Table of ContentsView AllTable of ContentsHow It WorksDosageSide EffectsInteractionsContraindications
Table of ContentsView All
View All
Table of Contents
How It Works
Dosage
Side Effects
Interactions
Contraindications
Topamax (topiramate) is an anti-seizure medication that may be prescribed to prevent certain types ofmigraine headachesfor adults and adolescents age 12 and older.A migraine is more severe than a headache and often lasts longer (up to 72 hours).
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Besides Topamax, topiramate is sold under two other brand names—Qudexy XR and Trokendi XR—and is also available in a generic form.
Topamax blocks channels in the body that deliver electrical impulses to nerve, muscle, and brain cells. This may enhance the activity of aneurotransmitterknown asgamma-aminobutyricacid (GABA), which is involved in regulating motor control, vision, and anxiety.
Researchers aren’t certain how this process works to prevent migraine headaches or seizures, but it does so effectively, and it is considered safe.
How Effective Is Topamax for Migraine Prevention?
Topamax is available in 25 milligram (mg), 50 mg, 100 mg, and 200 mg tablets. It’s also available in 15 mg and 25 mg capsules that contain a powdered form of the medication. The capsules can be swallowed whole or opened up and sprinkled onto soft food.
Gradually titrating the dose of Topamax in this way will help to prevent side effects. It takes time for Topamax to work when you first start using it. It may take 1 month for your migraine attacks to become less frequent and 2 to 3 months for Topamax to become fully effective.
How Long Do You Stay on Topamax for Migraines?Topamax is a daily medication that must be taken for as long as you and your healthcare provider decide you need it. For migraine prevention, the drug is typically taken two times a day for a minimum of six to 12 months.
How Long Do You Stay on Topamax for Migraines?
Topamax is a daily medication that must be taken for as long as you and your healthcare provider decide you need it. For migraine prevention, the drug is typically taken two times a day for a minimum of six to 12 months.
If you’ve been taking Topamax and would like to quit, it’s advisable to first consult with your healthcare provider, who will guide you through tapering down your dose to lower the risk of side effects that can occur if you stop cold turkey. Withdrawal seizures are a potential side effect of stopping abruptly, even if you do not haveepilepsy.
One downside of Topamax is that it can cause a host of side effects. Most are mild to moderate in severity and temporary; as your body gets used to the medication, some side effects are likely to disappear. Call your healthcare provider if they don’t.
There also are a number of potentially serious side effects associated with Topamax, all of which you should let your healthcare provider know about right away.
Mild Side EffectsNumbness, tingling, or burning in hands or feetSlowed reaction time/muscle weaknessNervousnessDrowsinessUncontrollable shaking or eye movementsConstipationHeartburnWeight lossChanges in ability to taste foodDry mouthNosebleedsTeary or dry eyesPain in bones or musclesBack or leg painHeavy menstrual bleeding or missed periodsSerious Side EffectsBlurred or double vision/loss of visionEye pain or rednessChills/low body temperatureDifficulty concentrating, confusion, memory problemsTrouble speaking or thinking of specific wordsLoss of coordinationPounding or irregular heartbeatChest painShortness of breath/trouble breathing/fast, shallow breathingInability to respond to things around youExcessive tiredness orinsomniaNausea/diarrhea/vomiting/loss of appetiteStomach, back, or side painBloody, cloudy, or foul-smelling urine/frequent, difficult, or painful urinationReduced ability to sweat and increased body temperatureKidney stonesSerious skin reactions (Steven-Johnson’s syndrome or toxic epidermal necrolysis)
Mild Side EffectsNumbness, tingling, or burning in hands or feetSlowed reaction time/muscle weaknessNervousnessDrowsinessUncontrollable shaking or eye movementsConstipationHeartburnWeight lossChanges in ability to taste foodDry mouthNosebleedsTeary or dry eyesPain in bones or musclesBack or leg painHeavy menstrual bleeding or missed periods
Numbness, tingling, or burning in hands or feet
Slowed reaction time/muscle weakness
Nervousness
Drowsiness
