Uses

Topiramate is an effective medication used for migraine prevention and to reduce seizure activity.

How to Use

Take this medication by mouth with water, it can be taken with food.

Take it exactly as directed, do not take it more than directed.

Do not chew or crush the tablet.

If you miss a dose, take it as soon as you can. If your upcoming dose should be taken within 6 hours or less, take only the upcoming dose and do not take the missed dose. Do not double up on any dose.

Important Information

Be sure to have regular check ups with your doctor while on this medication.

Do not stop taking this medication suddenly, without consulting with your doctor. This could increase your risk of getting a seizure if you are taking it for seizures.

It is important to wear a bracelet or chain if you have seizures, and to carry a card that lists your medications.

Stay hydrated while taking this medication.

Stand and sit slowly when first starting this medication to avoid dizziness.

Avoid extreme temperatures such as hot baths, saunas, and steam rooms while taking this medicine. Be cautious when exercising in hot weather, and watch for signs of decreased ability to sweat and fever, particularly in young children.

Do not operate heavy machinery, drive a car, or engage in other activity that requires fine motor skills until you are sure of how this medication affects you.

Avoid alcohol consumption, alcohol can increase chances of dizziness or drowsiness.

Inform your doctor if you are on birth control while taking this medication. They may require a second form of birth control to be used because this medication can decrease birth control effectiveness.

If you develop pain in the eyes, blurred vision or loss of vision, contact your healthcare provider.

If you develop stomach pain, nausea or vomiting along with yellowing of the skin or eyes, contact your healthcare provider immediately.

if you develop fatigue, heartbeat changes, fast breathing, loss of appetite or loss of consciousness, contact your healthcare provider immediately. These are signs of metabolic acidosis.

Monitor yourself for mood changes or development of depression or suicidal thoughts while taking this medication. Report effects like these to your healthcare provider right away.

Women who become pregnant can enroll in the North American Antiepileptic Drug Pregnancy Registry by calling 1 888 233 2334. This agency collects information regarding the use of this medication during pregnancy.

Be sure that your prescribing doctor is aware if you have any of the the following conditions before taking this medication

Blood conditions, history of allergic reactions, liver disease, diarrhea, glaucoma, kidney disease, kidney stones, low blood cell counts, lung diseases such as asthma, COPD, or emphysema, metabolic acidosis, if you are on a ketogenic diet, if you are scheduled for any surgeries or procedures in the near future, depression, suicidal thoughts or actions, pregnancy, trying to become pregnant, breastfeeding.

Side effects that should be immediately reported to your healthcare provider

Allergic reactions(hives, itching, rashes, swelling of the face or mouth), trouble breathing, an increase in body temperature, decreased sweating, depression, trouble speaking, changes in breathing patterns, trouble walking or controlling muscle movements, loss of hearing, tingling, pain or numbness in the hands or feet, unusual bruising or bleeding, excessive fatigue, mood changes, depression, suicidal thoughts or actions.

Other Side Effects

Altered taste, back pain, joint pain, muscle pain, diarrhea, constipation, headache, tremors, upset stomach, indigestion, nausea, appetite loss.

Adult Dose

Migraine Prophylaxis

The usual starting dose is 25 mg once in the evening for a week, then twice daily for the following week, then 25 mg in the morning and 50mg  in the evening for the following week, and finally 50 mg by mouth twice daily.

Initial Monotherapy for Partial Seizures

Topamax®:

Week one: 25 mg’s by mouth twice daily.

Week two: 50 mg’s by mouth twice daily.

Week three: 75 mg’s by mouth twice daily.

Week four: 100 mg by mouth twice daily.

Week five: 150 mg by mouth twice daily.

Week six: 200 mg by mouth twice daily

Qudexy™XR and Trokendi XR:

Week one: 50 mg by mouth once daily.

Week two: 100 mg by mouth once daily.

Week three: 150 mg by mouth once daily.

Week four: 200 mg by mouth once daily.

Week five: 300 mg by mouth once daily.

Week six: 400 mg by mouth once daily.

Adjunct Therapy for Partial Seizures

Topamax ®: Between 25 and 50 mg by mouth per day as a starting dose. The dose can then be increased by 25 - 50 mg at intervals of no less than 1 week. The typical maintenance dose is between 200-400 mg per day in 2 divided doses.

Qudexy (™)XR, Trokendi (™)XR: Between 25 and 50 mg by mouth per day as a starting dose. The dose can then be increased by 25 - 50 mg at intervals of no less than 1 week. The typical maintenance dose is between 200-400 mg per day in 2 divided doses.

Tonic Clonic Seizures Initial Monotherapy

Topamax®:

Week One: 25 mg by mouth twice daily(morning and nighttime).

Week Two: 50 mg by mouth twice daily(morning and nighttime).

Week Three: 75 mg by mouth twice daily(morning and nighttime).

Week Four: 100 mg by mouth twice daily(morning and nighttime).

Week Five: 150 mg by mouth twice daily(morning and nighttime).

Week Six: 200 mg by mouth twice daily(morning and nighttime).

Max Dose: 200 mg by mouth twice daily.

Qudexy(™)XR/Trokendi XR(™):

Week One: 50 mg by mouth once daily.

Week Two: 100 mg by mouth once daily.

Week Three: 150 mg by mouth once daily.

Week Four: 200 mg by mouth once daily.

Week Five: 300 mg by mouth once daily.

Week Six: 400 mg by mouth once daily.

Tonic Clonic Seizures Adjunct

Topamax®: Between 25 and 50 mg per day as a starting dose. The dose may then be increased by 25-50 mg at intervals of no less than one week. The usual maintenance dose is 400 mg per day given in 2 divided doses.

Qudexy (™)XR, TrokendiXR(™): Between 25 and 50 mg by mouth once per day. The dose may then be increased by 25 - 50 mg at intervals of no less than one week. The usual maintenance dose is 400 mg per day given in 2 divided doses.

Sources

1. Topamax (topiramate) [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2014.

2. Topamax ® oral tablets capsules, topiramate oral tablets capsules[package insert]. Titusville, NJ: Janssen Pharmaceuticals(Per FDA); 2011.

3. Qudexy (TM) XR oral extended-release capsules, topiramate oral extended-release capsules[package insert]. Maple Grove, MN: Upsher-Smith Laboratories; 2014.

4. Trokendi XR(TM) oral extended-release capsules, topiramate oral extended-release capsules[package insert]. Rockville, MD: Supernus Pharmaceuticals; 2013.

5. Topamax (topiramate) [package insert]. Titusville, NJ: Janssen Pharmaceuticals Inc; 2014.

6. Trokendi XR (topiramate) [package insert]. Rockville, MD: Supernus Pharmaceuticals; 2015.