Part 1: Indications, efficacy, dosage, titration, discontinuation, pros and cons, adverse events, availability and how supplied.

> Topamax (topiramate) Review


The Topamax (topiramate) Overview is a briefer, more consumer-friendly version of this article. The information in this article comes from twelve separate pages, with more explanatory material, to which the overview links. The title of each section on both pages of this article is also a link to each of those pages.

Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences

Abstract

Consumers need more information than what is provided in the patient information literature, but are intimidated by, or have no desire to read all of, the prescribing information for a drug. This review of the drug Topamax (topiramate) provides what the educated consumer wants, highlighting its use as, and comparing it with other AntiepilepticDrugs. Also discussed are off-label uses, efficacy, adverse events and how to mitigate them, titration and discontinuation schedules, clinical pharmacology, other aspects of using Topamax (topiramate), and consumer experiences.

Classification

Primary Drug Class

Topamax (topiramate) is in the AntiepilepticDrugs/Anticonvulsants class of medications.

Additional Drug Categories

Migraine/NeuropathicPain

Indications

A review of Topamax’s prescribing information, the literature, and consumer experience. Regarding off-label applications: if something is to be considered as “clinically significant” there need to be large, double-blind studies or clinical trials in addition to lots of consumer experiences, otherwise it will still be considered as experimental.

FDA-Approved Indications

Migraine1: Monotherapy (used by itself) for adults to prevent (prophylaxis) migraine headaches.

Epilepsy:

Weight Loss: Topiramate combined with phentermine, sold under the brand name Qsymia2, is approved to treat obesity.

Drugs sometimes have different approvals in different countries.3 Consumers want to know this if they are running out of treatment options; or if they are researching their treatment options they may wish to know if, and why, a medication is approved for something in the US but not anywhere else.

Approved Uses Outside of the US

Clinically Significant or Otherwise Common Off-Label Uses

Less Common/Experimental Off-Label Uses

Failed off-label uses

Potentially dangerous off-label uses



Efficacy & Comparisons with Other AntiepilepticDrugs

A review of prescribing information, the literature and consumer experiences. In addition to review sites, which don’t skew as negative as one would think, consumer experiences with medications are frequently reported on social media sites that have nothing to do with medications or illnesses. There is such a consistent overlap in many demographics (e.g. women with bipolar 2 and/or migraines and scrapbooking) to provide a great deal of data on efficacy and adverse reactions from a very natural environment where consumers discuss their conditions and how to treat them that is free of almost all prejudices regarding medications and other treatment options.

Onset of Action

Migraines

Anywhere from one day (don’t get your hopes up, but it happens) to a month. Three months is the longest wait time given, but unless you’re desperate (i.e. nothing else worked) you shouldn’t wait that long if Topamax has done nothing for you.

Epilepsy

Like most everything with epilepsy it’s complicated. Two weeks to a month is about the soonest most people can hope for, as that is how long it takes to work up to 100mg a day. A lot of it depends on your seizure activity and what sort of titration schedule you and your doctor work out. If you start flopping around like a fish out of water, with no warning, on a daily basis, your doctor will most likely want to start you at 100mg a day and ramp you up to 200–400mg a day as quickly as possible. The side effects will really suck, but suck less than daily seizures. If you have the luxury of a slow titration Topamax is either going to stop, or mostly stop your seizures within four to six weeks, two months at the most, or it’s time to find another drug.

Efficacy for its Approved Indications

Migraines

Really good, as far as these things go, which is probably why Ortho-McNeil is all about Topamax for migraines these days. There are slight variations depending on the type and frequency of migraine involved, but it mostly maps to the results from clinical trials: at least half of the people who take Topamax have the number of days they get migraines cut in half. Actual response rates are higher, in that Topamax will do something positive for 75% of people who take it, but not necessarily enough to justify dealing with the side effects. So it works out to 50–60% of people who take Topamax for migraines can keep taking it for as long as they need to.

Not only that, around 40% of people for whom Topamax works are taking 50mg a day, or even 25mg a day. As side effects are typically dosage-dependent (the more you take, the more likely it is you’ll have a side effect and/or the worse it is, or it hangs around longer) with Topamax, people taking 25–50mg a day aren’t dealing with much in the way of side effects. At 100mg a day Topamax may suck as much as other headache treatments, at 50mg a day Topamax doesn’t suck at all.

If you experience paresthesia (the pins and needles feeling in your extremities), that’s a good sign. It might mean the Topamax is more likely to work than not.

Epilepsy

It’s complicated, of course. Topamax works best if it’s the first med you’ve taken for epilepsy, and you’ve gone to see a doctor as quickly as your insurance and/or circumstances let you. Most doctors, who tend to be rational people, want you to have as few seizures as possible, with as much time between them, until you have none at all. That means working you up to a target dosage of 400mg a day as quickly as possible, which is where more than half the people who take Topamax have the highest rate of seizure reduction. The problem is, a rapid titration means more and more intense side effects, so most people who start taking Topamax aren’t taking it six months later. Fortunately the exception is when treating people who had their very first seizure. 100mg a day seems to do it, and working up from 25mg a day to 100mg a day can be tailored to your circumstances, and not a one-size-fits-all schedule. So for new onset epilepsy, having either partial onset or primary tonic-clonic generalized seizures, you’re in also in coin-toss territory, with around a 50% chance of Topamax reducing your seizure frequency by at least 50%. Like all AEDs Topamax will be better for some types of seizures than others. Topamax does especially well for nocturnal frontal lobe epilepsy. Topamax doesn’t do all that well if you don’t respond to other treatments. If other meds haven’t worked, talk to your doctor about trying Keppra, which has a better success rate for people who have had no luck with lots of other drugs. Topamax can work for people with refractory partial and generalized epilepsy, but it has the same rate of success as most other meds - not very good. Otherwise people wouldn’t be refractory to them. Duh.

As an add-on for Lennox-Gastaut you’re looking at about a one-in-three chance Topamax will help enough for you to notice. For Lennox-Gastaut those are decent numbers.

