Topiramate weight loss: Sustainable weight loss with this prescription drug

If you’re thinking about medicine for weight loss, one option you may not have heard about is an anti-seizure drug. Topiramate, or the brand name medication Topamax^®, also helps people lose weight—and the generic topiramate is also affordable compared to other popular medications used for weight loss.

How does topiramate weight loss work—and how do you know it’s right for you? Found offers access to treatment for weight, including consultations with a clinician trained in obesity medicine who can personalize a prescription for you. Here’s what you need to know as you consider your options for weight management. ‍
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What is topiramate? 

Topiramate is an anticonvulsant medication to treat certain seizures, epilepsy, and migraines. Ongoing research is also being done on its efficacy in treating alcoholism, post-traumatic stress disorder (PTSD), and binge-eating disorder. The drug was first synthesized in 1979 and received U.S. Food and Drug Administration (FDA) approval in 1996 as an antiepileptic drug.

As more patients started taking topiramate, the medical community began noticing weight loss as a side effect of topiramate. In 2012, after years of clinical trials, the FDA approved Qsymia®—a controlled-release combo of phentermine/topiramate—for weight management. Phentermine (another medication you may be familiar with) helps activate the sympathetic nervous system and suppress appetite. Combined with topiramate, the duo may also increase energy expenditure (the number of calories your body burns). 

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How does topiramate help weight loss? 

Medical science doesn’t yet fully understand the exact mechanism by which topiramate helps weight loss. Researchers believe topiramate is a glutamate inhibitor— glutamate is a neurotransmitter that increases appetite. It also enhances dopamine release, which can act as an appetite suppressant and decrease food cravings. 

Health care providers can prescribe topiramate for weight loss off-label. A paper on the first clinical trial for the use of the drug for obesity, published in 2003, found topiramate produced significant weight loss in participants. Among 385 healthy people with obesity, those on topiramate lost an average of 6.3% of their body weight over 24 weeks, compared to a placebo group that dropped only 2.6%. 

Perhaps even more intriguing, those in the placebo-controlled trials taking topiramate didn’t plateau during the study, suggesting the weight management benefits would continue (though it may mean taking the medication for an extended period of time to get the maximum results). 

A review of other studies found that topiramate appears to be more likely to cause weight loss among people with a high body mass index (BMI). However, its impact on weight change may not be directly related to its dosage, so higher doses aren’t necessarily more effective. 

Because topiramate works differently for different people, it’s really important to work closely with your health care provider to choose the best medication for you—whether it’s topiramate, combination topiramate/phentermine, or a different weight loss medication entirely.

Your Found-affiliated health care provider will use your personal MetabolicPrint^TM, Found’s proprietary assessment, along with your medical and weight history, to determine what type of medications will be most effective in weight reduction for your biology. Prescriptions are written at a medical provider’s discretion. 

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Topiramate weight loss: possible side effects

With any medication you take, side effects are possible. Although rare, there are potentially serious side effects when taking topiramate for weight loss. Contact your health care provider immediately if you experience any of the following: 

• Blurred vision
• Burning, prickling, or tingling sensations
• Dizziness
• Drowsiness
• Dry mouth
• Eye redness or pain
• Generalized slowing of mental and physical activity
• Increased eye pressure
• Memory problems
• Menstrual changes or pain
• Nervousness
• Kidney stones
• Speech or language problems
• Trouble concentrating or paying attention
• Unusual tiredness or weakness
  
  

Topiramate may also become habit-forming, so be sure to follow your provider’s instructions—never take higher doses or take it more often than prescribed.

Also, if you take topiramate and decide you want to stop, be sure to ask your provider for instructions. You shouldn’t suddenly stop taking this medication—your provider will help you gradually wean off the medication.

For more severe and other common side effects and risk information, visit our dedicated topiramate page. 

