body weight. If your child’s seizures aren’t managed with this dose, their doctor may gradually raise the dose. This increase will continue until your child is at the maximum dose for their body weight.

Recommended daily dose

For children ages 2 to 16 years, the usual recommended daily dose is 5 mg to 9 mg per kg of body weight. The recommended daily dose is split into two equal doses. One dose is taken in the morning, and the other dose is taken in the evening.

Dosage questions

Here are answers to some questions you may have about taking Topamax.

What if I miss a dose?

If you miss a dose of Topamax and it’s more than 6 hours until your next dose is due, you should take the missed dose. However, if it’s less than 6 hours until your next dose is due, skip the missed dose. Take your next dose at your usual time. Do not take a double dose to make up for a missed dose.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Topamax is meant to be used as a long-term treatment. If you and your doctor determine that Topamax is safe and effective for you, you’ll likely take it long term.

You should avoid drinking alcohol with Topamax. Drinking alcohol during Topamax treatment can increase the frequency and severity of Topamax’s side effects, such as:

  • sleepiness
  • dizziness
  • confusion
  • difficulty with concentration, memory, or speech

In serious cases, drinking alcohol with Topamax may lead to serious side effects. These may include slow, shallow breathing, loss of consciousness, and coma. In rare cases, it can even be fatal.

If you have questions about the safety of drinking alcohol with Topamax, talk with your doctor.

Here are answers to some frequently asked questions about Topamax.

Does Topamax cause weight gain?

Topamax isn’t known to cause weight gain. This side effect wasn’t reported in clinical trials of Topamax. However, weight gain has been reported with some anticonvulsant drugs, which are medications in the same drug class as Topamax.

Topamax can cause weight loss. To read more about this, see the “Topamax for weight loss” section.

Do Topamax and Wellbutrin interact?

It’s possible for Topamax to interact with Wellbutrin. As a result, doctors typically won’t prescribe Wellbutrin to people with a seizure disorder. Keep in mind that Topamax is used to treat epilepsy in certain people. (Epilepsy is a seizure disorder.)

Wellbutrin may cause seizures in people with seizure disorders as well as people who haven’t had a seizure before. Because of this, doctors won’t give Wellbutrin to people with a seizure disorder. They also won’t prescribe the drug in certain situations that raise the risk of seizure.

Topamax is also used to prevent migraine attacks in adults and certain children. It may be safe for people taking Topamax for migraine prevention to take Wellbutrin.

However, doctors typically won’t prescribe Wellbutrin to people who have suddenly stopped taking certain drugs, including antiepileptic drugs. So, if your doctor prescribes both Topamax and Wellbutrin, it’s important that you do not suddenly stop taking Topamax. Doing so may cause or worsen seizures.

Note that Wellbutrin is available in two versions, Wellbutrin XL and Wellbutrin SR. Both are approved to treat depression in adults. Wellbutrin XL is also approved to treat seasonal affective disorder in adults. These medications both contain the active ingredient bupropion.

For more information about Wellbutrin and Topamax, talk with your doctor.

How long does it take to flush Topamax out of your system?

Topamax has a half-life of about 21 hours. The half-life of a drug is the time it takes for the amount of the drug in your body to fall by half. It takes about five half-lives for a drug to be almost completely removed from your body. So for Topamax, most of the drug will be flushed out of your system within about 5 days after you stop taking it.

For more information about how long it takes your body to flush Topamax out, talk with your doctor or pharmacist.

Is Topamax a mood stabilizer?

Topamax is sometimes used off-label as a mood stabilizer in people with bipolar disorder. Off-label drug use means using a drug for a purpose other than what the FDA has approved it for.

Mood stabilizers are drugs that help prevent extreme changes in mood, such as those that occur with bipolar disorder. People with bipolar disorder typically have episodes of depression and episodes of mania. Mania is a mood disorder that gives you an unnatural feeling of physical and mental energy.

Several anticonvulsant medications also work as mood stabilizers in people with bipolar disorder. Topamax, which is an anticonvulsant medication, is sometimes used in this way. However, there’s not much evidence that Topamax is effective for this use.

To learn more, talk with your doctor or pharmacist.

What’s Topamax’s drug classification?

Topamax belongs to a class of drugs called anticonvulsants. These drugs are also called antiepileptic drugs.

Anticonvulsants are mainly used to treat epilepsy (a condition that causes repeated seizures). Many drugs in this class, including Topamax, are also effective for other conditions that don’t involve seizures. These include migraine and nerve pain.

There haven’t been studies on whether Topamax can cause drug dependence. (With drug dependence, a person’s body needs the drug to function as usual.)

However, once Topamax manages your condition, you will need to keep taking it to continue to treat seizures or prevent migraine attacks. If you stop taking Topamax, your seizures or migraine symptoms, such as headaches, may happen more often. They could also become more severe. Sometimes, people without epilepsy have had seizures after suddenly stopping Topamax.

