Topiramate

Topiramate is used to treat certain types of seizures. Topiramate is also used to prevent migraine headaches but not to relieve the pain of migraine headaches when they occur. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.

Topiramate comes as a tablet, a sprinkle capsule (capsule that contains small beads of medication that can be swallowed whole or sprinkled on food), an extended-release (long-acting) capsule, an extended-release sprinkle capsule, and solution (liquid) to take by mouth. Take the tablets, sprinkle capsules, and solution with or without food once or twice a day. Take the extended-release capsules and extended-release sprinkle capsules with or without food once a day. Take topiramate at around the same time(s) every day. 

Take topiramate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Topiramate tablets have a bitter taste so you should swallow them whole. Do not take topiramate tablets that have been broken for any length of time because broken tablets may lose their effectiveness over time.

Swallow extended-release capsules whole; do not split, chew, or sprinkle on food.

Swallow the sprinkle capsules and sprinkle extended-release capsules whole or open and pour over soft food. To take the sprinkle capsules or extended-release capsules mixed with food, carefully open the capsule and sprinkle the entire contents onto a spoonful of soft foods, such as applesauce. Swallow the mixture right after you mix it without chewing and then follow by drinking a liquid to make sure that you swallow all the medication. Do not store the mixture for future use.

Use a marked (calibrated) measuring device to measure the topiramate solution dose to make sure the correct dose is being given. Do not use a household teaspoon or tablespoon. Ask your pharmacist for a measuring device if one is not included with your medication.

Your doctor will probably start you on a low dose of topiramate and gradually increase your dose, not more than once every week.

Topiramate may control your seizures or migraines but will not cure your condition. Continue to take topiramate even if you feel well. Do not stop taking topiramate without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking topiramate, you may have severe seizures, even if you have not had seizures in the past. Your doctor will probably decrease your dose gradually.

You will be given the Medication Guide. Read the information carefully and ask your doctor or pharmacist if you have any questions.  

Topiramate is also sometimes used for the management of alcohol dependence and for the treatment of binge eating disorder and essential tremors (a movement disorder that causes involuntary shaking, especially in the hands). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Before taking topiramate,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any other drugs, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• you should know that the following nonprescription or herbal products may interact with topiramate: aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen and naproxen. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking topiramate. Do not start any of these medications while taking topiramate without talking to your healthcare provider.
• you should know that topiramate may decrease the effectiveness of hormonal contraceptives (birth control pills, patches, rings, and injections). You will need to use another method of contraception to prevent pregnancy while taking topiramate. Talk to your doctor about other ways to prevent pregnancy while you are taking this medication.
• tell your doctor if you or any family members have or have ever had kidney stones, and if you have ever thought about killing yourself or tried to do so. Also tell your doctor if you have or have ever had metabolic acidosis (a disturbance in the body's acid-base balance that results in excessive acidity of the blood); osteopenia, osteomalacia, or osteoporosis (conditions in which the bones are soft or brittle and may break easily); glaucoma (a type of eye disease); any disease that affects your breathing such as asthma or chronic obstructive pulmonary disease (COPD); depression or abnormal moods; a growth problem; or liver or kidney disease. Also tell your doctor if you have diarrhea or if you develop diarrhea during your treatment.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding.   If you become pregnant while you are taking topiramate, call your doctor right away, but do not stop taking topiramate before talking to your doctor. Topiramate may harm the fetus.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking topiramate.
• you should know that topiramate may make you drowsy, dizzy, confused, or unable to concentrate. Do not drive a car or operate machinery until you know how this medication affects you.
• if you are taking topiramate to control seizures, you should know that you may continue to have seizures during your treatment. You may need to avoid activities such as swimming, driving, and climbing so that you will not harm yourself or others if you lose consciousness during a seizure.
• tell your doctor if you if you drink alcohol. Do not drink alcohol within 6 hours before and 6 hours after you take extended-release capsules. Your doctor may also tell you not to drink alcohol while taking other topiramate products.
• you should know that topiramate can prevent you from sweating and make it harder for your body to cool down when it gets very hot. This happens most often in warm weather and to children who take topiramate. Avoid exposure to heat, drink plenty of fluids and tell your doctor if you have a fever, headache, muscle cramps, or an upset stomach, or if you are not sweating as usual.
• you should know that you may be more likely to develop a kidney stone while you are taking topiramate. Drink plenty of water or other fluids every day to prevent kidney stones from forming.
• you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking topiramate for the treatment of epilepsy, mental illness, or other conditions.   There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as topiramate, but there may also be a risk that you will experience changes in your mental health if your condition is not treated.  You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.

Talk to your doctor before changing your diet or beginning any type of weight loss program. Do not follow a ketogenic diet (a high-fat, low-carbohydrate diet used to control seizures) or any other high-fat, low-carbohydrate diet while you are taking this medication.

If you are taking topiramate tablets, sprinkle capsules, or solution, take the missed dose as soon as you remember it. However, if it is less than 6 hours before you are scheduled to take your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

If you are taking topiramate extended-release or extended-release sprinkle capsules, take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you have missed more than one dose, contact your doctor.

Topiramate may cause other side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• numbness, burning, or tingling in the hands or feet
• slowed reactions
• nervousness
• weakness
• lack of appetite, weight loss
• change in ability to taste food
• diarrhea
• menstrual bleeding changes

Some side effects can be serious. If you experience any of the following symptoms or those listed in the SPECIAL PRECAUTIONS section, call your doctor immediately:

• rash, hives, skin blisters, skin peeling, fever, trouble breathing or swallowing, or swelling of your face, eyes, lips, tongue, or throat
• blurred, double, or loss of vision
• eye redness, or pain
• worsening of seizures
• feeling cold, chills, or low body temperature
• nausea, vomiting, difficulty concentrating, confusion, memory problems, or speech problems
• excessive tiredness, confusion, coma (loss of consciousness for a period of time)
• loss of coordination
• chest pain, pounding or irregular heartbeat
• intense back or side pain
• fever or other signs of infection

Topiramate may cause osteoporosis (a condition in which bones can break more easily) in adults and rickets (abnormal, curved bone growth) in children. Topiramate may also slow the growth of children and may decrease the final height that children reach. Talk to your doctor about the risks of taking topiramate.

Topiramate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Tablets, extended-release capsules, extended-release sprinkle capsules, and solution should be stored at room temperature and away from excess heat and moisture (not in the bathroom). Sprinkle capsules should be stored at or below 77°F (25°C) and not in the bathroom. Dispose of any unused solution 90 days after first opening the bottle.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• seizures
• drowsiness
• speech problems
• blurred or double vision
• trouble thinking
• loss of coordination
• loss of consciousness
• dizziness
• stomach pain
• agitation
• depression

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to topiramate.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

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