One good thing about Topamax: if you decide to try something else because the side effects are more than you can deal with, go ahead, as Topamax usually works as well, or at least nearly as well, as it did the first time you took it. With one exception. You won’t lose any weight the second time around. Even if you do, it won’t be as much. Now if weight loss was actually a bug and not a feature, then taking a medication holiday for a couple of months should fix it. Although in my experience those of us who don’t need to lose weight are the ones who usually do.

For Off-Label Applications

Other Forms of Epilepsy / Seizure Disorders

There aren’t a hell of a lot of consistent data on using Topamax for other forms of epilepsy, except for one - West syndrome. Topamax seems to be an effective first-line treatment for West syndrome, which means it meets the criteria of a greater than 50% reduction in spasm frequency for more than 50% of patients. In several of the studies half, or nearly half of the kids were spasm-free.

Bipolar Disorder

Topamax is probably not going to work by itself as a mood stabilizer. As an add-on, this really depends on what form of bipolar disorder you have, and even then the odds aren’t going to be great.
So if your bipolar symptoms can be best described as both:

  • Really rapid cycling. You have at least one mood swing every 24 hours.
  • When not cycling every day, or hour, or five minutes, you’re primarily manic (either euphoric or dysphoric) or mixed.

Or if you can answer yes to either of these:

  • You’re male and your symptoms first appeared as mania in childhood or early adolescence and you get really aggressive or violent during dysphoric manias.
  • You have epilepsy or migraines.

Then Topamax has a one-in-four chance of working for you. At best it’s one-in-three, and that’s if you are both a primarily-manic rapid cycler who is also epileptic, a migraineur, and/or had early-onset bipolar as described above. Otherwise it’s unlikely Topamax will do squat for bipolar disorder. Having another comorbid condition that Topamax successfully treats like binge eating or alcoholism can push the odds in your favor a bit, but if that’s all you have in addition to being bipolar5, Topamax might help somewhat for your bipolar symptoms, but you may still need a third med to get your symptoms completely under control, or something else entirely.

Binge Eating

You’d think giving a med that causes weight loss to someone with an eating disorder is a bad idea, but Topamax is a great med for nocturnal sleep-related eating disorder (NSRED), or sleep eating, which is actually a sleep disorder like sleep walking, and is often misdiagnosed as night eating syndrome (NES), which is an eating disorder. But what does any of that matter to someone who can’t lose weight, can’t keep food in their fridge, and can’t figure out why that is happening? Only in deciding which med to try first. If it’s nocturnal sleep-related eating disorder, Topamax is probably the best med on the market, if you don’t have restless leg syndrome (RLS) that is. NSRED is often part of RLS, so you may need to adjust your RLS meds one way or the other. If what you have is NES, then you’ll probably want to try an SSRI first, and if you fail two of those, Topamax should be the next med. For NSRED Topamax is a first-line med, so you have a better than 50% chance of your symptoms getting at least 50% better. I can’t tell you any more than that because there aren’t enough data for me to nail it down any better. For NES the odds aren’t quite as good, and there aren’t enough data, but they’re probably a little better than one-in-three. Generic binge eating is about the same as NES.

Alcoholism

There are clinical trials recruiting people to use Topamax to treat their alcoholism. Johnson & Johnson might be serious in getting FDA approval for Topamax to treat alcoholism. There isn’t enough money in NSRED to jump through all the hoops for FDA approval, but there’s plenty of money in alcoholism. There aren’t enough data for me to nail it down, but just for them to think about it means you have a better than 50% chance of your symptoms getting at least 50% better.

Smoking Cessation

I could have told them Topamax wouldn’t work that well. It’s all too random. If you take Topamax for epilepsy, migraines, or maybe even an off-label application and you also smoke, see how long you can go without smoking. Don’t try to not smoke, just notice if there’s a difference in how long between smokes (or patches or chews or whatever) you can go before you feel like having more nicotine. Topamax will probably make no difference whatsoever, while some people will find they don’t want to smoke as much. And a few outliers like me, we don’t care one way or the other. The highest report has been from one pack a day to none, with the person essentially forgetting to smoke.

