Topamax - Antiepileptic medicine

This article was medically reviewed by M.Pharm, Marko Tanaskovic on Thu, 27 Dec 2018. To read more about an author, click here.

Topamax is a medicine that contains ab active substance called topiramate. It belongs to a group of medicines called anticonvulsants (also known as antiepileptic medicines). It is used to treat the following conditions:

  • Generalized tonic - clonic seizures.
  • Partial seizures with or without secondarily generalized seizures.
  • Prevention of migraine.
  • Lennox-Gastaut syndrome (a rare and severe type of epilepsy).


Topamax should be avoided in the following conditions:

  • If you are allergic to the active substance topiramate or other similar medicines
  • If you are pregnant or breastfeeding

Drinking plenty of fluids while you are using this medicine is important for preventing kidney stones.

This medicine can cause suicidal thoughts and behaviors. If you are having suicidal thoughts, call your doctor immediately.

This medicine can cause liver damage, therefore should be used only with extra precautions in patients who have liver disease.

Topamax should be used only with extra precautions in the following conditions:

  • In patients with diabetes
  • In patients with glaucoma (increased eye pressure)
  • Patients who take antidepressants
  • In patients who have difficulty breathing
  • In patients with metabolic disorders (e.g. metabolic acidosis)

It should be avoided in children under the age of 2.

Avoid high heat and physical activity, because this medicine can decrease sweating and increase body temperature, leading to severe dehydration. Therefore, it is important to drink lots of fluids before, during and after exercise while using this medicine.

Use of Topamax during pregnancy and breastfeeding

Topamax can be used during pregnancy only if the benefit to the mother outweighs the risk to the child. Topamax can cause cleft lip and anomalies of various organs in the newborns. However, if you have seizure it may harm your unborn baby. Your doctor will probably tell you to continue with the Topamax treatment.

This medication passes into breast milk and may harm your baby. Therefore, you should avoid breastfeeding while using this medicine.

How to use

The usual initial dose is Topamax 25 mg once a day in the evening. The dose can be increased after one week to 50 mg or 75 mg per day (in divided doses).

The dose depends on the severity of the condition and the type of epilepsy. Your doctor will determine the proper dose of Topamax for you.

This medicine can be taken regardless of meals, because food does not affect its efficacy.

Swallow the tablet whole with plenty of fluids.

Use with other medicines (Interactions)

Topamax should be avoided in combination with the following medicines:

  • Medicines used to treat diabetes, such as metformin.
  • Oral contraceptives also known as birth control pills. Topamax can reduce the effectiveness of birth control pills. In this case, you should use an extra method of birth control.
  • Medicines used to treat glaucoma.
  • Medicines used to treat depression, such as lithium.

Tell your doctor about all medications and herbal products you are taking.

Side effects

Topamax may cause the following side effects:

  1. nausea,
  2. vomiting,
  3. abdominal pain,
  4. dyspepsia (indigestion),
  5. constipation,
  6. diarrhea,
  7. dry mouth,
  8. inflammation of the pancreas (pancreatitis),
  9. bleeding gums,
  10. bad breath,
  11. decreased appetite,
  12. increased appetite,
  13. anorexia,
  14. anemia,
  15. low white blood cells count (leukopenia),
  16. low blood platelets count (thrombocytopenia),
  17. metabolic acidosis,
  18. alopecia (hair loss),
  19. insomnia,
  20. depression,
  21. mood swings,
  22. suicidal thoughts,
  23. hallucinations,
  24. decreased libido,
  25. impaired attention,
  26. impaired memory,
  27. dizziness,
  28. taste disorder,
  29. speech disorder,
  30. blurred vision,
  31. transient loss of vision,
  32. glaucoma,
  33. hearing loss,
  34. low blood pressure (hypotension),
  35. muscle pain,
  36. joint pain,
  37. kidney stones,
  38. blood in the urine,
  39. erectile dysfunction,
  40. fever,
  41. dehydration,
  42. weight gain,
  43. weight loss,
  44. Steven-Johnson syndrome,
  45. allergy and others.

Tell your doctor if you are experiencing any side effects.

Information on this website are provided for educational purposes only and are not intended for medical advice, diagnosis or treatment.

If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.