side effects, dosage, how to take & discontinue, uses, pros & cons, and more

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Topamax Article Index | Brand and Generic Availability

Brand & Generic Names; Drug Class

US brand name: Topamax
Generic name: topiramate
Drug Class: AntiepilepticDrugs/Anticonvulsants
Learn More about Topamax’s Generic & Worldwide Availability

Topamax’s Approved & Off-Label Uses (Indications)

US FDA Approved Treatment(s)

Epilepsy - by itself or with other meds, for adults & children. Migraines. Qsymia is topiramate combined with phentermine, and is approved to treat obesity.

Popular Off-Label Uses

Bipolar disorder (works best as an add-on). Eating disorders - especially sleep eating. Alcoholism. PTSD. Used by itself for weight loss - especially for weight gain caused by other crazy meds.

Learn More about Topamax’s Approved & Off-label Uses

How Long Until Topamax Starts Working (Onset of Action)

For migraines: anywhere from one day (don’t get your hopes up, but it happens) to a month.

For epilepsy: it’s complicated.

Likelihood of Working

For migraines: Really good, which is probably why OrthoMcNeil P-Diddy Janssen are all about Topamax for migraines these days.
For epilepsy: pretty good.

Learn how Topamax Compares with Other Drugs

How to Take Topamax

Manufacturer’s Recommendations

Here are OrthoMcNeil MS-Passport’s recommendations for Topamax’s most popular uses

For adults with migraines: Migraine (2.2) 25 mg/day administered nightly for the first week. The dosage should be increased weekly by increments of 25 mg. Dose and titration should be guided by clinical outcome. Recommended Dose: 100 mg / day administered in two divided doses. the Topamax Full US Prescribing Information

In English:

  • Start with one 25 mg tablet or capsule a night.
  • If you need more after the first week (and you probably will), take one 25 mg tablet or capsule in the morning along with the one at night.
  • Wait another week. Increase by another 25 mg, but only if you need to. Morning or night is up to you.
  • Wait one more week before increasing that final 25 mg - again, only if you need it - so you’re taking 50 mg in the morning and 50 at night.
  • After another week or two talk to your doctor about how well Topamax is working at whatever dosage you’re taking.

Monotherapy for adults and pediatric patients ≥10 years with epilepsy: 50 mg/day in two divided doses. The dosage should be increased weekly by increments of 50 mg for the first 4 weeks then 100 mg for weeks 5 to 6. Recommended Dose: 400 mg / day in two divided doses. the Topamax Full US Prescribing Information

In English:

  • Week one take one 25 mg tablet or capsule in the morning and one at night.
  • Week two take two 25 mg tablets every morning and night.
  • Week three take three 25 mg tablets every morning and night.
  • Week four take four 25 mg tablets, or one 100 mg tablet every morning and night.
  • Week five take 150 mg every morning and night.
  • Week six take 200 mg every morning and night.

Crazymeds’ Suggestions

For migraines: Now that OMJHF finally decided to agree with me about the correct target dosage being the one where your symptoms stopped, I can’t add anything to the English-language translation of their recommendations.

For epilepsy: Depending on the type and frequency of seizures you have, you may or may not have the luxury of stopping, or at least slowing the titration when your seizures stop. That’s for you and your neurologist to have a what could be a very quick or very long conversation about.

How to Stop Taking Topamax (Discontinue, Withdrawal)

OrthoMcNeil-Janssen Hunger Force Rainbow Neurologics now agrees with us. Per the PI sheet, unless you need to stop taking Topamax due to a severe adverse reaction, you should reduce your dosage by 25–50mg a day every week.

Learn More about Taking and Discontinuing Topamax


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Topamax’s Pros and Cons

Pros

Currently the only modern AED approved by the FDA that you can take by itself to treat both generalized, flopping around tonic-clonic seizures as well as partial seizures. You’re more likely to lose weight than gain weight. Can (but doesn’t always) work for migraines at 25mg a day with barely any side effects after a few weeks. Can (but doesn’t always) work for seizures at 100mg a day.

Cons

The promise of losing weight is oversold and often leads to disappointment. Topamax can make you dumber than a box of rocks.

Interesting Stuff your Doctor Probably didn’t Tell You about Topamax

Topamax may encourage you to stop smoking, in that you may just not like to smoke after you start and withdrawal symptoms won’t be as bad. Topamax can mess with lithium levels in seemingly random ways, and taking it along with Depakote or any other valproate can cause hypothermia (excessively low body temperature) and/or hyperammonemia (elevated ammonia in your blood), so taking Topamax to lose medication-induced weight gain can get tricky.

Best Known for

Turning you into the stereotype of a supermodel: thin and stupid.
In-Depth Pros & Cons

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Topamax’s Potential Side Effects (Adverse Reactions)

Typical Side Effects

Sleepiness , fatigue , and/or lethargy . A pins & needles effect / tingling in the extremities that usually goes away after a week or two - but you want this one if you’re taking Topamax for migraines. Sodas and other carbonated beverages will taste like ass. Memory loss , aphasia (weird words coming out in place of what you meant to say or write) , word find problems (not being able to recall the names of people, things or concepts), and a general cognitive impairment that has earned this drug the nicknames “Stupamax” and “Dopamax.”

Uncommon Side Effects

Dry and/or itchy eyes along with assorted vision problems. You may find yourself having panic attacks when you drink coffee , so be prepared to quit the bean. Food in general, and not just carbonated beverages, may not taste quite the same . Frequent, intense déjà vu or jamais vu. If you were experiencing one prior to taking Topamax be prepared to experience the other.