Topamax versus Other AntiepilepticDrugs/Anticonvulsants for Approved Indications

Migraines

  • Low-dosage Topamax vs. Lamictal vs. placebo for migraine prophylaxis. Lamictal? For migraines? Actually Lamictal is used off-label all the time for headaches, proving the adage6 that whatever adverse event (side effect) an AED causes it can also treat, and vice versa. Or the other way around. In any event the results: Topamax wins, probably because Lamictal usually needs a higher dosage and is most effective for migraine with aura.
  • Topamax vs. sodium valproate in chronic migraine. Topamax takes on sodium valproate, the commie Depakote of everywhere outside of North America. The results: a tie. Worked and sucked about the same, and they recommend if you’re on one and it stops working or starts sucking too much, just switch to the other.
  • Topamax vs. sodium valproate - the rematch. A slightly larger and longer-lasting study than the one above. The results: Statistically a tie, but Topamax did a little better. Nothing in the abstract about side effects.
  • Topamax vs. Depakote in the preventive treatment of migraine. How does Topamax stand up to all-American Depakote? Once again, it’s a tie.
  • Topamax vs. Zonegran in migraine prophylaxis. The way Zonegran works is similar to the way Topamax works, although Zonegran does more stuff. The results of this study: Zonegran reduced headache severity “significantly” more than Topamax did (but the numbers aren’t in the abstract). Other than that, there was no difference.
  • Topamax vs. Botox for chronic migraine prophylaxis. This is a tough call on how you want to look better: thinner or fewer wrinkles? It’s funny because I’ve had three migraines my entire life, and I’ll bet none of them came close to sucking as much as any of yours. In any event, it’s also a tough call on deciding which med is better. Topamax worked a lot better, but three times as many people stopped taking it than the Botox (7 vs. 2 in this huge study of 60). Ultimately Topamax wins, because more people stopped taking Botox than Topamax because their med didn’t work, and Topamax worked better.
  • Topamax vs. Botox - the rematch. Like the study above, this one was small, but didn’t last as long. Unlike the one above, I’ve got the full text. The results: a tie. What’s striking in this study is Botox sucked more. While statistically a tie, at the end of the 12 weeks more people taking Botox had “major” side effects, including cognitive effects. Every now and then you get an anomalous outcome.
  • Topamax vs. propranolol in migraine prophylaxis. The results: I didn’t know propranolol was that effective in preventing migraines in the first place. Topamax kicked its ass, but still, if you can’t deal with the side effects of other meds, there’s always propranolol.
  • Topamax vs. flunarizine in migraine prophylaxis. Flunarizine is a calcium channel blocker that is currently unavailable in the US. The results: They worked about the same, and Topamax sucked more.
  • Topamax vs. propranolol vs. flunarizine in migraine prophylaxis. This is Dr. Sagar Singhal’s dissertation for his degree in pharmacology, so it’s over 100 pages long. It also contains an incredible amount of information about migraines and migraine treatments. If every study were written like this, I’d still complain for one stupid reason or another, mainly about how no one needs to read Crazymeds because the studies and trials make more sense. In any event, the winner is: flunarizine! Suck it, America. Topamax came in second and propranolol third. Topamax had more, and more severe side effects except, of course, people lost weight instead of gaining a few kilos. And that might be the reason why more people rated Topamax as an “excellent” drug than flunarizine, even though flunarizine was superior.
  • Topamax vs. Lyrica in the prophylaxis of chronic daily headache with analgesic overuse. The idea of taking a drug to the prevent headaches that occur because you take too many painkillers gives me a headache. There is something inherently wrong with that equation, but really I don’t know what it is. In any event, the results: a tie. This is one of the few studies I’ve read where the numbers really are close to identical. There’s nothing in the abstract about side effects, but it’s a given as to which drug sucked more.
  • Topiramate versus amitriptyline for prevention of episodic migraines. I’m surprised I can’t find more Topamax vs. TCA studies. The results of this one: a tie. They worked about the same, and they sucked about the same, albeit in different ways. The people taking the meds preferred Topamax for quality of life reasons, and you probably know why.
  • Topamax vs. subcutaneous histamine. Histamine desensitization is an experimental therapy when it comes to migraines, or anything else for that matter. How does it stack up against Topamax? Damned if I can tell from this abstract. They both worked, but it’s not really clear how well each med did, or how they compared with each other. I infer from that the histamine desensitization bombed, but that could just be my cynicism getting the better of me.
  • Topamax vs. relaxation therapy vs. exercise for migraines. No, that isn’t an aphasia moment. Relaxation therapy has been used to treat migraines since forever. 40 minutes of exercise three times a week is new, to me at least. The winner: a tie? I can’t understand the statistical method they used, and they write way too much about oxygen intake as well as a philosophical discourse about side effects instead of providing concrete numbers on how well each method worked for the whopping 30 people in each group. Hey, Europe School, here’s a clue about side effects: don’t ramp up study participants to 200mg a day of Topamax (two, possibly four times as much as they needed to take) so quickly. As with the study above this reeks of trying to bury the failure of the treatment you wanted to win in obfuscated stats and language.
  • Topamax vs. acupuncture for migraines. This is one study where the double-blind protocols would be kind of difficult to do7. The winner: acupuncture! It was more effective - average days with headaches cut from 20 days to 10 vs. 20 to 12 with Topamax. As you could probably guess, acupuncture sucked one hell of a lot less, with only two people (6%) complaining about side effects, vs. 22 people (66%) in the Topamax group.

Epilepsy

Carbamazepine is better than lamotrigine for time to first seizure, but this efficacy outcome might be dependent on initial dosing and could indicate that initial lamotrigine dosing in the trial was conservative, which would favour better tolerability outcomes, but detract from its efficacy early in the study. This inference is supported by the way in which per-protocol analysis of time to 12-month remission shows lamotrigine catching up with and eventually overtaking carbamazepine. There is also a lower rate of rash in patients randomised to lamotrigine in this arm of the study than might have been expected, a further potential consequence of conservative initial dosing. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial

