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

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Brand & Generic Names; Drug Classes

US brand name: Topamax
Generic name: topiramate

Drug Class(es)

Primary drug class: AntiepilepticDrugs/Anticonvulsants
Additional drug class(es): Migraine/NeuropathicPain

Approved & Off-Label Uses (Indications)

Topamax’s US FDA Approved Treatment(s)

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

Uses Approved Overseas but not in the US

Off-Label Uses of Topamax

When & If Topamax Will Work

Topamax’s Usual Onset of Action (when it 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. Return to Table of Contents

Likelihood of Working

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.

Return to Table of Contents

Taking and Discontinuing

How to Take Topamax

Manufacturer’s Recommendations

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

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

In English:

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

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

In English:

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

Crazymeds’ Suggestions

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

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

Return to Table of Contents

How to Stop Taking Topamax (discontinuation / withdrawal)

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

Topamax’s Pros and Cons

Pros

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

Cons

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

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

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

Best Known for

Turning you into the stereotype of a supermodel: thin and stupid. Return to Table of Contents




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Topamax’s Potential Side Effects

Potential Side Effects All Crazy Meds Have

No matter which neurological and/or psychiatric drug you take, you’ll probably get one or more of these side effects. These will usually be gone, or at least will diminish to the point where you barely notice it most of the time, 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.1
  • All crazy meds can, and probably will affect your dreams as well. There is no way of telling if that will be good or bad, let alone if this side effect is permanent or temporary.
  • Any of the above side effects you see listed again below means they’re even more likely to happen and/or stick around longer and/or are worse than most other meds.

Typical Potential Side Effects

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

Uncommon Potential Side Effects

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

Freaky Rare Side Effects

Tongue paralysis, neverending cough, staghorn calculus (I’d like to know how you do calculus using antlers), and palinopsia and the Alice in Wonderland syndrome. So Topamax explains Sarah Palin? Return to Table of Contents

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What You Really Need to be Careful About

Glaucoma, not sweating (oligohidrosis), kidney stones, metabolic acidosis.

Return to Table of Contents

Pregnancy Category

D-Will probably harm your baby Return to Table of Contents

Pharmacology

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

Half-life: 21 hours. Plasma Clearance: four to five days.

Steady State

Steady state is reached in four days

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream2, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what3, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.

Return to Table of Contents

How topiramate Works

the current best guess at any rate
Topamax is a fairly broad-spectrum anticonvulsant. Topamax inhibits the voltage-gated (dependent) sodium and calcium channels, inhibits glutamate and carbonic anhydrase, and promotes the reception of GABA and/or increases the amount of GABA, depending on the location in your brain and the study you read. Topamax may also affect voltage-sensitive sodium channels, modulate voltage-gated potassium channels, and modulate voltage-gated calcium channels instead of merely inhibiting them.

In English: Topamax doesn’t just reduce the electrical activity being transmitted through sodium ion channels, but also calcium channels. Additionally it modulates potassium and calcium channels, so it smooths the peaks and valleys as well. Topamax doesn’t just help you use the GABA you have, it also increases the amount of GABA available. GABA = mellow and tipsy, less glutamate = less seizurey.

Topamax’s neuroprotective / antikindling effect is due to its positive GABAergic actions, particularly with GABAA1, and being an antagonist at specific glutamate receptors. Again, when it comes to epilepsy more GABA is good, less glutamate is better. For bipolar more GABA is tricky, and can result in mania.

Originally discounted as having any effect, being a CAI (mainly at CA2 & CA4) is an important part of topiramate’s MOA after all.

Topamax may have an effect on your 5-HT2C receptors. Working on serotonin explains lots of things, from being God’s gift to migraineurs to affecting mood in a positive or negative fashion.

And for the question that is asked at least once a week, how does Topamax make you lose weight? I may finally have an answer for that one. Topamax was initially developed as an oral hypoglycemic to control weight in diabetes 2. It is an inhibitor of gluconeogenesis. As such Topamax is similar to metformin. Being a CAI is also a contributory factor. Serotonin at 5-HT2C is also a factor in weight control, but it’s still not clear if Topamax does anything there at all, much less to what extent.

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 Diamox, or any other CAI as a diet pill4. 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.

Return to Table of Contents

Active Ingredient

freebase topiramate USP


The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.

Return to Table of Contents

Shelf Life

Tablets: 3 years. Sprinkles: 2 years. Return to Table of Contents

Topamax’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

  • Don’t mix Topamax with ethinyl estradiol (estrogen)-based birth control.
  • Don’t take Topamax with carbonic anhydrase inhibitors like acetazolamide and brinzolamide.
  • Topamax + phenytoin or fosphenytoin = less Topamax and more phenytoin/fosphenytoin.
  • Topamax can cause lithium levels to change in an unpredictable manner.
  • Taking Topamax and Glucophage (metformin) together may not be a good idea, since they do the exact same thing.
    • Topamax’s affect on metformin’s clearance, etc. is minor. You’d get the equivalent of a 25% increase in metformin dosage. Since they do the same thing, but there’s not a lot of information on how well Topamax works in that regard, there’s no way to tell how much of Topamax equal how much metformin.