Freaky Rare Side Effects

Tongue paralysis, neverending cough, staghorn calculus (I’d like to know how you do calculus using antlers), and palinopsia and the Alice in Wonderland syndrome. So Topamax explains Sarah Palin?
Learn More about Topamax’s Side Effects.
TMI at times

What You Really Need to be Careful About

Glaucoma, not sweating, kidney stones.

Topamax’s Black Box and Other Warnings, Pregnancy Category, etc.


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Pharmacology

topiramate’s Half-Life & How Long Until It Clears Your System

Plasma half-life: Half-life: 21 hours. Clearance: four to five days.
topiramate’s Pharmacokinetics Information Overload

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on topiramate’s pharmacokinetics page.

How topiramate Works

the current best guess at any rate
Topamax is a fairly broad-spectrum anticonvulsant. It prevents migraines and various types of seizures by blocking voltage-dependent sodium and calcium channels, inhibiting glutamate and carbonic anhydrase, and promoting the reception of GABA and/or increasing the amount of GABA, depending on the location in your brain and the study you read. Topamax may also affect voltage-sensitive sodium channels.

Learn More than You Probably Ever Wanted to Know about How topiramate Works
AKA mechanism/method of action, pharmacodynamics


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Ratings, Reviews, Comments, PI Sheet, and More

Topamax Comments

Whichever nickname you use, Dopamax, Stupamax, or a supermodel drug, when it works Topamax is a freaking Godsend. I’m more than happy to put up with the frequent renal calculus (doctorese for the sediment in my piss that is more “kidney sand” and “kidney pebbles” than kidney stones), the hosed memory, the increased problems in getting the right words out of my mouth, and random periods of coffee = panic attacks so I don’t have to worry about having some kind of seizure activity a couple times a week or go through the hell that is ultradian rapid cycling.

With one of the simplest titration schedules and approval to be used as monotherapy (by itself) to treat generalized, flopping on the ground & pissing your pants seizures, Topamax will often be prescribed before Depakote or Stavzor - the newest flavor of valproic acid - even if the side effects for lower dosages of valproates often suck less than the side effects of Topamax at dosages required to treat some of those forms of epilepsy. Topamax side effects might suck more, but it is easier to take, so it’s a hard call as to which really sucks less.

Topamax (topiramate) has long been


Extended Comments
As if I didn’t go on long enough already.

Rate Topamax

Give your overall impression of Topamax on a scale of 0 to 5. Detailed ratings and reviews are available on the Topamax Ratings & Reviews Page.

Get all critical about Topamax

3.5 stars Rating 3.2 out of 5 from 143 criticisms.
Vote Distribution: 21 – 6 – 20 – 15 – 33 – 48


Rate this article

If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Topamax (topiramate) Overview

4 stars Rates 3.9 out of 5 from 88 value judgments.
Vote Distribution: 7 – 4 – 1 – 6 – 32 – 38


Topamax Consumer Reviews, Comments & Experiences

Discussion board

Consumer experiences with and questions about Topamax on Crazymeds Topamax discussion board. Sign up for a free account to post your own.

More Allegedly Useful Links. Mostly official sites, PI sheet-equivalents4 from countries other than the US, and consumer/patient review sites.

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.



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References

  1. Topamax’s Full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) 3rd edition Stephen M. Stahl
  4. Antiepileptic Drugs René H. Levy, Richard H. Mattson, Brian S. Meldrum, Emilio Perucca, et al.
  5. Clinical Handbook of Psychotropic Drugs 18th edition Adil S. Virani, K. Bezchlibnyk-Butler, J. Jeffries
  6. A Primer of Drug Action: A Comprehensive Guide to the Actions, Uses, and Side Effects of Psychoactive Drugs Robert M. Julien, Claire D. Advokat, Joseph E. Comaty
  7. The Prescriber’s Guide (Essential Psychopharmacology Series) 3rd edition Stephen M. Stahl
  8. Essential Neuropharmacology: The Prescriber’s Guide Stephen D. Silberstein, Michael J. Marmura
  9. Epilepsy: Patient and Family Guide Orrin Devinsky
  10. PDR: Physicians’ Desk Reference 2010 64th edition
  11. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series)
  12. Clinical Neurology for Psychiatrists 5th edition David Myland Kaufman
  13. Topiramate in the prevention and treatment of migraine: efficacy, safety and patient preference Steffen Naegel and Mark Obermann
  14. Topiramate for Migraine Prevention: A Randomized Controlled Trial
  15. Psychiatric uses of topiramate: What is the current evidence? Pierre M Joubert, MB ChB, FCPsych, MMed (Psych) (SA)
  16. Topiramate in the Treatment of Epilepsy – A Review
  17. Psychopharmacology of topiramate: from epilepsy to bipolar disorder
  18. Open-Label Adjunctive Topiramate in the Treatment of Bipolar Disorders
  19. The Stanley Foundation Bipolar Network 2. Preliminary summary of demographics, course of illness and response to novel treatments
  20. The New Antiepileptic Drugs
  21. “Targets for antiepileptic drugs in the synapse” Cecilie Johannessen Landmark Medical Science Monitor Volume 13, Issue 1, January 2007

Topamax Article Index | Brand and Generic Availability


1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.

2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

4 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.


If you have any questions not answered here, please see the Crazymeds Topamax discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


Last modified on Wednesday, 31 December, 2014 at 17:47:31 by JerodPoorePage Author Date created Tuesday, 11 January 2011 at 13:43:23
“Topamax (topiramate): a Synopsis for the Educated Consumer.” by Jerod Poore is copyright © 2011 Jerod Poore Published online 2011/01/11
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Topamax, and all other drug names on this page and used throughout the site, are a trademark of someone else. Topamax’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2003 - 2015. All rights reserved.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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‘Everything is true, nothing is permitted.’ - Jerod Poore


1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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