  • Topamax vs. Keppra for long-term treatment of chronic, refractory epilepsies. Two of the best meds for some of the most difficult to treat types of epilepsy. 301 on Keppra and 429 taking Topamax. The results: Keppra sucked less and worked better. After one year was 65.6% of patients were still taking Keppra vs. 51.7% for Topamax-treated patients. At two years it was 45.8% still on Keppra and 38.3% still on Topamax. Adverse events led to drug discontinuation in 21.9% of Topamax-treated patients compared to 6.0% of Keppra-treated patients. The number of patients discontinuing treatment because of lack of efficacy was similar for both groups. Topamax was somewhat better in seizure freedom rates, between 11.6% and 20.0% for Topamax and between 11.1% and 14.3% Keppra LEV per 6-months interval.
  • Topamax vs. Keppra for short-term treatment of refractory partial epilepsy. Keppra wins hands down. 61 patients received Keppra and 61 Topamax. During the 15 days of the study 26 people (42.6%) taking Keppra were seizure free compared to 10 (16.4%) taking Topamax.
  • Topamax vs. Dilantin (phenytoin) for rapid relief of new-onset epilepsy. You know how we’re all about slow and steady titration schedules here at Crazymeds. Not everyone has that luxury. For some people the amount of time between their first seizure and their second is best measured in hours, if not minutes. So after that injection of Ativan wears off and you no longer have the bliss of benzodiazepine-induced oblivion, you get to figure out which is the best med to start at the minimum effective dosage and titrate up as quickly as possible8. The results: Dilantin (phenytoin) worked somewhat better, but it was too close to call. Topamax sucked a lot less, so more people stayed on it, which makes it the overall winner.
  • AED geezer cagematch! Tegretol vs. clobazam vs. Neurontin vs. Keppra vs. Lamictal vs. Trileptal vs. Dilantin (phenytoin) vs. Topamax vs. Depakote vs. Zonegran in people 55 or older with a variety of types of epilepsy. The winner: Lamictal, with 79% of people staying on it for one year or longer and 54% seizure-free. Keppra was a close second with 73% staying on it and 43% seizure-free. The same was true even for refractory epilepsy, with 47.4% responding to Lamictal and 38.9% responding to Keppra. The biggest loser: Trileptal, with only 24% staying on and 4% remaining seizure-free.
  • Stupidity Smackdown! Topamax vs. other AEDs for cognitive side effects in epilepsy
    • Topamax vs. Lamictal, which makes grandpa stupider? It all depends on which test he takes, and who decides what qualifies as “better” or “worse.” The results: a tie. Both Topamax and Lamictal made some things worse and some things better. The study was just too small for the differences in opinion between the doctors, the geezers, and the geezers’ families to be statistically significant.
    • Topamax vs. Lamictal in AED polytherapy. What happens when you add Topamax or Lamictal to someone’s cocktail? As far as Topamax is concerned, they tend to get the stoopids. This is one of the few studies where cognitive side effects and dosage aren’t necessarily related, which is something we see a lot of.
    • Topamax vs. Lamictal in people taking other meds - the rematch. Which med used as an add-on will have the greater adverse effect on cognitive performance? Any guesses? That’s right, Topamax makes you teh dum.
    • Low dosage Topamax vs. Trileptal, who’s still stupid after one year? Let’s see if I can do the math….OK at dosages of 50–75mg a day, there’s barely any change in the baseline scores for a variety of tests, while with Trileptal most people improved. So you may not get stupid on a low dosage of Topamax, but you might not get the same benefits as you would from other meds.
    • Topamax vs. valproate, which makes dumb people dumber? Proving once again you can get grant money for practically anything, these people gave Topamax or an unidentified (in the abstract) valproate to untreated, mentally-impaired epileptics for three months, then took them off of the meds to test them again three months later. There’s some medical ethics for you. The results: Topamax will make people with low IQs score even lower on tests involving fuzzy black & white photos. I’m sure there was a point to it.
    • Topamax vs. Gabitril for efficacy and idiocy in refractory epilepsy. This is just sad. Topamax made these people stupider than Gabitril? And didn’t work that much better? Oh, wait, there seemed to be some issues in self-reporting. Quality of life was much better with Topamax. I think the people taking Gabitril forgot a lot of problems they had, along with their PINs, keys, wallets, birthdays, children’s names, and their places of employment.
    • AED stupidity cagematch! Depakote vs. Dilantin (phenytoin) vs. Keppra vs. Lamictal vs. Neurontin vs. Tegretol vs. Topamax vs. Trileptal vs. Zonegran in which makes you the stoopidedist. The wiener: Stupamax Dopamax Topamax, with 21.5% of people reporting intolerable (where they had to stop taking it) cognitive side effects. In second place was Zonegran with 14.9% and in third place was Trileptal with 11.6%. Keppra scored fairly high with 10.4%, but that includes people who were taking Keppra along with one or more other AEDs. When taking only Keppra it had the fewest (no number in the abstract) number of reported cognitive side effects.
    • Now this just isn’t fair. Comparing Topamax with Keppra for cognitive side effects. Really?

For Off-Label Uses

These are not prescribing guidelines per se. For consumers they are an antidote to the direct-to-consumer marketing phrase “Talk to your doctor about…” regarding the advertised drug. For physicians they are likewise an antidote to drugs being pushed on them by pharm reps.

A synthesis of the literature and consumer experiences can provide good rules of thumb as to when consumers should and should not talk to their doctors, and when doctors should and should not talk to their patients, about particular drugs the first time they discuss treatment options. If at all.

Why/When Topamax (topiramate) Should Be Recommended

  • You have frequent migraines and/or seizures of the type your neurologist thinks would respond well to Topamax.
  • You’ve never taken a medication to treat epilepsy before.
    • Really. Topamax works best for epilepsy when it’s the first med you’ve taken. Hence the complicated approval.
  • Sometimes the best thing to do is shut up, be a good little boy/girl/whatever and take your freaking medication.

Why/When Topamax (topiramate) Should Not Be Recommended

You’re bipolar and you don’t want to take any other med because you’re afraid you’ll gain weight.



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Dosage, Titration, and Discontinuation

A review of Topamax’s prescribing information, the literature, and consumer experience. We have found that for most consumers in an out-patient situation the titration schedule published in the prescribing information is often too aggressive. Many would often be better served by starting at a dosage lower than recommended by the manufacturer and, instead of a fixed target dosage, the dosage where symptoms are controlled within a given range is the goal. Patients could adjust their dosage as needed without having to schedule an appointment with their prescriber.

Dosage and Doses

For migraines, other headaches, and epilepsy the usual way is half your daily dosage in the morning and half at night. If you’re taking only one tablet, though, just take it at night. Never split a Topamax tablet. The sprinkle capsules you can open up and divide as best you can if you want.

The effective dosage for migraines is usually 50–100mg a day. Sometimes dosages up to 200mg a day are required.

The effective dosage for epilepsy is usually 200–400mg a day. Lower dosages sometimes work. Dosages above 400mg a day are sometimes required, usually if you’re taking Tegretol or Dilantin (phenytoin), but some people just need more Topamax. Topamax is rated as safe for adults in dosages up to 1,000mg a day9, although 800mg a day is the upper limit of efficacy under any circumstances.

For off-label uses it’s usually the same, i.e. you take anywhere between 50 and 400mg a day, divided into two doses, but not always. E.g. for ultradian rapid cycling you’ll need to take your Topamax four times a day, although the doses don’t need to be the same size.

Dosing Schedule

If you are also taking Tegretol (carbamazepine) and/or Dilantin (phenytoin) you’ll need to take twice as much Topamax. Both of those meds double the rate at which Topamax is cleared from your system.

If you experience nausea or similar problems, try taking Topamax with food. The sprinkles were designed to be mixed into soft foods like pudding. You’ll need to scroll down to see what I’m referring to. OrthoMcNeil Janssen Hunger Force (or whatever they’re calling themselves this week) keeps taking those instructions out and putting them back in10.

Titration Schedule

Migraines

The initial dose is 25mg a day, increased by 25mg a day each week as needed until you reach 100mg a day, usually divided into two doses. Lots of people have reported (anecdotal evidence) that Topamax will work for migraines at 25mg a day. Lots of studies and trials show that 50 mg a day will work for 25–50% of of those who take that dosage.

