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What is Topamax?

Topamax (topiramate) is a seizure medication, also called an anticonvulsant.

Topamax is used alone or in combination with other medications to treat seizures in adults and children who are at least 2 years old.

Topamax is also used to prevent migraine headaches in adults. It will only prevent migraine headaches or reduce the number of attacks. It will not treat a headache that has already begun.

Topamax may also be used for purposes not listed in this medication guide.

Important information about Topamax

Topamax may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant while taking Topamax for seizures. Do not start or stop taking topiramate during pregnancy without your doctor's advice.

Seek emergency medical attention if you have a sudden change in vision or pain around or behind the eyes. These may be early signs of a serious and permanent side effect on your vision. Do not stop using Topamax without first talking to your doctor, even if you feel fine. You may have increased seizures if you stop using Topamax suddenly. You may need to use less and less before you stop the medication completely. Contact your doctor if your seizures get worse or you have them more often while taking Topamax.

Before taking Topamax

You should not use Topamax if you are allergic to topiramate.

To make sure Topamax is safe for you, tell your doctor if you have:

  • kidney disease, a history of kidney stones, or if you are on dialysis;

  • liver disease;

  • glaucoma or other eye problems;

  • a history of depression or suicide attempt;

  • a growth disorder;

  • a history of metabolic acidosis;

  • osteoporosis or low bone density;

  • asthma, emphysema, or other breathing disorder;

  • if you are sick with diarrhea;

  • if you take other seizure medication; or

  • if you are pregnant or plan to become pregnant while using Topamax.

Some people have thoughts about suicide when first taking an anticonvulsant. Your doctor will need to check your progress at regular visits while you are using Topamax. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category D. Do not start or stop taking Topamax during pregnancy without your doctor's advice. Taking topiramate during pregnancy may increase the risk of cleft lip and/or cleft palate in the newborn. But having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant while taking Topamax for seizures.

Seizure control is very important during pregnancy. The benefit of preventing seizures may outweigh any risks posed by taking Topamax. There may be other seizure medications that can be more safely used during pregnancy. Follow your doctor's instructions about taking this medicine while you are pregnant.

Topamax can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking Topamax. If you are not planning a pregnancy while taking this medicine, use effective birth control, and tell your doctor if you become pregnant during treatment.

Topiramate can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I take Topamax?

Take Topamax exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

This mediicne can be taken with or without food.

You may open the Topamax Sprinkle Capsule and sprinkle the medicine into a spoonful of applesauce or other soft food to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

Drink plenty of liquids while you are taking Topamax. This will lower your risk of having kidney stones or an electrolyte imbalance. Call your doctor if you have ongoing vomiting or diarrhea. You can easily become dehydrated while taking this medication.

If you need surgery, tell the surgeon ahead of time that you are using Topamax. You may need to stop using the medicine for a short time.

Do not stop using this medicine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose.

Contact your doctor if your seizures get worse or you have them more often while taking this medicine.

While using Topamax, you may need frequent blood tests. Your kidney or liver function may also need to be checked.

Wear a medical alert tag or carry an ID card stating that you take Topamax. Any medical care provider or dentist who treats you should know that you are taking a seizure medication.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

If you are less than 6 hours late in taking your medicine, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Call your doctor for instructions if you miss two or more doses.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, dizziness, agitation, depression, thinking problems, lack of energy, double vision, problems with speech or coordination, stomach pain, feeling light-headed, fainting, and seizure (convulsions).

What should I avoid while taking Topamax?

Topamax may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Avoid drinking alcohol. It can increase certain side effects of Topamax, and can also increase your risk of a seizure.

Ketogenic or "ketosis" diets that are high in fat and low in carbohydrates can increase the risk of kidney stones. Avoid the use of such diets while you are taking Topamax.

Topamax side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Topamax: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • vision problems, pain around or behind your eyes, sudden vision loss;

  • confusion, slowed thinking, memory problems, trouble concentrating, problems with speech or balance;

  • vomiting, loss of appetite, feeling tired, irregular heartbeats, feeling like you might pass out; or

  • fever, chills, or other flu symptoms;

  • dry mouth, increased thirst, drowsiness, decreased sweating, increased body temperature, and hot, dry skin; or

  • severe pain in your side or lower back, painful or difficult urination.

Common Topamax side effects may include:

  • numbness or tingling in your arms and legs;

  • mild dizziness or drowsiness, feeling nervous;

  • changes in your sense of taste;

  • flushing (warmth, redness, or tingly feeling);

  • diarrhea, weight loss; or

  • cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Topamax?

Taking this medicine with other drugs that make you sleepy or slow your breathing can worsen these effects. Ask your doctor before taking Topamax with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Topamax, especially:

  • divalproex sodium;

  • metformin; or

  • valproic acid.

