Topamax Topiramate

Topamax is approved by the FDA for reducing the frequency of migraine headaches and preventing epileptic seizures.

What is Topamax?

Approved by the FDA to treat epilepsy in 1996, Topamax is a medication used to treat seizures (also known as an anticonvulsant). It is used to treat certain types of seizures (partial onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut Syndrome) in adults and children over 2 years old.

The FDA later approved Topamax in 2004 for the use of preventing migraine headaches in adults and adolescents 12 years and older.

Topamax is available in pill form in six doses: 25mg, 50mg, 100mg and 200mg, and two gelatin capsules in 15mg and 25mg doses.

How does Topamax work?

For seizures (epilepsy)

Normally, brain cells fire at a certain rate to function optimally. During a seizure, brain cells fire much more rapidly. Topamax is designed to prevent brain cells from working rapidly, thus stopping seizures as they begin.

For migraine headaches

During a migraine, nerve cells become overexcitable and send pain signals. In the treatment of migraines, Topamax is believed to calm the the over-firing nerve cells to reduce the occurrence of migraines.

When treating either condition, it may take several weeks for the medication to build up its effectiveness.

Off-label usage

Even though Topamax is not approved to treat other conditions, physicians can legally prescribe the medication for other uses. In some instances, Topamax has been prescribed by doctors for promoting weight loss (it is thought to affect the urge to binge and purge), bipolar disorder, methamphetamine use disorder, cocaine use disorder, alcohol use disorder, post-traumatic stress disorder, obsessive compulsive disorder, and borderline personality disorder.


Topamax Has Many Serious Side Effects, Including Permanent Vision Loss

Serious side effects have been indicated with Topamax (specifically its active ingredient, Topiramate) and the FDA has ordered that drug labels and guides contain up-to-date warnings and precautions about its use.

Are there complications?

Topamax contains the active ingredient Topiramate, which is also the main ingredient in weight loss drug Qsymia (formally called Qnexa). Qnexa was rejected by the FDA due to adverse side effects, including increased heart rate, suicidal thoughts, mood and sleep disorders, cognitive impairment, and potential seizures.

Common Side Effects

  • Loss of appetite
  • Change to taste
  • Anorexia
  • Weight loss
  • Fatigue
  • Nausea
  • Abdominal pain
  • Dizziness
  • Fever
  • Memory problems
  • Upper respiratory tract infections
  • Speech problems
  • Abnormal vision
  • Numbness
  • Burning/prickling in extremities
  • Reduced effectiveness of birth control pill

Serious Side Effects

  • Increased levels of acid in the blood
  • Decreased sweating
  • Increased body temperature
  • Serious eye disorders
  • Permanent vision loss
  • Increased risk of suicidal thoughts and behavior
  • Cognitive impairment affecting the ability to operate machinery
  • Kidney stones
  • Risk of cleft lip and or palate in newborns
  • Risk of low birth weight in newborns

Who is at Risk?

A Child With Epilepsy Who Is Being Treated With Topamax

Risks vary depending on the patient and on any other medications they are taking that are metabolized by the liver. Pregnant women in particular are at risk, as the drug has been linked to birth defects. Any reactions should be discussed with a physician.

Drug reactions?

Topamax is known to be metabolized more quickly if taken with other seizure medications, such as carbamazepine, phenobarbital, primidone, or phenytoin. Taking Topamax with valproic acid is also contraindicated due to risk of hypothermia. Topamax also affects the efficacy of birth control pills. It is also advised to avoid taking sedatives and tranquilizers, or drinking alcohol, when taking Topamax.

Sources & Author

Last Edited: March 26, 2018