TopamaxPagesIndex

Table of Contents (hide)

  1. 1. Names, Availability, Brand vs. Generic Issues, Forms
    1. 1.1 US brand name: Topamax
    2. 1.2 Available as Topamax in these countries1
    3. 1.3 Other trade name(s) for Topamax used in these countries1
    4. 1.4 Generic Name and Availability
    5. 1.5 topiramate is available in these countries2
    6. 1.6 Branded generic names3
    7. 1.7 Specific generics with complaints, or preferred generics manufacturers
    8. 1.8 Generics with independently-tested bioequivalence
    9. 1.9 Forms and Classes
  2. 2. Approved and Off-Label Uses
    1. 2.1 US FDA approved use(s)
    2. 2.2 Topamax is approved elsewhere for
    3. 2.3 Common off-label uses
    4. 2.4 Less common/experimental off-label uses
    5. 2.5 Failed off-label uses
    6. 2.6 Potentially dangerous off-label uses
    7. 2.7 When / why you should take Topamax
    8. 2.8 When / why you should not take Topamax
  3. 3. Chances of Working & Comparisons with Other Meds
    1. 3.1 How long until Topamax starts working:
    2. 3.2 Likelihood Topamax will work for its approved indications:
    3. 3.3 For off-label applications:
    4. 3.4 Topamax versus other AntiepilepticDrugs/Anticonvulsants for approved treatments:
    5. 3.5 For off-label uses:
  4. 4. Dosage, Titration, and Discontinuation
    1. 4.1 Dosage and doses:
    2. 4.2 Best time / way to take Topamax:
    3. 4.3 Titration schedule:
    4. 4.4 How to discontinue Topamax:
    5. 4.5 Discontinuation symptoms:
    6. 4.6 Notes, tips, etc. about discontinuing Topamax:
  5. 5. Pros, Cons, and Interesting Information
    1. 5.1 Pros
    2. 5.2 Cons
    3. 5.3 Interesting stuff your doctor probably didn’t tell you:
  6. 6. Side Effects and Pregnancy Category
    1. 6.1 Typical side effects
    2. 6.2 Uncommon side effects
    3. 6.3 Potentially dangerous side effects:
    4. 6.4 Freaky rare side effects:
    5. 6.5 Ways to counter / minimize / mitigate / deal with some side effects
    6. 6.6 Pregnancy category

This is essentially everything we know about Topamax (topiramate) on two big-ass pages. On this page is brand / trade names to odds of working and comparisons with other meds, or pretty much everything most people want to know. Page two is pharmacokinetics to the bibliography, or: I’m sure somebody wants to about 0.1% of people who read about a med look at it.

The titles for most sections link to the pages for those sections. While all the information is on these two comprehensive pages, the individual section pages go into a little more detail about what it all means.

1.  Names, Availability, Brand vs. Generic Issues, Forms

1.1  US brand name: Topamax

Just because a drug is available in one country doesn’t mean you can get it everywhere. Even if a medication is available elsewhere, it won’t necessarily have the same brand, or trade name everywhere it is sold.

1.2  Available as Topamax in these countries1

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

1.3  Other trade name(s) for Topamax used in these countries1

  • 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

1.4  Generic Name and Availability

A drug’s generic, or international nonproprietary name (INN) is how it is uniquely identified around the world. Or not. The generic version of a med is are often available in other countries long before they are in the US.

Generic name/INN:topiramate
US Generic available?Yes

1.5  topiramate is available in these countries2

Australia, France, New Zealand

1.6  Branded generic names3

  • topiramaat: Dutch for topiramate
  • topiramaattia: Finnish for topiramate
  • topiramato: Spanish for topiramate
  • топирамат: Russian for topiramate
  • topiramatum - Latin for topiramate4
  • Toplep: South Africa
  • Tamate: Australia
  • Epiramax: Australia
  • Topitaren: France
  • Tipiramate: France

1.7  Specific generics with complaints, or preferred generics manufacturers

In theory the generic version of a med is the same as the brand-name version. In practice that is usually, but not always the case. Especially with crazy meds. If we know of any problems with particular generics, or if some generics are better than others, we’ll let you know.

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.

1.8  Generics with independently-tested bioequivalence

1.9  Forms and Classes

Available/supplied as:

Tablets have OMN on one side and the dosage on the other. The color of the tablets varies with dosage.

  • 25 mg is cream
  • 50 mg is light yellow
  • 100 mg is yellow
  • 200 mg is salmon

Sprinkle capsules contain small, white to off white spheres. The gelatin capsules are white and clear and printed with “TOP” and the dosage, either “15 mg” or “25 mg”

Primary Drug Class:AntiepilepticDrugs/Anticonvulsants
Additional Drug Categories:
 Migraine/NeuropathicPain

2.  Approved and Off-Label Uses

Drugs are officially approved to be used for certain things, and they may be approved for one thing in one country but something else entirely in another.5

2.1  US FDA approved use(s)

Migraine6: Monotherapy (used by itself) for adults to prevent (prophylaxis) migraine headaches.

Epilepsy:

Weight Loss: Topiramate combined with phentermine, sold under the brand name Qsymia7, is approved to treat obesity.