This list is not complete. Other drugs may interact with topiramate, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

For the Consumer

Applies to topiramate: oral capsule, oral tablet

Along with its needed effects, topiramate (the active ingredient contained in Topamax) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking topiramate:

More common
  • Any vision problems, especially blurred vision, double vision, eye pain, or rapidly decreasing vision
  • burning, prickling, or tingling sensations
  • clumsiness or unsteadiness
  • confusion
  • continuous, uncontrolled back-and-forth or rolling eye movements
  • dizziness
  • drowsiness
  • eye redness
  • generalized slowing of mental and physical activity
  • increased eye pressure
  • memory problems
  • menstrual changes
  • menstrual pain
  • nervousness
  • speech or language problems
  • trouble in concentrating or paying attention
  • unusual tiredness or weakness
Less common
  • Abdominal or stomach pain
  • fever, chills, or sore throat
  • lessening of sensations or perception
  • loss of appetite
  • mood or mental changes, including aggression, agitation, apathy, irritability, and mental depression
  • red, irritated, or bleeding gums
  • weight loss
  • Blood in the urine
  • decrease in sexual performance or desire
  • difficult or painful urination
  • eye pain
  • frequent urination
  • hearing loss
  • itching
  • loss of bladder control
  • lower back or side pain
  • nosebleeds
  • pale skin
  • red or irritated eyes
  • ringing or buzzing in the ears
  • skin rash
  • swelling
  • troubled breathing
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • blisters in the mouth
  • blisters on the trunk, scalp, or other areas
  • bloating
  • clay-colored stools
  • constipation
  • cough
  • diarrhea
  • increased rate of breathing
  • itching
  • joint or muscle pain
  • pain or tenderness in upper abdomen or stomach
  • red skin lesions, often with a purple center
  • sores, ulcers, or white spots in the mouth or on the lips
  • yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur while taking topiramate:

Symptoms of overdose
  • Decreased awareness or responsiveness
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
  • muscle tremors
  • nausea
  • rapid, deep breathing
  • restlessness
  • severe sleepiness
  • stomach cramps
  • sweating unusual

Some side effects of topiramate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Breast pain in women
  • tremors
Less common
  • Back pain
  • chest pain
  • constipation
  • heartburn
  • hot flushes
  • increased sweating
  • leg pain

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Applies to topiramate: oral capsule, oral capsule extended release, oral tablet


General side effects including fatigue, fever, and malaise have been reported to occur frequently. Oligohidrosis, pain, chest pain, and hyperthermia have also been reported.

Nervous system

The majority of cognitive-related adverse events were mild to moderate in severity and frequently occurred in isolation. Rapid titration rate and higher initial doses were associated with higher incidences of cognitive-related adverse events.

Nervous system side effects have been common and have included somnolence, dizziness (greater than 25%), ataxia, speech disorders, psychomotor slowing, hypokinesia, vertigo, grand mal seizures, diplopia, nystagmus, tinnitus, and paresthesias. These nervous system adverse reactions do not appear to be dose-related. Dose-related adverse effects have included fatigue (frequently), nervousness, difficulty with concentration or attention, confusion, psychomotor slowing, difficulty with concentration/attention, difficulty with memory, speech, or language problems (particularly word finding difficulties), and tremor. Headache, vertigo, sensory disturbance, and aggravated migraine have also been reported. A case has been reported of cerebrospinal fluid acidosis associated with hyperventilation that was probably caused by topiramate.


Hepatic side effects including hepatic failure (sometimes fatal) and hepatitis have been reported.


The primary treatment of cases of secondary angle closure glaucoma cause by topiramate (the active ingredient contained in Topamax) is discontinuation of the drug.

Ocular side effects including cases of secondary angle closure glaucoma characterized by ocular pain, acute myopia, abnormal accommodation, and increased intraocular pressure have been reported. Maculopathy has also been reported.


Gastrointestinal side effects include diarrhea, vomiting, pancreatitis, gastroenteritis, constipation, gastroesophageal reflux, tooth disorder, and flatulence have been reported. Tongue edema has been reported rarely.


Cardiovascular side effects including palpitations have been reported frequently. Hypertension and hypotension have been reported infrequently.


Hematologic side effects including anemia and epistaxis have been a reported frequently.


Metabolic side effects have included metabolic acidosis, dehydration, diabetes mellitus, and weight increase.


Musculoskeletal side effects including arthralgia, myalgia, and muscle weakness have been reported. A case of hemiparesis has also been reported.


Psychiatric side effects including insomnia, personality disorder, impotence, hallucination, euphoria, psychosis, decreased libido, anxiety, depression, mood problems, and suicide attempts have been reported. Two cases of panic attacks have also been reported.

Depression and mood problems were dose related.


Genitourinary side effects in the female frequently have included intermenstrual bleeding, leukorrhea, menorrhagia, vaginitis, and amenorrhea. Urinary tract infections, micturition frequency, urinary incontinence, dysuria, and renal calculus have also been reported frequently. Cases of reversible anorgasmia have also been reported. Kidney stones (1.5%) have occurred more frequently in men.


Respiratory side effects including pulmonary embolism, coughing, pneumonia, asthma, and bronchitis have been reported.


Dermatologic side effects including bullous skin reactions (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), pemphigus, acne, rash, and alopecia have been reported. Pruritus has been reported rarely.


Other side effects including taste perversion have been reported frequently. Headaches have also been reported to occur.


Renal side effects including kidney stones (1.3% to 1.5%) and renal tubular acidosis have been reported.


Hypersensitivity side effects including allergic reaction have been reported.


Immunologic side effects have been reported including infection and genital moniliasis.