Should you take Topamax for your migraines? By Sarah Bradley Updated on Jul. Torres, Pharm. Top Reads in Drug Info. Can you mix Trintellix and alcohol? Does hydroxyzine for anxiety work? Do coffee and Zoloft mix? Titusville, N. Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol. Topiramate for migraine prevention: a randomized controlled trial. Topiramate in migraine prophylaxis—results from a placebo-controlled trial with propranolol as an active control.
J Neurol. Chronicle E, Mulleners W. Anticonvulsant drugs for migraine prophylaxis. Cochrane Database Syst Rev. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial Neurology. Each update provides an independent review of a new medication by authors who have no financial association with the drug manufacturer.
The series coordinator is Allen F. Shaughnessy, Pharm. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. What to do about: feeling sick - stick to simple meals and do not eat rich or spicy food. It might help to take your topiramate after a meal or snack. Try to avoid drinking alcohol, as this will make you feel more tired.
If you feel dizzy, stop what you're doing and sit or lie down until you feel better. As your body gets used to topiramate, these side effects should wear off. If they do not after a few weeks or you feel dizzy all the time, speak to your doctor. Signs of dehydration include peeing less than usual or having strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. If this becomes a problem, speak to your doctor or pharmacist.
It's important for you and your baby to stay well during pregnancy. Do not stop taking it without talking to your doctor first. Topiramate and breastfeeding If your doctor or health visitor says your baby is healthy, topiramate can be taken while you're breastfeeding. It's been linked with side effects in very few breastfed babies.
Non-urgent advice: Talk to your doctor if you're:. Tell your doctor if you're taking any of these medicines: medicines used to treat diabetes, such as metformin, glibenclamide and pioglitazone medicines used to treat depression or anxiety, such as venlafaxine and amitriptyline medicines for heart or blood pressure, such as diltiazem, hydrochlorothiazide and propranolol antipsychotic medicines, such as risperidone any other epilepsy medicines Mixing topiramate with herbal remedies and supplements Do not take St John's wort, the herbal remedy for depression, while you're being treated with topiramate.
This is because St John's wort may make topiramate less effective. Important Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements. How does it work? How long does it take to work? For epilepsy, it can take 1 to 2 weeks for topiramate to work properly. But it can take 2 to 3 months for topiramate to fully work. How long will I take it for? Is it safe to take long term? Yes, many people take topiramate safely for many months or years.
Are there similar medicines? They might have different side effects, or be taken more or less often. Your doctor will discuss the best medicine with you.
How does topiramate compare with other medicines for epilepsy? There are many different medicines for treating epilepsy. It's not possible to say that one works better than the other. Other epilepsy medicines include: carbamazepine clobazam ethosuximide gabapentin lamotrigine levetiracetam pregabalin sodium valproate valproic acid To help to decide, your doctor will take into account your age and gender, the medicines you're already taking and any other health problems you may have.
It's usual to try to treat epilepsy using a single medicine. How does topiramate compare with other medicines for migraines? There are different medicines available to prevent migraines. These include: beta blockers, such as propranolol antidepressants, such as amitriptyline other epilepsy medicines, such as sodium valproate or gabapentin It's not possible to say that one works better than the other.
Can I switch to a different medicine? Can I come off topiramate? Do not stop taking topiramate suddenly unless your doctor tells you to. Will it affect my contraception? Topiramate might stop these contraceptives working: combined hormonal contraceptives the combined pill , patches , and vaginal ring - look out for bleeding between periods, which might be a sign the pill is not working.
Talk to your doctor if this happens. Your doctor may advise you to use a different type of contraceptive, or condoms as well as combined hormonal contraceptives. A clinical study found Topamax to be effective for treating partial-onset and generalized tonic-clonic seizures when used alone. In this study, adults and children ages 6 years and older took Topamax alone to treat their seizures. In clinical studies , Topamax was found to be effective in treating partial-onset and generalized tonic-clonic seizures.
The following results were found when Topamax was used with other seizure medications. People in the studies took either:. Studies looked at adults with partial-onset seizures. Compared with the number of seizures they had before the studies:. One study looked at children ages 2 to 16 years with partial-onset seizures. A second study looked at adults and children ages 2 years and older with generalized tonic-clonic seizures. A third study looked at adults and children ages 2 years and older with seizures linked to Lennox-Gastaut syndrome.
In addition to the uses listed above, Topamax may be used off-label for other purposes. Despite this, Topamax may sometimes be used off-label to treat bipolar disorder. People with bipolar disorder have episodes of depression and mania.
However, the drug may sometimes be used off-label to treat people with certain anxiety disorders, such as obsessive-compulsive disorder OCD. For example, some studies suggest topiramate may be helpful as an add-on treatment for OCD. Another small study found Topamax to be effective for treating OCD in people with bipolar disorder.
More studies are needed to determine if Topamax can be effective for OCD and when it should be used. But the drug may sometimes be used off-label to treat this condition. For example, various studies have found that Topamax can help people with alcohol dependence drink less alcohol.
The drug seems to work by helping to reduce cravings for alcohol. However, the drug may be used off-label to treat certain types of chronic pain. Chronic pain is pain that lasts at least 12 weeks. For example, studies have found Topamax to be effective in relieving chronic low back pain. Topamax has also been found effective in treating various forms of nerve pain. However, Topamax may be used off-label to treat certain types of nerve pain. For example, studies have found Topamax to be effective in relieving painful diabetic neuropathy.
