Topamax (topiramate) was first licensed by the FDA as a seizure drug (also known as an anticonvulsant). Topiramate is a drug that is used to treat seizures in adults and children over the age of two.
Topamax is also used to treat migraine headaches in adults and adolescents aged 12 and up. This medication will only help you avoid migraine headaches or lessen the number of times you have them. It won’t help with a headache that has already started.
Indications of Topamax
There are both approved and off-label uses for Topamax. The medicine has been approved by the Food and Drug Administration (FDA) in the United States for the following uses:
• Preventing migraines in adults and adolescents aged 12 and up
• Treatment for partial-onset seizures in adults and children aged two and up
• Adults and children aged two and up receiving primary generalized tonic-clonic seizure treatment
• To treat partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome, Topamax can be used in combination with other medications (a severe form of childhood epilepsy).
Topamax is sometimes recommended for the following conditions that aren’t listed on the label:
- • Addiction to alcohol
- • Bipolar illness
- • Personality disorder with a borderline personality (BPD)
- • Depression
- • PTSD (post-traumatic stress disorder) is a condition in which a person (PTSD)
- • Tourette’s disease
- • Loss of weight (specifically to control binge-eating and purging)
Topamax for weight loss
Topamax is also used to help with binge eating and purging, as well as weight loss. This is not, however, an FDA-approved use. Despite the fact that it is prohibited for drug companies to advertise medications for off-label applications, doctors are free to prescribe any drug they see fit to address a patient’s condition.
Along with phentermine, topiramate, the active ingredient in Topamax, is a key component of the weight-loss medicine Qsymia. Qsymia was approved by the FDA in 2012. The FDA had previously rejected the identical medicine, then known as Qnexa, due to the combo product’s poor side effect profile (e.g. birth defects and possible heart problems).
According to the FDA label, Qsymia can cause mood and sleep disturbances, as well as cognitive impairment and an elevated heart rate. It may also cause suicidal thoughts, and patients who quit taking it quickly may experience convulsions.
Topamax side effects
Tiredness, drowsiness, dizziness, loss of coordination, tingling hands/feet, loss of appetite, unpleasant taste in the mouth, diarrhea, and weight loss are all possible side effects. Confusion, slower thinking, difficulty concentrating or paying attention, anxiousness, memory problems, or speech/language problems are all possible side effects. Tell your doctor or pharmacist right away if any of these side effects persist or worsen.
Remember that your doctor provided this medication because he or she believes the benefit to you outweighs the risk of adverse effects. The majority of people who take this medicine do not have any substantial adverse effects.
If you experience any serious side effects, such as severe back/side/abdominal/groin pain, fever, chills, painful/frequent urination, bloody/pink urine, rapid breathing, fast/slow/irregular heartbeat, bone pain, broken bones, loss of consciousness, or unusual bleeding/bruising, contact your doctor right away.
Anticonvulsants may cause depression, suicidal thoughts/attempts, or other mental/mood disorders in a small percentage of people who take them for whatever reason (seizures, bipolar illness, pain, etc.). If you or a family member/caregiver detect any unusual/sudden changes in your mood, thoughts, or behavior, such as indicators of depression, suicidal thoughts/attempts, or ideas about injuring yourself, contact your doctor straight once.
Topiramate can cause a major eye condition in some people, usually within one month of commencing treatment. This eye condition, if left untreated, might result in permanent blindness. If any of the following side effects occur, get medical attention right away: Eye pain/redness, sudden vision changes (such as diminished eyesight, blurred vision).
This medicine, especially if combined with valproic acid, might induce a significant metabolic issue (excess ammonia in the blood). If you develop sudden/unexplained exhaustion, vomiting, or mental changes, call your doctor straight once (such as decreased alertness).
This medicine seldom causes a severe allergic reaction. However, if you detect any symptoms of a major allergic response, such as a rash, itching/swelling (particularly of the face/tongue/throat), extreme dizziness, or problems breathing, seek medical treatment right once.