You should not stop taking Topamax without first talking with your doctor. If you and your doctor decide to stop treatment, you may need to stop taking Topamax gradually. This can help reduce your risk of seizures. Your doctor will explain how to do this.

Topamax can interact with several other medications. It can also interact with certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Topamax and other medications

Here, you’ll find examples of medications that can interact with Topamax. Not all drugs that may interact with Topamax are listed here.

Before taking Topamax, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also, tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Topamax and birth control

Topamax can make birth control drugs that contain estrogen less effective at preventing pregnancy.

Examples of birth control pills that can be made less effective by Topamax include:

  • levonorgestrel/ethinyl estradiol (Lessina, Levora, Seasonique)
  • desogestrel/ethinyl estradiol (Bekyree, Kariva)
  • norethindrone/ethinyl estradiol (Balziva, Junel, Lo Loestrin Fe)
  • norgestrel/ethinyl estradiol (Cryselle)
  • drospirenone/ethinyl estradiol (Loryna, Yaz)
  • norgestimate/ethinyl estradiol (Sprintec, Tri-Sprintec)

Topamax treatment can also make certain birth control medications less effective at preventing pregnancy. These include:

If you use birth control that contains estrogen, your doctor may recommend switching to a different type of birth control medication while you take Topamax.

Topamax and certain other seizure medications

Taking Topamax with phenytoin (Dilantin) or carbamazepine (Tegretol) can lower the level of Topamax in your blood. This could make Topamax less effective at managing seizures or preventing migraine attacks.

If you need to take Topamax with phenytoin or carbamazepine, your doctor may prescribe a higher dosage of Topamax. This should increase the likelihood that the drug works for you.

Topamax and Depakote

Taking Topamax with divalproex sodium (Depakote) can raise your risk of certain side effects. These include:

  • hyperammonemia (an increased level of ammonia in your blood)
  • hypothermia (low body temperature)

Both conditions can be very serious and, in rare cases, life threatening.

If you need to take Topamax with valproic acid, your doctor may recommend blood tests. These will monitor the amount of ammonia in your blood.

Topamax and carbonic anhydrase inhibitors

Taking Topamax with drugs called carbonic anhydrase inhibitors can raise your risk of a side effect called metabolic acidosis (a high level of acid in your blood). Metabolic acidosis can also raise your risk of kidney stones.

Examples of carbonic anhydrase inhibitors include:

  • acetazolamide
  • zonisamide (Zonegran)

If you need to take one of these drugs with Topamax, you may need more frequent blood tests than usual. These tests will check the level of acid in your blood.

Topamax and CNS depressants

Central nervous system (CNS) depressants are medications that slow down activity in your central nervous system (brain and spinal cord). These medications typically cause you to feel drowsy and less alert. However, in serious cases, they can also cause slow, shallow breathing, loss of consciousness, coma, and, in rare cases, death.

There have been no studies involving people who took Topamax with a CNS depressant. However, taking the two drugs together could raise your risk of the side effects mentioned previously. For this reason, you should avoid CNS depressants while taking Topamax.

Examples of CNS depressants that should be avoided with Topamax include:

For more information on Topamax’s interaction with alcohol, see the “Topamax and alcohol” section.

Topamax and anticholinergic medications

Anticholinergic drugs are used to treat many different conditions, including overactive bladder, asthma, and Parkinson’s disease. These drugs can sometimes cause reduced sweating. Topamax can also reduce sweating. Therefore, taking Topamax with anticholinergic drugs could raise your risk of overheating and hyperthermia (high body temperature), especially in hot weather.

Examples of anticholinergic drugs that could raise your risk of hyperthermia with Topamax include:

If you need to take one of these drugs, talk with your doctor about whether Topamax is right for you.

Topamax and hydrochlorothiazide

Hydrochlorothiazide (Microzide) is a diuretic medication used to treat high blood pressure.

Taking Topamax with hydrochlorothiazide may increase the level of Topamax in your blood. It’s not known whether this increases your risk of side effects. However, your doctor may prescribe a lower dose of Topamax if you need to take hydrochlorothiazide as well.

Topamax and pioglitazone

Pioglitazone (Actos) is a medication for type 2 diabetes.

Taking Topamax with pioglitazone may decrease the level of pioglitazone in your blood. It’s not known whether this makes pioglitazone less effective. However, if you need to take pioglitazone with Topamax, your doctor may monitor your blood sugar more often. This is to check that pioglitazone is still working for you.

Topamax and lithium

Lithium (Lithobid) is a medication used for certain mental health conditions, such as bipolar disorder and severe depression.

Taking high doses of Topamax with lithium may increase the level of lithium in your blood. This could raise your risk of lithium side effects. Examples include slurred speech, memory problems, kidney failure, and muscle tremors or twitches. A high lithium level can be serious.