Return to Table of Contents

Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions Topamax may have at

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

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



Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? Yes

Other Trade Names and Overseas Availability

Not including controlled/extended/sustained release suffixes (Efexor ER, Trevilor retard e.g.) or branded generics that are a hyphenate of the generic name and the drug company name (Apo-Citalopram e.g.).

Available as Topamax in These Countries

Argentina, Australia, Brazil, EU, Ireland, New Zealand, Norway, and the UK.

Available as Generic Topiramate in These Countries

Australia, France, New Zealand

Transliterated, Overseas Trade and Branded Generic Names

  • 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
  • topiramaat: Dutch for topiramate
  • topiramaattia: Finnish for topiramate
  • topiramato: Spanish for topiramate
  • топирамат: Cyrillic transliteration of topiramate
  • topiramatum - Latin for topiramate6
  • Toplep: South Africa
  • Tamate: Australia
  • Epiramax: Australia
  • Topitaren: France
  • Tipiramate: France

Return to Table of Contents

Shapes & Sizes (How Supplied)

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.

Return to Table of Contents

Comments, PI Sheet, Ratings, Reviews and More

Comments

Topamax is also known as Dopamax and Stupamax, and here at Crazymeds7 we coined the term “supermodel drug” for both Topamax and Zonegran, because they can make you skinny and stupid. Among the bi-polor8 it’s known as Topomax.

Topamax is also a Godsend for a lot of people with migraines and/or various forms of epilepsy, and is the first thing a lot of neurologists will prescribe. Why? Because it’s the first drug since Tegretol (carbamazepine) with FDA approval to be used by itself to treat full-on, generalized, flopping-on-the-ground seizures. While Topamax might make you skinny, in the long run more people would rather take a low dosage of Depakote than a high dosage of Topamax to control their seizures, only you can’t officially take Depakote by itself for generalized seizures. And carbamazapine can be as much of a pain in the ass to take as Depakote, hence Topamax is the first med to try for a lot of people.

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

Topamax was originally synthesized in the 1970s, and was initially developed as an oral hypoglycemic to control weight in diabetes 2. It is an inhibitor of gluconeogenesis, as such is similar to metformin. Now that it is available generically Johnson & Johnson has probably given up its 40-year-long quest to get Topamax approved as a weight-loss drug for people with diabetes. Instead they’ll leave that to Vivus, who have combined topiramate and phentermine in an obesity pill called Qnexa. Qnexa - Mayan for “You’ve got to be fracking kidding me.”


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Pages and Forum Topics Google Thinks are Relevant to Your Mental Health

Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Topamax’s Full US Prescribing Information / PI Sheet

Official Sites

Janssen-Cilag has a buttload of sites for their products. Links to all the SPCs & PILs we could find are below. Some of the sites are good only for that, some have information about conditions, services, etc. that is useful, and some are as content-free as a lot of support group sites.

PI Sheets from Around the World

Rating and Review Sites

Other Sites of Interest

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Discussion board

If you have any questions not answered here, please see the Crazymeds Topamax discussion board. Return to Table of Contents


