plus assorted interesting stuff about Topamax (topiramate) your doctor won’t tell you

> Topamax Pros and Cons

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Anyone who uses this page, or any other short list of pros and cons, as the only sources of information in deciding which med to take for their condition is a complete idiot and/or crazier than they or anyone else suspects. Although far less stupid and/or crazy than those who choose meds based only on side effects or the recommendations of random people on sites like

How to Take and Discontinue | Topamax Index | Side Effects
Return to the Topamax Page

Topamax 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.

Topamax 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.

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.1

Interesting Stuff Your Doctor Probably won’t Tell You about Topamax (topiramate)

  • 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.

Most drugs are known for something. Whenever Viagra or Cialis are mentioned what do you think of first? How effective either one is for erectile dysfunction? The pros and cons of each? Viagra’s weird side effect of cyanopsia (where everything you see is tinted blue)? Or that a hard-on can last over four hours, and that if it does you’re supposed to call Dr. Buzzkill about it to see if you may need a surgical happy ending?2

Crazy meds are no different. Most of them are notorious for some reason. Lamictal is best known for “The Rash” (or “The Lamictal Rash”), but it’s also the best drug on the planet to treat Bipolar II. Topamax is also known as Dopamax and Stupamax, and here at Crazymeds we coined the term “supermodel drugs” to describe Topamax and Zonegran, because they can make you skinny and stupid. Yet 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.

Drugs can sometimes have lesser-known traits and effects that make them unique, such as Keppra’s ability to stop mania immediately as if it were an antipsychotic as well as killing brain cancer. Some are good, some are bad, some are just weird. Some might be helpful for you to know about in order to make the best use a med, or to help it suck less. Others are meaningful only to pharmacology geeks.

What Topamax (topiramate) is Best Known for

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

Noted Traits & Effects

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

First - why does Topamax cause you to lose weight? Being a carbonic anhydrase inhibitor (CAI) is probably a big part of it. Zonegran is a CAI and, like Topamax, it’s also a supermodel drug. Diamox (acetazolamide) is used to treat altitude sickness and glaucoma, and is used off-label (in the US) as an AED. Diamox also causes weight loss, but the side effects suck so much more than Topamax and Zonegran combined that no one in their right mind would use Topamax as a diet pill3. Being a CAI is also why Topamax makes carbonated beverages taste like ass and is responsible for kidney stones and other kidney problems, and metabolic acidosis being potentially serious problems for anyone who takes Topamax and Zonegran. I go into more details on the page about how Topamax works.

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

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

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

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

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

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

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

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

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

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

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  1. Topamax’s Full US Prescribing Information
  2. Tabibi A, Abdi H, Mahmoudnejad N. “Erectile function and dysfunction following low flow priapism: a comparison of distal and proximal shunts.” Urology Journal 2010;7:174–177.

Contains up-close and personal pictures of rather bloody thigh and penis surgery. Don’t say I didn’t warn you.

The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition by Stephen Stahl © 2009 ISBN:978-0521743990 Published by Cambridge University Press.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond MD © 2002. ISBN:978-0393703917 Published by W.W. Norton.

Primer of Drug Action 12th edition by Robert M. Julien Ph.D, Claire D. Advokat, Joseph Comaty © 2011 ISBN:978-1429233439 Published by Worth Publishers.

Essential Neuropharmacology: The Prescriber’s Guide Stephen D. Silberstein, Michael J. Marmura © 2010 ISBN:978-0521136723 Published by Cambridge University Press.

Efficacy of add-on topiramate therapy in psychiatric patients with weight gain. Ann Pharmacother. 2008 Apr;42(4):505-10. Cates ME, Feldman JM, Boggs AA, Woolley TW, Whaley NP

A Randomized, Double-Blind, Placebo-Controlled, Multicenter Study to Assess the Efficacy and Safety of Topiramate Controlled Release in the Treatment of Obese Type 2 Diabetic Patients Diabetes Care June 2007 vol. 30 no. 6 1480-1486 Julio Rosenstock, MD, Priscilla Hollander, MD, Kishore M. Gadde, MD, Xiang Sun, PHD, Richard Strauss, MD, Albert Leung, MD, PHD for the OBD-202 Study Group

A randomized double-blind placebo-controlled study of the long-term efficacy and safety of topiramate in the treatment of obese subjects International Journal of Obesity (2004) 28, 1399–1410. J Wilding, L Van Gaal, A Rissanen, F Vercruysse and M Fitchet for the OBES-002 Study Group Published online 21 September 2004

How to Take and Discontinue | Topamax Index | Side Effects

1 Interesting to me at any rate.

2 Fun facts: The cause of that never-ending boner (priapism) is often a blood clot, which can work its way loose, make its way to your brain or heart, and kill you. So it's not so much about the inconvenience of a tent pole that can never be unpitched, it's about a potentially fatal side effect of ED drugs that they never say is POTENTIALLY FATAL in the TV ads. Viagra and Cialis are as, if not more likely to kill you than an antidepressant, but is Tom Cruise jumping up and down on a couch screaming about that? Maybe Scientology alone couldn't help him with that issue. As for the surgery that might be required, see Erectile function and dysfunction following low flow priapism: a comparison of distal and proximal shunts for the gory details, with pictures that will make you lose a few inches.

3 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.

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 (

Last modified on Tuesday, 08 July, 2014 at 23:05:18 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
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Topamax, and all other drug names on this page and used throughout the site, are a trademark of someone else. Topamax’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.

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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 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.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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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.
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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.
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‘Everything is true, nothing is permitted.’ - Jerod Poore

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

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

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion 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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