Topiramate weight loss: What to avoid 

After reading the side effects, you may wonder, is this drug right for me? Your Found health care provider can cover the side effects of using topiramate for weight loss in depth. They’ll also share what other medications and supplements you shouldn't take when on topiramate. In addition, here are some lifestyle guidelines to keep in mind: 

• Stay hydrated. The FDA cautions that in some cases during clinical trials, patients didn’t sweat normally, and their base temperature increased. Drink plenty of water if you take topiramate. Also, if you feel warmer than usual, tell your doctor right away.
  
  
• Steer clear of ketogenic diets (keto). A keto plan is high in fat and low in carbohydrates. Taking topiramate can cause metabolic acidosis–a buildup of acid in the body–while a keto diet can cause ketoacidosis, leading to even more acid. Too much acid can cause kidney stones, kidney disease, or even kidney failure. Taking topiramate while following a keto diet might compound the problem and increase the risk of acid overload.
  
  
• Reduce salt intake. The National Institute of Diabetes and Digestive and Kidney Diseases warns that sodium can increase the risk of developing kidney stones. (Check out the keto info above.) So, watch how much salt you’re getting in your diet to avoid increasing your risk of kidney stones. The Dietary Guidelines for Americans recommends less than 2,300 mg of salt daily—about one teaspoon each day.
  
  
• Watch out for certain birth control pills. A small study of twelve women, published in 1997 in the journal of the International League Against Epilepsy, Epilepsia, looked at the efficacy of oral contraceptives among women taking topiramate. Researchers found that while the birth control pill was still just as effective, they did see some breakthrough bleeding between periods. However, more recent studies suggest that topiramate may reduce the effectiveness of estrogen-containing contraceptives. You may want to talk to your provider about using progestin-only birth control.
  
  
• Don’t plan to get pregnant. Similarly, if you’re pregnant or planning on becoming pregnant, in 2011, the FDA issued a warning that data showed an increased risk of cleft lip or palate with women treated with topiramate during pregnancy. 

Again, be sure to tell your health care provider your medical history and any medication or supplements you’re on for guidance on what not to take with topiramate.

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Topiramate dosage for weight loss

Studies indicate you can take topiramate in low doses—typically 25 mg—to begin with to see how well your body tolerates it. Over time, your provider may increase it to 50 mg daily. Patients take doses evenly spaced, twice a day; providers typically increase dosages weekly.

People may lose weight on lower doses of topiramate in combination with lifestyle changes. A study in the International Journal of Obesity found that 60 weeks of treatment led to an average of more than 9% loss in body weight for those taking 192 mg of topiramate daily. 

Researchers concluded that lower doses of topiramate for weight loss may have beneficial results over a more extended period of time. This study looked at topiramate taken alone, finding people can lose weight on lower doses and in combination with behavior change. The effective dose varies from person to person. 

Topiramate is also available in an extended-release capsule called topiramate XR. It comes in the same daily dose as the original medication but you only need to take it once a day. So if life gets busy, it may be easier for you to remember to take that one dose daily instead of two times a day for topiramate weight loss.

Topiramate weight loss: What’s the verdict?

As effective as topiramate can be for weight loss, it may not be the right weight loss medication for you. Many factors cause or contribute to obesity—including genetics and hormones—and each person’s biology is different. So, no single medication is a one-size-fits-all treatment for chronic weight management. 

Now, with advances in medical research and the growing list of drugs available to treat excess weight and obesity, treatment can and should be personalized. That’s how Found approaches weight loss. A MetabolicPrint assessment and a consultation with a Found-affiliated health care provider can help you discover what your body needs to lose weight. If topiramate isn’t the right medication for you, your Found provider can recommend another prescription. Found also offers health coaching, a supportive community, and an in-app lifestyle change program to help you reach your goals.

To start your journey with Found, take our quiz.
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About Found

To discover your MetabolicPrint and start your journey with Found, take our quiz. Found is among the largest medically supported weight care clinics in the country, having served more than 250,000 members to date.

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