The responder rate was significantly greater with topiramate at 50 mg/d (39%, P = .01), 100 mg/d (49%, P<.001), and 200 mg/d (47%, P<.001) vs placebo (23%). Reductions in migraine days were significant for the 100-mg/d (P = .003) and 200-mg/d (P<.001) topiramate groups. Rescue medication use was reduced in the 100-mg/d (P = .01) and 200-mg/d (P = .005) topiramate groups. Topiramate for Migraine Prevention A Randomized Controlled Trial

As you can see, 200mg didn’t work much better than 100mg. Other studies have shown that if 100mg a day doesn’t work, 200mg a day might, but if 200mg a day doesn’t work, don’t bother going higher than that unless you’re low on med options.

Epilepsy

It’s complicated, although nowhere near as complicated as Lamictal’s.11 Here’s the party line from the PI sheet for reaching the optimal dosage of 400mg a day when you aren’t taking anything else:

 Morning DoseEvening Dose
Week 125 mg25 mg
Week 250 mg50 mg
Week 375 mg75 mg
Week 4100 mg100 mg
Week 5150 mg150 mg
Week 6200 mg200 mg

To which we say, “BULLSHIT!” So does Dr. Devinsky, Dr. Faught, Drs. Silbersein & Marmura, and pretty much everyone else with a clue about how things work in the real world. Unless you are flopping around on the floor with a seizure at least once a day, every day, there is no need to increase the dosage that rapidly.

Here’s the Crazymeds suggestion to discuss with your doctor:

 Morning DoseEvening Dose
Week 125 mg25 mg
If your seizures stopped  
Week 225 mg50 mg
Did you have a seizure? No?  
Week 350 mg50 mg
How about this week? Great news!  
Week 450 mg50 mg

Still no seizures? Talk to your doctor about dosage increases from this point forward.
And that’s where you stay, unless you have another seizure. If you experience really bad side effects after a dosage increase that don’t get better by the day of your next scheduled increase, then discuss the dosage adjustment with your doctor.
If your seizures didn’t stop at Week 2, or whenever, follow the 50mg a day increase as laid out in the PI sheet until you reach a dosage where they do stop and stay at that dosage.

No matter what your dosage is, you’ll probably need to adjust it later, mainly to deal with side effects. That usually means decreasing, or even increasing the dosage by 25–50mg a day. Yup, even though the side effects tend to be dosage-dependent12, which usually means they get worse as you raise the dosage, AEDs in general, and Topamax in particular, is so freaking weird that sometimes you need to take 25–50mg a day more to make some of the cognitive side effects go away.

One aspect of taking a medication that is frequently missing from patient information, as well as prescribing information, is how to stop taking it. Consumers are left with nothing more than the warning to not stop taking their medication without first talking to their doctor. Circumstances do not always allow for that. Many consumers feel better if they have the knowledge about what they should do.

How to Discontinue

Ortho-McNeil Janssen Hunger Force now agrees with us. They used to say that you could reduce the dosage by 100mg a day every week as long as you’re taking another anticonvulsant and 50–100mg a day every week no matter what. No more. 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, and you should be under close supervision.

If the side effects really suck, but aren’t dangerous, you could get away with a 25–50mg reduction every 5 days. Especially if you’re taking another anticonvulsant.

Discontinuation Symptoms

Notes, Tips, etc. About Discontinuing Topamax



Pros, Cons, and Interesting Information

Even though they want more information than the patient information literature provides, consumers also want a very high-level synopsis. A synthesis of the prescribing information, the literature, and consumer experience provides the pros and cons of using Topamax (topiramate) for its approved indications and clinically-significant or otherwise common off-label uses.

Pros

  • Currently the only modern (approved after 1990) 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.
  • Topamax can (but doesn’t always) work for migraines at 25mg a day with only a few, short-lived side effects.
  • Topamax can (but doesn’t always) work for epilepsy at 100mg a day.
  • A lot of the side effects are usually dosage-dependent, so if Topamax does work for you at a low dosage, then the side effects may not be much of an issue.
  • Topamax will work again if you stop taking it and then try it again later; although the weight loss effect is less likely to work, and even if it does it won’t work as well the second time around. So if you were taking Topamax primarily to lose weight, trying it again probably won’t do you much good.
  • Topamax doesn’t have much in the way of potentially dangerous side effects.

Cons

  • The promise of losing weight is oversold and often leads to disappointment.
  • The same applies to the low side effect profile. Sometimes they hit hard at a low dosage and never go away.
  • Topamax can make you dumber than a box of rocks.
  • You may need to raise or lower your dosage by 25–50mg a day for as long as you’re taking it. It’s just picky that way.
    • As in after a year or so of being fine and dandy at whatever dosage you’re on, you suddenly experience a new side effect that is really messing with you. Lowering, or even raising your dosage by 25–50mg a day will make it go away.
    • Then you’re fine for another nine months, or however long.
    • Lather, rinse, repeat.

When doing their own research about a medication, the educated consumer, and perhaps medical students and healthcare professionals may find interesting pieces of information that are rarely discussed in a prescriber-patient setting. Such information may be rarely discussed because it is trivial, but many people tend to remember interesting, albeit trivial information about something along with other information associated with it. There may be something here to get a patient to remember a more important point about a medication. The other side of that mnemonic coin is what a medication is best known for, something a drug-naïve consumer might not know. While prescribers don’t always assume their patients are aware of a drug’s trait that is “common knowledge,” consumers who do some research don’t want to feel like idiots. They want to know something that isn’t misinformation. Prescribers can always couch questions about well-known traits in forms like “You’re aware that Panacea can cause significant giddiness, right?”

