How to use it
Take topiramate as instructed by a qualified health care provider. Topiramate comes in various dosages and forms: tablets, extended-release capsules, sprinkle capsules, extended-release sprinkle capsules. It is also available in liquid form. To help prevent kidney stones, your provider may recommend that you take each dose with a full glass of water (with or without food).
Dosing
Your health care provider will customize dosing based on various factors, including your weight and how well you tolerate the medication. For most patients, topiramate is initially taken in low doses—typically 25 mg to begin with to see how well your body tolerates it. Your provider may then bump up the dose to 50 mg daily. The doses are taken twice daily, morning and evening, and are typically increased weekly to a recommended maintenance dose of 100 mg daily. (Note: Your provider will determine the dose that’s appropriate for your needs.)
Side effects
Before using topiramate, tell your health care provider about your medical history, especially if you have glaucoma or eye problems, kidney problems (such as kidney stones), liver problems, depression or thoughts of suicide, lung or breathing problems, metabolic acidosis, high blood ammonia levels, long-term diarrhea, low body temperature, a diet high in fat and low in carbohydrates (like a ketogenic diet), or soft or brittle bones.
The FDA cautions that during clinical trials, some patients had decreased sweating and their base temperature increased. To avoid dehydration, drink plenty of water. If you feel warmer than usual, tell your doctor right away.
The FDA also warns that topiramate may cause birth defects, like cleft lip and cleft palate. Do not take this medication if you’re pregnant, breastfeeding, or planning to become pregnant.
Topiramate may reduce the effectiveness of estrogen-containing contraceptives. So, take extra precautions with birth control methods while using this medication and for a month after discontinuing it. Using two methods of birth control, including a non-hormonal method (such as condoms paired with a progestin-only birth control) while using this medication is recommended.
Steer clear of ketogenic or any other high-fat, low-carbohydrate diets while using this medication. Taking topiramate can cause metabolic acidosis—too much acid in the body—and a keto diet can cause ketoacidosis, leading to even more acid. An excess of acid can cause kidney stones, kidney disease, or even kidney failure.
Do not stop taking topiramate without talking to your doctor. If you suddenly stop taking topiramate, you may have severe seizures, even if you have not had seizures in the past.
Black Box Warning
Precautions
Before using topiramate, tell your health care provider about your medical history, especially if you have glaucoma or eye problems, kidney problems (such as kidney stones), liver problems, depression or thoughts of suicide, lung or breathing problems, metabolic acidosis, high blood ammonia levels, long-term diarrhea, low body temperature, a diet high in fat and low in carbohydrates (like a ketogenic diet), or soft or brittle bones.
The FDA cautions that during clinical trials, some patients had decreased sweating and their base temperature increased. To avoid dehydration, drink plenty of water. If you feel warmer than usual, tell your doctor right away.
The FDA also warns that topiramate may cause birth defects, like cleft lip and cleft palate. Do not take this medication if you’re pregnant, breastfeeding, or planning to become pregnant.
Topiramate may reduce the effectiveness of estrogen-containing contraceptives. So, take extra precautions with birth control methods while using this medication and for a month after discontinuing it. Using two methods of birth control, including a non-hormonal method (such as condoms paired with a progestin-only birth control) while using this medication is recommended.
Steer clear of ketogenic or any other high-fat, low-carbohydrate diets while using this medication. Taking topiramate can cause metabolic acidosis—too much acid in the body—and a keto diet can cause ketoacidosis, leading to even more acid. An excess of acid can cause kidney stones, kidney disease, or even kidney failure.
Do not stop taking topiramate without talking to your doctor. If you suddenly stop taking topiramate, you may have severe seizures, even if you have not had seizures in the past.
Interactions
Some drugs can interact with topiramate, including:
- Antiepileptic drugs
- CNS depressants
- Oral contraceptives
- Lithium and other carbonic anhydrase inhibitors
- Hydrochlorothiazide
- Pioglitazone
- Amitriptyline
- Marijuana
Avoid drinking alcohol and taking illegal drugs while taking topiramate.
If you take diabetes medications, discuss with your prescribing clinician before taking topiramate since your diabetes medications may need to be adjusted as you lose weight.
Do not drive, operate heavy machinery, or perform any hazardous task until you know the effects of this medication.