Interaction with other medicines
There are numerous drug-drug interactions with topiramate. The following are a few of the most common:
• Because topiramate inhibits carbonic anhydrase, it raises the risk of kidney stones when combined with other carbonic anhydrase inhibitors (e.g. acetazolamide).
• Enzyme inducers (e.g., carbamazepine) might enhance topiramate elimination, necessitating topiramate dose escalation.
• Topiramate may raise phenytoin levels in the blood.
• Topiramate is a mild inhibitor of CYP2C19 and induces CYP3A4; topiramate therapy has been associated with lower levels of estrogens and digoxin in the blood. Oral contraceptives (birth control tablets) may lose their effectiveness as a result; alternate birth control techniques should be used instead. Topiramate has no effect on intrauterine devices (IUDs) or Depo-Provera.
• Alcohol can cause sleepiness or sedation, as well as increasing the chance of a seizure.
• Because topiramate can cause acidosis, other treatments that cause it may exacerbate the problem.
• Oligohidrosis and hyperthermia have been documented in topiramate post-marketing studies; antimuscarinic medications (such as trospium) can exacerbate these conditions.
Precautions
Before you start taking Topamax, talk to your doctor about your medical history. If you have certain medical disorders or other variables that affect your health, this medicine may not be the best treatment for you. The following are some of the conditions and factors to consider:
Osteoporosis is a type of bone disease. Metabolic acidosis is a rare side effect of Topamax (too much acid in your blood). This illness, if left untreated, can develop to bone disorders such as osteoporosis (weakened bones). If you currently have bone abnormalities, metabolic acidosis may increase your risk of bone complications. Your doctor can help you figure out if taking Topamax is safe for you.
Problems with breathing or the lungs. If you use Topamax and have breathing or lung issues, you may be more susceptible to metabolic acidosis. Chronic obstructive pulmonary disease (COPD) is one of these issues (COPD). Your doctor can help you figure out if taking Topamax is safe for you.
Suicidal ideation or depression. Topamax has been linked to an increased incidence of depression and suicidal ideation or action. If you already have depression or suicide thoughts, you may be at a higher risk. Your doctor can help you figure out if taking Topamax is safe for you.
Glaucoma. Treatment with Topamax can produce secondary closed-angle glaucoma, which is an unusual side effect. Topamax may not be safe to take if you have glaucoma. Your doctor can help you figure out if taking Topamax is safe for you.
Diarrhea. If you have diarrhea while taking Topamax, you run the risk of developing metabolic acidosis. If you suffer frequent or uncontrollable diarrhea while taking Topamax, tell your doctor. Blood tests may be required to ensure that the level of acid in your blood is safe.
Problems with the liver. If you have liver disorders, such as cirrhosis or hepatitis, using Topamax may raise your risk of elevated blood ammonia levels. While using Topamax, you may require additional blood tests to monitor your levels. If you have liver problems, your doctor can help you assess whether Topamax treatment is safe for you.
The ketogenic diet is a high-fat, low-carbohydrate A ketogenic (“keto”) diet can cause your blood acid levels to rise. A potential negative effect of taking Topamax is an increase in blood acidity. As a result, maintaining a ketogenic diet while on Topamax is usually not advised. Consult your doctor about the best diet and treatment options for your problem, as well as whether Topamax is appropriate for you.
Problems with the kidneys. If not treated, Topamax can produce metabolic acidosis, which can lead to kidney stones. If you have a kidney condition, such as chronic renal disease, you’re more likely to develop metabolic acidosis and kidney stones. If you have renal difficulties, your doctor can help you assess whether Topamax therapy is safe for you. If they do prescribe Topamax, they might start you on a lower dose than usual.
An allergic reaction has occurred. If you’ve ever had an adverse reaction to Topamax or any of its constituents, you shouldn’t use it. Consult your doctor to see if there are any other treatments that may be a better fit for you.