Interesting Things Doctors Rarely Tell Their Patients

  • If you’re taking Topamax for migraines, paresthesia (pins and needles feeling in your extremities) is a good sign. It might mean the Topamax is more likely to work than not.
  • Topamax may encourage you to stop smoking. That study is just to back up my experience and anecdotal evidence I have. A lot of smokers who start start taking Topamax find they don’t like to smoke, or can stop smoking with only mild withdrawal symptoms, or can just smoke whenever they feel like it instead of having to smoke every day. Put me in that last group, even if it’s a stupid thing to do.
  • Considering or taking Topamax to lose some weight due to taking lithium? Get ready for more frequent blood draws, because Topamax can mess with lithium levels in seemingly random ways. See the drug-drug interactions page for details.
  • Taking Topamax along with Depakote or any other valproate can cause hypothermia (excessively low body temperature), while taking Topamax by itself can cause hyperthermia (excessively high body temperature), usually due to hypohydrosis or oligohydrosis (reduced sweating or not being able to sweat). Your doctor and/or pharmacist might tell you about the not sweating and elevated body temperature as that combo is one of Topamax’s potentially dangerous side effects.
  • Most of the really annoying (e.g. tingling extremities, sodas tasting like ass) and severe (e.g. metabolic acidosis, kidney stones) side effects are due to Topamax being a carbonic anhydrase inhibitor (CAI). However, Topamax is a mild CAI, and few people get any benefit from it, as CAIs aren’t used very often as AEDs, mainly because their side effects greatly outweigh the effect they have.
  • The reason why CAIs make carbonated beverages taste so bad and food in general taste weird is because carbonation is something we have taste buds for.
  • As an enzyme-inducing AED, albeit a dosage-dependent one, at a high enough dosage Topamax will sap your body of vitamin D, folic acid, and maybe even calcium. So ask your doctor about tests for vitamin D and calcium levels and supplements, because mileage is going to vary as to if you need to take vitamin D and/or calcium and when you would. You should probably take 400–1,000mcg of folic acid in any event, but no more than that, otherwise it might interfere with how well Topamax works.

What Topamax (topiramate) is Best Known for

Turning you into the stereotype of a supermodel: thin and stupid.

Noted Traits & Effects

Time to get into the mechanics and effects of Topamax’s weight loss properties.

First - why does Topamax cause you to lose weight? Being a carbonic anhydrase inhibitor (CAI) is probably a big part of it. Zonegran is a CAI and, like Topamax, it’s also a supermodel drug. Diamox (acetazolamide) is used to treat altitude sickness and glaucoma, and is used off-label (in the US) as an AED. Diamox also causes weight loss, but the side effects suck so much more than Topamax and Zonegran combined that no one in their right mind would use Topamax as a diet pill13. Being a CAI is also why Topamax makes carbonated beverages taste like ass and is responsible for kidney stones and other kidney problems, and metabolic acidosis being potentially serious problems for anyone who takes Topamax and Zonegran. I go into more details on the page about how Topamax works.

Now that we have an idea as to why Topamax (and probably Zonegran) makes us lose weight, how effective is Topamax as a weight-loss drug?

The results were pretty good in Johnson & Johnson’s last big clinical trial of using Topamax for what they thought a sulfamate-substituted monosaccharide would be good for when it was first developed in the 1970s - a diabetes treatment:

The safety population consisted of 1282 subjects, and the MITT efficacy population was 854 subjects. At 60 weeks, subjects in the placebo group lost 1.7% of their baseline body weight, while subjects in the topiramate 96, 192, and 256 mg/day treatment groups lost 7.0, 9.1, and 9.7%, respectively (P<0.001, MITT, last observation carried forward). Weight loss >/=5% of baseline weight was achieved by 18% of subjects in the placebo arm vs 54, 61, and 67% of subjects receiving topiramate 96, 192, and 256 mg/day, respectively; weight loss >/=10% was achieved by 6 vs 29, 40, and 44%, respectively (P<0.001). Weight loss was accompanied by significant improvements in blood pressure (systolic/diastolic changes of +0.4/+1.0, −3.1/−1.3, −5.7/−3.4, and −4.6/−2.4 mmHg were observed for placebo, topiramate 96 mg/day, 192 mg/day, and 256 mg/day, respectively, P<0.001) and glucose and insulin. A randomized double-blind placebo-controlled study of the long-term efficacy and safety of topiramate in the treatment of obese subjects

You don’t see the term “modified intent to treat” (MITT) in a lot of studies. Why is it in this one? Because 21% of the people taking Topamax dropped out due to the side effects sucking more than having a BMI above 30. From what I’ve read of what people will do to lose weight, those had to be some pretty harsh side effects.
So they used the term MITT to indicate their data came from everyone who took at least one dose of Topamax. Just so they’d have enough to be statistically significant, since J&J ended the trial a year ahead of schedule. Because they’re developing a controlled-release version of Topamax to make it easier to take (Twice a day is hard? I take it three times a day, down from four.) and to abate some of the side effects.

Don’t hold your breath waiting for Topamax CR. That trial failed as well. The results were still good, people losing an average of 6 kilos, good glycemic and lipid numbers, but with 91% of the people who took Topamax reporting adverse events, and 9% dropping out before four months were up, J&J may have finally given up on making Topamax any sort of weight control medication.

But those are for people with diabetes. What about weight gain induced by other meds? There are a bunch of case reports and studies, mostly small-to-medium sized. This one sums it up nicely:

RESULTS:Forty-one patients were included in the study. There was a 58.5% (n = 24) response rate. Mean reductions in weight and BMI were approximately 2.2 kg and 0.5 points, respectively. Responders lost an average of 7.2 kg, whereas nonresponders gained an average of 5.0 kg. Patients with a baseline weight of at least 91 kg and those receiving a greater number of psychotropic medications were more likely to experience success with topiramate therapy. Of the 24 patients who responded to therapy, 22 experienced onset of weight reduction by the next clinic visit (1–4 mo) following either initiation of therapy or titration to the eventual therapeutic dose, and the usual rate of weight loss was 0.45–1.4 kg per month. Therapy was typically initiated at 50 mg/day. The mean maximum dose was 93.9 mg/day and the median maximum dose was 100 mg/day. Seven (17.1%) patients had documented adverse effects to topiramate therapy. CONCLUSIONS:Topiramate therapy resulted in overall modest (ie, <2%) decreases in weight and BMI, but many patients experienced more impressive weight loss. Efficacy of add-on topiramate therapy in psychiatric patients with weight gain.

That’s why Topamax has this reputation as a weight-loss wonder drug. For some people the results are spectacular, and when it does work, it works especially well for people taking antipsychotics. That it does anything at all for people taking Clozaril or Zyprexa is considered a huge win.

But when it doesn’t work - it really doesn’t work. You get to gain weight and deal with the side effects. Ask me about my kidney stones. OK, they’re more like kidney sand and pebbles, and since I’ve been taking magnesium citrate I’m only bothered by them two or three times a month instead of twice a week, but it’s only around a 1.5% chance of having annoying kidney problems i.e. not bad enough to require surgical intervention.