This is a type of nerve damage that occurs in people with diabetes. One small study found Topamax to be similar to gabapentin Neurontin in its ability to treat nerve pain. Gabapentin is widely used for nerve pain. Topamax is a brand-name drug that contains the active drug topiramate. This active drug is also available as a generic medication. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug.
Generics tend to cost less than brand-name drugs. They can tell you if it comes in forms and strengths that can be used for your condition. Topamax can cause mild or serious side effects.
The following lists contain some of the key side effects that may occur while taking Topamax. These lists do not include all possible side effects. For more information about the possible side effects of Topamax, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome. These side effects may go away within a few days or a couple of weeks.
Call your doctor right away if you have serious side effects. Topamax is approved for treating certain types of seizures in children ages 2 years and older.
Side effects of Topamax in children are similar to those in adults. One clinical study looked at children ages 6 years and older who took Topamax alone for epilepsy.
The most common side effects were:. In other clinical studies , children ages 2 to 15 years took Topamax with other medications for epilepsy. The most common side effects in these studies were:. In clinical studies involving children ages 12 years and older who took Topamax for migraine, the most common side effects were:.
Children who take Topamax are less likely than adults to have speech problems, slow reactions, and trouble concentrating. One possibly serious side effect is more common in children than in adults. Children taking Topamax are more likely than adults to have fever and reduced sweating. These problems can lead to hyperthermia high body temperature , which may need treatment in a hospital. If they sweat less than usual or develop a high temperature, call your doctor for advice.
You may wonder how often certain side effects occur with this drug or whether certain side effects pertain to it.
As with most drugs, some people can have an allergic reaction after taking Topamax. A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:. Call your doctor right away if you have an allergic reaction to Topamax, as the reaction could become severe. They may be able to suggest ways to help manage this side effect or suggest other treatment options. Topamax can raise the risk of developing kidney stones. In clinical studies , kidney stones were reported in an average of 1.
Topamax was compared with a placebo in some studies. But people treated with Topamax had 2 to 4 times more kidney stones than people in the general population. If you have any of these symptoms while taking Topamax, call your doctor right away. You may need treatment to help your body get rid of any kidney stones. This can reduce your risk for developing kidney stones. Kidney stones can be a sign that you have metabolic acidosis a high level of acid in your blood.
If you have metabolic acidosis, your doctor may lower your Topamax dose. Topamax may cause eye side effects. These may include vision changes, such as decreased or blurry vision, and secondary closed-angle glaucoma sudden raised pressure in your eye. Glaucoma can lead to permanent blindness if not treated. In clinical studies of people ages 16 years and older, they were given either Topamax or a placebo. This was in addition to one or two other epilepsy drugs.
Abnormal vision, such as blurry vision, occurred in:. In clinical studies of adults with migraine, they were given 50 milligrams mg or mg of Topamax, or a placebo. Blurry vision occurred in:.
But eye side effects typically occur within the first month of Topamax treatment. If you have symptoms of eye side effects while taking Topamax, talk with your doctor. They may refer you to an eye specialist , who can check the pressure in your eyes. If you have glaucoma, you may need treatment for it. However, eye side effects usually get better after you stop taking Topamax. If you have eye side effects, your doctor will typically recommend that you stop taking Topamax and switch to a different treatment.
Ideally, Topamax should be stopped gradually. Your doctor will explain how to do this. Topamax can sometimes cause personality changes that affect the way people behave, react, feel, or interact with others. For example, the drug may cause agitation, aggression , or other behavior problems. Topamax may also cause mood changes, such as anxiety , mood swings , and depression. In addition, the medication may raise your risk for suicidal thoughts or behaviors. All antiepileptic drugs medications used to treat seizures due to epilepsy are known to slightly raise the risk of suicidal thoughts and behaviors.
Clinical studies looked at people taking an antiepileptic drug for any condition. The people had about twice the risk of suicidal thoughts or behaviors than people taking a placebo. In these studies, suicidal behavior or thoughts occurred in:. These symptoms can include:. If you have any symptoms of new or worsening depression while taking Topamax, talk with your doctor right away. They can suggest ways to ease this condition. They may also recommend that you switch to a different medication.
If you need to stop taking Topamax, your doctor will explain how to taper off the drug gradually. However, weight gain has been reported with some anticonvulsant drugs that are in the same class as Topamax. A drug class is a group of medications that work in a similar way. Topamax can cause weight loss. However, the drug may reduce your appetite, which may lead you to lose weight. This depended on the dosage and condition treated.
One review of studies looked at the average weight loss in people who took Topamax. It also looked at how long it took them to lose weight when they took the drug. People who took Topamax for at least 4 months lost an average of But your doctor might recommend Topamax for preventing seizures or migraine if you would also benefit from weight loss.
You should take it as prescribed by your doctor for seizures or migraine. Note: Weight loss is an approved use for the brand-name medication Qsymia. Qysmia contains topiramate the active drug in Topamax with another drug called phentermine. The drug is also approved for use in people who are overweight and have an increased risk of health problems. These can include conditions such as high blood pressure , high cholesterol , and type 2 diabetes. Typically, your doctor will start you on a low dose.
Your doctor will ultimately prescribe the smallest dose that provides the desired effect. The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs. The usual recommended dosage is 50 mg taken once in the morning and once in the evening.
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