Topamax® (Topiramate) Medication Guide

Topamax® (Topiramate) Oral Tablet

How Topamax® (Topiramate) Works

Topamax® (topiramate) is a medication indicated for the treatment of seizures in epilepsy and for the prevention of migraines.  Topiramate works for weight loss by affecting certain brain chemicals, potentially reducing appetite and increasing feelings of fullness, contributing to possible weight loss.

Dosing and Storage Instructions

  • Take topiramate as prescribed by your healthcare provider. Follow the instructions on your prescription label carefully.
  • Usually, the initial dose is low, gradually increasing to minimize side effects. This is called a dosing titration. 
  • Topiramate should be stored in tightly closed containers at controlled room temperature (59 to 86F, 15 to 30C) in a dry place, protected from moisture and light.
  • Swallow the topiramate tablets whole with plenty of water. Avoid crushing, chewing, or breaking the tablets.
  • Take topiramate consistently, either with or without food.

What If I Miss a Dose of Topamax® (Topiramate)?

  • If you miss a single dose of topiramate, it should be taken as soon as possible. However, if you are within 6 hours of taking the next scheduled dose, you should wait until then to take the usual dose and skip the missed dose. You should not take a double dose in the event of a missed dose. You should contact your healthcare provider if you have missed more than one dose.

When Should I Stop Taking Topamax® (Topiramate)?

  • Do not stop taking topiramate without consulting your healthcare provider, as the medication may need to be dose-reduced and tapered. Stopping topiramate suddenly can cause serious problems.
  • If you experience any unusual symptoms or side effects while taking Topamax® (topiramate), contact your healthcare professional immediately.

Refilling Your Prescription & Communicating with Your Healthcare Provider

  • For the initial four to six months of the Pine Medical program, refilling your prescription requires a monthly check-in with your Pine Medical physician. During this check-in, your physician will evaluate your weight-loss progress and determine if any changes are needed.
  • The goal of the monthly check-in with your physician is to optimize your weight-loss progress while minimizing side effects. 
  • Every month, we will reach out via email during Week 3 to initiate your check-in with your physician.

Common Side Effects of Topamax® (Topiramate)

Please message your Pine Medical physician if you are experiencing any adverse symptoms. Call 911 or go to an emergency room if you feel like you are experiencing a medical emergency.

  • Tingling Sensations: Some individuals may feel a tingling sensation, often described as "pins and needles," in their hands or feet. This sensation is usually harmless but can be bothersome.
  • Changes in Taste: Topiramate might alter your sense of taste, leading to changes in how foods or beverages taste. You may notice differences in the taste of certain foods or drinks.
  • Dizziness: Feeling lightheaded or dizzy can occur, especially when standing up quickly from a sitting or lying position. Take caution when changing positions to prevent falls.
  • Drowsiness or Sleepiness: Some individuals may feel more tired or drowsy than usual. This can affect your ability to concentrate or perform certain tasks requiring alertness.
  • Decreased Appetite: Topiramate might reduce your desire for food or cause a decrease in appetite, which can lead to changes in eating habits or weight.
  • Nausea: Some people may experience a feeling of nausea, which can sometimes be accompanied by stomach discomfort.
  • Difficulty Concentrating: Topiramate might affect cognitive functions such as memory, attention, or thinking. You might notice difficulties in concentration or memory.
  • Vision Changes: In some cases, individuals may experience changes in vision, such as blurred vision or difficulty focusing.
  • Mood Changes or Irritability: Rarely, Topiramate might cause mood changes, leading to irritability or changes in emotions.

Not everyone experiences these side effects, and their severity can vary from person to person. If you notice any side effects or if they become bothersome, contact your healthcare provider for guidance.

Serious Side Effects

  • Severe Allergic Reactions: Symptoms may include rash, itching, swelling of the face, tongue, or throat, severe dizziness, or trouble breathing.
  • Mood Changes or Suicidal Thoughts: In rare cases, topiramate might cause changes in mood, depression, or thoughts of self-harm. Seek immediate medical attention if you or someone you know experiences these symptoms.

These serious side effects are uncommon but necessitate prompt medical intervention if they occur.

Who Should Not Take Topamax® (Topiramate)?

  • Discuss your medical history, especially kidney problems or metabolic disorders, before starting Topiramate.
  • Patients that experience any of the warnings or precautions below, or take other medications that have drug interactions with Topamax® (topiramate), should not take or continue to take the medication.

Warnings and precautions

  • Eye Problems: While on topiramate, be attentive to any sudden changes in your vision, like blurred vision, eye pain, or redness. These could indicate serious eye issues that need immediate attention. Contact your doctor if you notice any alterations in your eyesight.
  • Heat and Sweating: Topiramate might affect how much you sweat and increase body temperature, especially in hot weather. This is particularly important in children who might not be able to express feeling too hot. Pay attention to reduced sweating or excessive warmth, especially on warmer days.
  • Acid Balance: Topiramate can lower the body's natural acid levels, leading to mild to severe changes that might cause tiredness, confusion, or even heart rhythm problems. Your doctor may regularly check your acid levels.
  • Emotional Changes: Some individuals might experience mood changes, such as feeling down or anxious, while taking topiramate.
  • Risk During Pregnancy: Taking topiramate while pregnant might increase the risk of certain birth defects in the baby. It's essential to discuss pregnancy plans with your doctor if you're on this medication.  We require you to be on birth control while you’re on topiramate. 
  • Suicidal Thoughts: In rare cases, medications like topiramate might increase thoughts about self-harm or suicide. If you or someone you know experiences these thoughts, contact a healthcare provider immediately.
  • Brain and Concentration: Topiramate might impact thinking or concentration abilities, especially when the dosage is increased rapidly.
  • Kidney Stones: There's a higher likelihood of developing kidney stones while on topiramate. Drinking plenty of fluids can help decrease this risk.

Staying aware of these warnings and precautions while taking topiramate is essential. Always communicate with your doctor, especially if you notice any unusual changes or symptoms while on this medication.

Drug Interactions

Certain medications may interact with topiramate, affecting its effectiveness or increasing the risk of side effects. Inform your healthcare provider about all medications, including prescription, over-the-counter, herbal supplements, and vitamins you are taking. Some interactions to be cautious about include:

  • Birth Control Pills: Topiramate might reduce the effectiveness of hormonal birth control methods. Discuss alternative contraception options with your healthcare provider if you are taking Topiramate.
  • Other Antiepileptic Drugs: Concurrent use of other antiepileptic drugs with topiramate may increase the risk of side effects or alter their effectiveness. Close monitoring by a healthcare provider is recommended.
  • Carbonic Anhydrase Inhibitors: Combining Topiramate with other medications that are carbonic anhydrase inhibitors may increase the risk of metabolic acidosis.

Always consult your pharmacist or healthcare provider for a comprehensive understanding of potential drug interactions and precautions specific to your medical history and current medications.

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