One more thing: the weight-loss effect is the one thing Topamax may not give you a second chance on. And if it does, it may not work as well. You can stop taking Topamax and try it again for epilepsy, migraines, as an add-on for bipolar, or whatever and most people have reported that it works about as well as it did before. Except for the weight loss.



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Adverse Events

A review of prescribing information, the literature, and consumer experiences. One thing this review has found is no matter which neurological/psychiatric drug someone takes, one or more of these adverse events will happen and usually be gone, or at least will diminish to the point where they are barely noticed, within a week or two.

  • Headache
  • Drowsiness/fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
  • Will affect dreams. There is no way of telling if that will be good or bad, the extent of the change, let alone if this side effect is permanent or temporary.

Potential side effects are often used as a rationalization to not take a medication, and that is a valid reason why prescribers don’t like their patients looking up medications on The Internet. It’s a delicate balancing act between providing too little or too much information about side effects. What may be contrary to popular belief, reports of side effects from consumers on sites run by either medical professionals or consumers themselves are generally not too far outside what is published in the literature after a drug has been on the market.

Common Adverse Events

  • Memory loss.
  • Sleepiness, fatigue, and/or lethargy.
  • A pins & needles effect (paresthesia), usually in your extremities, and that usually goes away after a week or two. If it doesn’t go away after two weeks it may never go away. The paresthesia may or may not be constant.
    • Keep this in mind: Paresthesia is a good sign. At least if you’re taking Topamax for migraines. If your fingers14 are tingling, you’re way more likely to respond to Topamax than if they weren’t.
  • Sodas and other carbonated beverages will taste like ass.
  • Memory loss.
  • Weird words coming out in place of what you wrench to say or spoon (aphasia).
  • Word find problems, i.e. not being able to recall the names of people, things or, uh, you know, those thingies that are abstract…concepts! (dysnomia).
  • A general cognitive impairment that has earned this drug the nicknames “Stupamax” and “Dopamax.”
  • Shit, I’m sure I forgot one.

Uncommon Adverse Events

  • Dry and/or itchy eyes along with assorted vision problems up to narrow-angle glaucoma. Don’t flip out over the glaucoma. It goes away after you stop taking Topamax, even if you go blind.
  • You may find yourself not able to drink coffee any more, 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.
  • Full-body muscle aches that feel as if you were hit by a truck, or had a tonic-clonic seizure. Similar to Lamictal. 15

Potentially Dangerous Adverse Events

  • Kidney stones and similar renal problems.
  • Decreased sweating (oligohidrosis) and increased body temperature (hyperthermia). Adolescents and children are more susceptible to this one.
  • Metabolic acidosis
  • Hyperammonemia (build-up of ammonia in your blood), with and without encephalopathy (doctorese for “my brain hurts”). This usually happens when:

Never underestimate the value of gallows humor when confronted with a condition that comes with the dual stigmata of having a mental illness or other neurological disorder and treating it with a medication that everyone from family members to movie stars and other misinformed celebrities say is worse than the condition itself. It’s not for all consumers, but those who have been using the Internet most of their lives generally appreciate it.

Freaky Rare Side Effects:

  • Tongue paralysis
  • Neverending cough
  • Staghorn calculus. I’d like to know how you do calculus using antlers. “Calculus” is doctorese for “kidney stone” and similar problems that involve your squishy bits turning into rocks. “Staghorn” is your upper urinary tract. Staghorn calculus is painful, serious, and if you look at the pictures with this case report, rather gross.
  • Palinopsia and the Alice in Wonderland syndrome. So Topamax explains Sarah Palin?
    • Palinopsia is persistent after images, i.e. you keep seeing something you looked at when you look at something else. Read about one of our forum member’s experiences with Topamax-induced palinopsia. It was a temporary, albeit worrying, side effect.
    • Alice in Wonderland syndrome is when you perceive all or parts of your body as being very large (macropsia) or very small (micropsia). It is often a symptom of migraines and temporal lobe epilepsy, so it is often fixed by Topamax. As with all anticonvulsants, anything Topamax can fix is also a potential side effect. I still have an episode of macropsia now and then, due to epilepsy that affects my temporal lobes and other places (so it’s not officially temporal lobe epilepsy), but it happens far less often thanks to Topamax.

Ways to counter / minimize / mitigate / deal with some side effects

  • A lot of people who get the full-body muscle ache have reported regular stretching (e.g. yoga) helps.
  • While Topamax usually works a lot better for certain things (e.g. ultradian rapid cycling) when you take it twice (or even three or four) times a day, if the sleepiness and/or fatigue are bad enough you can try taking all or most of your dosage at night.
  • Drink plenty of water.
  • For some of us weight loss is actually a bug and not a feature. Topamax is a crazy med that usually works as well, or nearly as well, the second time you take it as it did the first. Except you won’t lose any weight the second time around. Even if you do, it won’t be as much. So if weight loss is a serious problem for you, then taking a medication holiday for a couple of months should fix it. Although in my experience those of us who don’t need to lose weight are the ones who usually do, and you’ll probably be one of those people who still lose weight no matter how many times you stop taking Topamax and try it again latter.

Names, Availability, Brand vs. Generic Issues, Forms

Consumers not only travel, they often live in other countries for extended periods. Thus they need to know if the medications they take are available in those countries, what trade names are used, and if the less-expensive generic version is available.

Available as Topamax in these countries

Argentina, Australia, Brazil, EU, Ireland, New Zealand, Norway, UK,

Other trade name(s) for Topamax used in these countries

  • Epitomax: France, Italy
  • Topamac: Columbia, Greece
  • Topimax: Denmark, Finland, Iceland, Norway, Sweden
  • Topiramat-Cilag: Germany
  • Topiramat-Janssen: Germany
  • Topamax migrans: Germany
  • Топамакс (Topamax): Russia
  • Topina: Japan

Generic Name and Availability

US Generic name/INN:topiramate
US Generic available?Yes

topiramate is available in these countries16

Australia, France, New Zealand

Branded Generic Names17 & Transcribed or Transliterated INN/Generic Name18

  • topiramaat: Dutch for topiramate
  • topiramaattia: Finnish for topiramate
  • topiramato: Spanish for topiramate
  • топирамат: Cyrillic transliteration of topiramate
  • topiramatum - Latin for topiramate19
  • Toplep: South Africa
  • Tamate: Australia
  • Epiramax: Australia
  • Topitaren: France
  • Tipiramate: France


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Not all generic medications are created equal. Consumers have noted differences in the quality of medications produced by different manufacturers. See the article on on the differences between brand and generic medications for more information.