If you need to take Topamax with lithium, your doctor may order more frequent blood tests than usual. These tests will check your lithium level. Your doctor may need to adjust the doses of your medications as needed.

Topamax and amitriptyline

Amitriptyline is an antidepressant medication that’s also used for nerve pain and to prevent migraine attacks.

Taking Topamax with amitriptyline can increase the level of amitriptyline in your blood. This could raise your risk of amitriptyline side effects. These side effects include drowsiness, dizziness, irregular heartbeats, and seizures.

If you need to take Topamax with amitriptyline, tell your doctor if you have any new side effects. Also, be sure to tell them if any side effects become more severe or occur more often. Your doctor may adjust the doses of your medications as needed.

Topamax and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Topamax. However, you should still check with your doctor or pharmacist before using any of these products while taking Topamax.

Topamax and foods

A ketogenic diet is low in carbohydrates and protein and high in fat. Following a ketogenic diet while you’re taking Topamax could raise your risk of a side effect called metabolic acidosis. This is a high level of acid in your blood.

If not treated, metabolic acidosis can raise your risk of kidney stones and weakening of your bones. Metabolic acidosis can also increase the risk of reduced growth in children.

You should avoid following a ketogenic diet while taking Topamax to lower your risk of these side effects.

Note: For some people, following a ketogenic diet can reduce the number of seizures they have. This type of diet is sometimes recommended for people with epilepsy that’s not well managed with medication. If you’re following a ketogenic diet or want to start one, you should discuss this with your doctor before taking Topamax.

Using more than the recommended dosage of Topamax can lead to serious side effects. Do not use more Topamax than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

  • convulsions
  • drowsiness
  • slurred speech
  • difficulty with coordination
  • blurred or double vision
  • abdominal pain
  • agitation (being anxious or restless)
  • dizziness
  • stupor (a state of not being alert to your surroundings)

In rare cases, fatal overdoses of Topamax have been reported.

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

If you can become pregnant, are breastfeeding, or are using birth control, it’s important to consider whether Topamax is a safe choice for you.

Topamax may not be safe to take if you’re pregnant or breastfeeding.

You can refer to this Topamax and reproductive health article for more information. If you have additional questions, talk with your doctor.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Topamax, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use means using a drug for a purpose other than what the Food and Drug Administration (FDA) has approved it for.

Alternatives for preventing migraine attacks

Examples of other drugs that may be used to prevent migraine attacks include:

Alternatives for treating seizures

Examples of other drugs that may be used to treat seizures include:

As with all medications, the cost of Topamax can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Topamax, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide whether the drug will be covered.

If you’re not sure whether you’ll need to get prior authorization for Topamax, contact your insurance company.

Drug coupons

You can visit Optum Perks for price estimates of Topamax. These estimates are based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with insurance copays or benefits.

Financial and insurance assistance

If you need financial support to pay for Topamax, or if you need help understanding your insurance coverage, help is available.

The manufacturer of Topamax offers a savings card that may help lower the cost of Topamax. For more information and to find out if you’re eligible for support, visit the manufacturer’s website.

Generic version

Topamax is available in a generic form called topiramate. A generic drug contains the same active ingredient as its brand-name version. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs.

If your doctor has prescribed Topamax and you’re interested in using topiramate instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

Optum Perks is owned by RVO Health. By clicking on this link, we may receive a commission. Learn more.

You should take Topamax according to your doctor’s or another healthcare professional’s instructions.

Topamax comes in two different forms: an oral tablet, which you swallow whole, and a sprinkle capsule. The capsule can be swallowed whole or opened to sprinkle on a teaspoonful of soft food and swallowed.

If you have difficulty swallowing Topamax tablets, talk with your doctor about using Topamax sprinkle capsules instead.

When to take

When you first start taking Topamax for migraine attacks or seizures, your doctor will gradually increase your dose. Some people may take Topamax once every evening for the first week of treatment. After this, most people will usually take Topamax twice per day.

The best time of day to take Topamax is once every morning and once every evening. Try to take your dose at roughly the same time or times each day.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Taking Topamax with food

You can take Topamax either with or without food.

Can Topamax be crushed, split, or chewed?

It depends on which form of Topamax you take.

You should not crush, split, or chew Topamax tablets, as they have a very bitter taste. These tablets should be swallowed whole.

If you take Topamax sprinkle capsules, you should swallow them whole. If you have difficulty swallowing them, you can split them open. Then, you’ll sprinkle the contents of the capsule onto a teaspoonful of soft food and swallow this mixture right away without chewing it.

If you have difficulty swallowing Topamax tablets, talk with your doctor about using Topamax sprinkle capsules instead.

Before taking Topamax, talk with your doctor about your health history. There are no contraindications to Topamax. (Contraindications are conditions or factors that would prevent you from taking the medication.)

However, Topamax may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:

Note: For more information about the potential negative effects of Topamax, see the “Topamax side effects” section.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.