2.2  Topamax is approved elsewhere for

2.3  Common off-label uses

Meds are often prescribed for conditions or people they aren’t approved to treat. This is known as off-label prescribing. Some off-label prescribing is so common that lots of people think the medication is a first-line treatment for the condition it’s prescribed to treat.

2.4  Less common/experimental off-label uses

When all else fails and you’ve run out of other options, the experimental use of some drug may be your best chance at treating something. Be careful! Otherwise safe meds can be downright dangerous when used for some things.

2.5  Failed off-label uses

2.6  Potentially dangerous off-label uses

2.7  When / why you should take Topamax

Just because a medication is approved or commonly prescribed for a particular condition doesn’t necessarily mean you should be taking it for that condition. There could be a drug that might be better to try first, or at least talk to your doctor about trying first, or the condition you have isn’t bad enough to warrant medication at all.

  • 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.

2.8  When / why you should not take Topamax

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

3.  Chances of Working & Comparisons with Other Meds

Two of the most important things to know when deciding on which med is the best for a particular condition9: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Unfortunately because no one is quite sure exactly what causes various conditions - further complicated when everything is a spectrum disorder - and they’re never really sure about how a med works in the first place, especially when there are lots of contradictory and/or questionable studies,10 we can only give you an idea somewhat less vague than support groups and PI sheets, but certainly more accurate than the implied “it fixes everything all the time!” promises of pharmaceutical advertising.
See our page on the tests researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.

3.1  How long until Topamax starts working:

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.

3.2  Likelihood Topamax will work 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.

3.3  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 bipolar11, 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.

3.4  Topamax versus other AntiepilepticDrugs/Anticonvulsants for approved treatments:

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 adage12 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 do13. 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 possible14. 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?

3.5  For off-label uses:

4.  Dosage, Titration, and Discontinuation

One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.
We here at Crazymeds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage15. More and more doctors are agreeing with us16. You and your doctor can always discuss increasing the dosage when you need to in advance.

4.1  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 day17, 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.

4.2  Best time / way to take Topamax:

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. Ortho-McNeil Janssen Hunger Force (or whatever they’re calling themselves this week) keeps taking those instructions out and putting them back in18.

4.3  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.19 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-dependent20, 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.

4.4  How to discontinue Topamax:

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others it can be a nightmare.
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.

4.5  Discontinuation symptoms:

4.6  Notes, tips, etc. about discontinuing Topamax:

5.  Pros, Cons, and Interesting Information

Every med has its good points and its bad points. This is what we think those are.
Doctors don’t have the time to tell you everything about a drug. Patient information leaflets leave out a lot. Even if the PI sheet covers everything the language is so dense and obtuse that the good stuff is often lost in information overload. Most meds have something interesting about them.

5.1  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.

5.2  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.

5.3  Interesting stuff your doctor probably didn’t tell you:

  • 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.

6.  Side Effects and Pregnancy Category

Potential side effects are used as a rationalization to not take a medication. Many people will stop taking an otherwise working drug because of one or more relatively minor, or often temporary side effects. There may even be ways to counter or mitigate side effects.
It all comes down to a very important question: which sucks less?
No matter what crazy med you take, it will probably make you feel spacey and generally out of it for the first few days (i.e. don’t operate heavy machinery), as well as make you drowsy. Even stimulants can make you drowsy. Topamax will probably affect your dreams as well, and there’s no way to tell if that will be a temporary or permanent side effect. Don’t be surprised if your stomach and/or other parts of your GI system complain for at least the first few days.

6.1  Typical side effects

Most everyone gets at least one or two of these.

  • 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 fingers21 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.

6.2  Uncommon side effects

You may or may not get one or more of these.

  • 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. 22

6.3  Potentially dangerous side effects:

If you have these, call your doctor ASAP. Or now. Or get the hell off of the Internet and go to the ER. NOW!

  • 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:

6.4  Freaky rare side effects:

You won’t get these. Unless you already have and that’s why you’re here.

  • 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.

6.5  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.

6.6  Pregnancy category

D-Will probably harm your baby Expanded pregnancy category explanation.


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Topamax Index


1 EU: European Union. Currently Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. Not all drugs approved in any one EU country are approved in all, but most crazy meds approved in several EU countries are at least obtainable in all EU countries on the European mainland. I'm not sure about Britain, Cyprus, Ireland, and Malta.
The UK and Ireland are listed separately because we're a primarily English-language site. Plus the UK tends to be more independent on more matters than any other EU member state, so it should probably be listed separately no matter what language a site like this is in.
While the EU is moving toward one brand name for the same med, that's not going to happen overnight. And people will still refer to meds by old brand names. So we'll list old brand names until they vanish.

2 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.

3 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.

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

5 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, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or 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.

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

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

8 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.

9 Assuming you were correctly diagnosed in the first place.

10 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.***** That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers.
Two additional papers along similar lines are Why Current Publication Practices May Distort Science******* and Why Most Published Research Findings Are False********. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.
While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.********

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

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

13 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.

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

15 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

16 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy****, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

17 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.

18 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.

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

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

21 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.

22 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.

Date created {{$$newlycreated}} Page Creator: JerodPoore Last edited by: JerodPoore on 2013–09–24


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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.
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.
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.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
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?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]

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