Specific generics with complaints, or preferred generics manufacturers

There have been a lot of complaints in the US about generic topiramate.

  • Teva Pharmaceuticals’ has had the fewest, and lately most everyone seems to be happy with it now.
  • Torrent Pharmaceuticals’ topiramate, while not as worthless as Dr. Reddy’s lamotrigine, is unpredictable. Some days it feels like you’ve taken too much, some days it feels barely acceptable, and some days are wasted in a benzodiazepine stupor because you feel a seizure coming on.
    • Oh, wait, you had a seizure anyway and crapped your pants. Fuck you, Torrent Pharmaceuticals.
  • Sun Pharmaceutical’s topiramate is easily identified by the well-designed S imprint on one side, a range of numbers in the low 700s on the other, (702 for 25mg, 712 for 200mg) and the same color scheme used by Teva for their topiramate. While nowhere near as bad as Torrent’s, it’s far from acceptable.

Generics with independently-tested bioequivalence

How Supplied

Available/Supplied As

Tablets have OMN on one side and the dosage on the other. The color varies with dosage.
  • 25 mg tablet is cream
  • 50 mg tablet is light yellow
  • 100 mg tablet is yellow
  • 200 mg tablet is salmon
  • 15 and 25 mg sprinkle capsules contain small, white to off white spheres. The gelatin capsules are white and clear and printed with “TOP” and the dosage.

Shelf Life

Tablets: 3 years. Sprinkles: 2 years.

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Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences




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References

  1. Hughes, Shannon, and David Cohen. “Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet.” Journal of medical Internet research 13.3 (2011).
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Topamax’s Full US Prescribing Information
  4. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587
  5. Article I, Section 8 of the US Constitution
  6. Greenstone Pharmaceuticals’ Product List. Greenstone LLC Last accessed 04 July 2014
  7. History of Pfizer and Warner-Lambert; 2000 to Present. Pfizer.com Last accessed 04 July 2014

1 Johnson & Johnson / Ortho-McNeil-Janssen Pharmaceuticals consider migraine prophylaxis to be the primary indication for Topamax.

2 Mayan for "You've got to be shitting me.

3 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, and my highly-skilled Google-fu, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or as Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

4 Although these days airport security is probably enough to make anyone's head explode. In any event, that's a somewhat graphic video. Don't say I didn't warn you.

5 As if being bipolar by itself wasn't bad enough.

6 If you can call something I made up an adage.

7 Actually it's not. Sham acupuncture is used, where needles are stuck in places that wouldn't do squat, and electricity may or may not be used with the sham needles. Sham acupuncture is just like any other placebo, sometimes it works, sometimes it doesn't.

8 It sure as shit isn't going to be Lamictal.

9 Remember - Pretty much all of the information on this site is for and about adults. You never want to give a kid 1,000mg of Topamax.

10 I think the antipsychotic sundae recipe Mouse and I came up with embarrassed them or something. Both Topamax and Depakote sprinkles are actually pretty tasty. So, too, is lithium citrate syrup. So it just made sense to sprinkle Topamax and Depakote on ice cream and cover it with the orange-flavored lithium citrate syrup. Prozac's oral solution tastes pretty good as well, but it's minty, so you'd probably want to use that on mint-flavored ice cream. It wouldn't work that well on chocolate, as the mint taste is somewhere between schnapps and high-end mouthwash.

11 Keep scrolling down, it takes six pages to explain most of Lamictal's commonly used titration schedules. For epilepsy and bipolar disorder.

12 Which is why everyone with a functioning brain and half a cup of common sense recommends as slow a titration as possible.

13 Which is why the FDA has given tentative approval to Qnexa, a combination topiramate and phentermine, and Mayan for "you frelling idiot," to treat obesity.

14 Or your toes, or some other part of your body that wasn't being stimulated in any fashion other than as a side effect of Topamax.

15 As Topamax and Lamictal are both approved to treat Lennox-Gastaut syndrome, and are particularly good at dealing with atonic, or drop seizures, my guess is this side effect is a result of that. Sort of like how allergies are immune responses to germs that no longer exist, in that you get this side effect if you don't have atonic/drop seizures. So the next time you feel like bitching about this side effect, google Lennox-Gastaut syndrome imagine what your life would be like if your kid had that. Unless you're in pain most of the day, day after day, shut up and take your meds.

16 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

17 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

18 In some countries the INN / generic name is transcribed into a local phonetic equivalent. In Spanish it's often so close as to be redundant (e.g. topiramato vs. topiramate). In Finnish it's close to being a different drug (e.g. escitalopram vs. essitalopraami). I can understand the need to transliterate the INN / generic name into another alphabet (topiramate becomes топирамат in Russian), but giving a med a different generic name using the Latin alphabet just makes it difficult to find.

19 For what, the Vatican City Walgreens? Pedantic snobbery? Why the holy fuck do you need an INN in fucking Latin?


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 Tuesday, 15 July, 2014 at 15:19:12 by JerodPoorePage Author Date created Tuesday 15 July, 2014, at 13:53:23
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with Microdata: <span itemprop='citation'>Poore, Jerod. "Topamax (topiramate)." <em>Crazymeds (crazymeds.us)</em>.(2014).</span>
Linked:<a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/TopamaxAReview'>"Topamax (topiramate): a Synopsis for the Educated Consumer."</a>. <a href="http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.us)</em></a>. (2014).
with Microdata:<span itemprop='citation'> <a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/TopamaxAReview'>"Topamax (topiramate): a Synopsis for the Educated Consumer."</a>. <a href="http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.us)</em></a>. (2014).</span>

Topamax, and all other drug names on this page and used throughout the site, are a trademark of someone else.

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 © 2004 - 2014. All rights reserved.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 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.
Know your sources!
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 through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. 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 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 the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running 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.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘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.

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