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References

  1. the Full US Topamax PI sheet
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition Cambridge University Press 2008. ISBN:978–0521673761
  4. Julien, Robert M. Ph.D, Claire D. Advokat, and Joseph Comaty Primer of Drug Action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs 12th edition Worth Publishers 2011. ISBN:978–1429233439
  5. Stahl, Stephen M. The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition Cambridge University Press 2009. ISBN:978–0521743990
  6. Virani, Adil S., K. Bezchlibnyk-Butler, and J. Jeffries Clinical Handbook of Psychotropic Drugs 18th edition Hogrefe & Huber Publishers 2009. ISBN:978–0889373693
  7. Kaufman, David Myland, MD Clinical Neurology for Psychiatrists W.B. Saunders Company 2001 ISBN:1416030743
  8. Levy, René H., Richard H. Mattson, Brian S. Meldrum, and Emilio Perucca Antiepileptic Drugs Lippincott Williams & Wilkins 2003. ISBN:0781723213
  9. Silberstein, Stephen D., Michael J. Marmura Essential Neuropharmacology: The Prescriber’s Guide Cambridge University Press 2010. ISBN:978–0521136723
  10. Kaufman, David Myland, MD Clinical Neurology for Psychiatrists W.B. Saunders Company 2001 ISBN:1416030743
  11. Epilepsy: Patient and Family Guide Orrin Devinsky
  12. PDR: Physicians’ Desk Reference 2010 64th edition
  13. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series)
  14. Stanley I. Rapoport, Mireille Basselin, Hyung-Wook Kim, and Jagadeesh S. Rao “Bipolar disorder and mechanisms of action of mood stabilizers” Brain Research Reviews Volume 61, Issue 2, October 2009
  15. T.D. Graves “Ion channels and epilepsy” QJM: An International Journal of Medicine Volume 99, Issue 4, April 2006
  16. Pharmacokinetic Interactions of Topiramate Bialer, Meir; Doose, Dennis ; Murthy, Bindu; Curtin, Christopher; Wang, Shean-Sheng; Twyman, Roy; Schwabe, Stefan Clinical Pharmacokinetics Volume 43, Issue 12 2004
  17. Bruce E. Maryanoff “Pharmaceutical “Gold” from Neurostabilizing Agents: Topiramate and Successor Molecules” The Journal of Medical Chemistry Volume 52, Number 11. That link takes you to the entire issue, which is 166-page-long PDF delivered through an ftp port, so be prepared to wait for it. It’s a good read if you’re interested in the history of Topamax and medications for diabetes.
  18. Steffen Naegel and Mark Obermann “Topiramate in the prevention and treatment of migraine: efficacy, safety and patient preference”
  19. Topiramate for Migraine Prevention: A Randomized Controlled Trial
  20. Pierre M Joubert, MB ChB, FCPsych, MMed (Psych) (SA) “Psychiatric uses of topiramate: What is the current evidence?”
  21. “Topiramate in the Treatment of Epilepsy – A Review”
  22. “Psychopharmacology of topiramate: from epilepsy to bipolar disorder”
  23. “Open-Label Adjunctive Topiramate in the Treatment of Bipolar Disorders”
  24. “The Stanley Foundation Bipolar Network 2. Preliminary summary of demographics, course of illness and response to novel treatments”
  25. “The New Antiepileptic Drugs”
  26. Cecilie Johannessen Landmark “Targets for antiepileptic drugs in the synapse” Medical Science Monitor Volume 13, Issue 1, January 2007
  27. Tomaž Vovk, Mihajlo B. Jakovljević, Mojca Kerec Kos, Slobodan M. Janković, Aleš Mrhar, and Iztok Grabnar “A Nonlinear Mixed Effects Modelling Analysis of Topiramate Pharmacokinetics in Patients with Epilepsy” Biological & Pharmaceutical Bulletin Volume 33, Number 7, March 2010

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1 As well as being an indication of half of said conditions.

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

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

4 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. They also gave it a pregnancy category of X to prevent anyone who takes it from further polluting our already disgusting gene pool.

5 More along the lines of 'sand' and the occasional 'pebble' than anything approaching a stone. My daughter, however, once passed a Topamax-induced stone about the size of a pencil eraser.

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

7 OK, I came up with the term "supermodel drug" in 2002 and first used it over at bipolar.about.com It started showing up all over teh Intergoogles in 2004, shortly after Crazymeds came into existence.

8 My rant about how bipolar is spelled is in a footnote for this site's homepage.

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


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


Last modified on Wednesday, 04 May, 2016 at 16:18:15 by JerodPoorePage Author Date created Tuesday, 11 January 2011 at 13:43:23
“Topamax (topiramate): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2011 Jerod Poore Published online 2011/01/11
Citation options to copy & paste into your article:
Plain text:Poore, Jerod. “Topamax (topiramate): a Review for the Educated Consumer.” Crazymeds (crazymeds.us). (2011).
with Microdata: <span itemprop='citation'>Poore, Jerod. "Topamax (topiramate)." <em>Crazymeds (crazymeds.us)</em>.(2011).</span>
Linked:<a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='https://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Topamax'>"Topamax (topiramate): a Review for the Educated Consumer."</a>. <a href="https://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.us)</em></a>. (2011).
with Microdata:<span itemprop='citation'> <a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='https://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Topamax'>"Topamax (topiramate): a Review for the Educated Consumer."</a>. <a href="https://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.us)</em></a>. (2011).</span>

Topamax, and all other drug names on this page and used throughout the site, are a trademark of someone else. Topamax’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2003 - 2016. 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 © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016 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 from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
Crazymeds now uses a secure server, but it is not so secure that you can discuss anything having to do with nuclear power facilities, air traffic control systems, aircraft navigation systems, weapons control systems, or any other system requiring failsafe operation whose failure could lead to injury, death or environmental damage. Just so you know. So if you’re mentally interesting and have a job that deals with that sort of thing, talk about said job elsewhere. Otherwise feel free to discuss your meds and brain cooties.
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 as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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

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