Uncontrollable shaking or eye movements
Constipation
Heartburn
Weight loss
Changes in ability to taste food
Dry mouth
Nosebleeds
Teary or dry eyes
Pain in bones or muscles
Back or leg pain
Heavy menstrual bleeding or missed periods
Serious Side EffectsBlurred or double vision/loss of visionEye pain or rednessChills/low body temperatureDifficulty concentrating, confusion, memory problemsTrouble speaking or thinking of specific wordsLoss of coordinationPounding or irregular heartbeatChest painShortness of breath/trouble breathing/fast, shallow breathingInability to respond to things around youExcessive tiredness orinsomniaNausea/diarrhea/vomiting/loss of appetiteStomach, back, or side painBloody, cloudy, or foul-smelling urine/frequent, difficult, or painful urinationReduced ability to sweat and increased body temperatureKidney stonesSerious skin reactions (Steven-Johnson’s syndrome or toxic epidermal necrolysis)
Blurred or double vision/loss of vision
Eye pain or redness
Chills/low body temperature
Difficulty concentrating, confusion, memory problems
Trouble speaking or thinking of specific words
Loss of coordination
Pounding or irregular heartbeat
Chest pain
Shortness of breath/trouble breathing/fast, shallow breathing
Inability to respond to things around you
Excessive tiredness orinsomnia
Nausea/diarrhea/vomiting/loss of appetite
Stomach, back, or side pain
Bloody, cloudy, or foul-smelling urine/frequent, difficult, or painful urination
Reduced ability to sweat and increased body temperature
Kidney stones
Serious skin reactions (Steven-Johnson’s syndrome or toxic epidermal necrolysis)
Complications
In addition to side effects, Topamax has been linked to several serious complications:
How to Avoid Side EffectsIt is important to have adequate fluid intake to minimize the risk ofkidney stones.Topamax may make you sweat less, making you more likely to get heatstroke. Avoid doing things that may cause you to overheat, such as hard work or exercise in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest.
How to Avoid Side Effects
It is important to have adequate fluid intake to minimize the risk ofkidney stones.Topamax may make you sweat less, making you more likely to get heatstroke. Avoid doing things that may cause you to overheat, such as hard work or exercise in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest.
It’s possible that taking Topamax along with other medications could lead to problems. Your healthcare provider will ask you what other drugs you take before prescribing Topamax; this means over-the-counter and prescription medications, as well as nutritional and herbal supplements and natural remedies.
The medications most likely to interact with Topamax include:
Taking Topamax may decrease the effectiveness of hormonal contraceptives. If you become pregnant while taking the drug, call your healthcare provider right away.
Among others who should be cautious about taking Topamax or who shouldn’t take it all are those who have:
Summary
Topamax is ananticonvulsantmedication that may be prescribed for migraine prevention. For most people who get episodic migraine headaches, Topamax is safe, effective, and may well be the key to having fewer migraine headaches per month. If your healthcare provider prescribes Topamax for you, it’s vital that you take it correctly and report any side effects without delay.
Common side effects may include abnormal sensations (often tingling), nausea, diarrhea, dizziness, and weight loss. That said, it’s important that you don’t stop taking Topamax abruptly—unless there is an urgent need and you are under the guidance of your healthcare provider.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.Topamax label. July 2020.Cross JH, Riney CJ.Topiramate. In: Shorvon S, Perucca E, Engel J, eds.The Treatment of Epilepsy. 1st ed. Wiley; 2015:642-651. doi:10.1002/9781118936979.ch50Silberstein SD.Topiramate in migraine prevention: a 2016 perspective.Headache. 2017;57(1):165-178. doi:10.1111/head.12997Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.Li B, Johari P, Camacho Ruiz C.Topiramate (Topamax) for migraine prophylaxis.Academic Emergency Medicine. 2021;28(11):1341-1343. doi:10.1111/acem.14242Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines.Headache. 2012 Jun;52(6):930-45. doi:10.1111/j.1526-4610.2012.02185.xNHS.Common questions about topiramate.NHS.How and when to take topiramate.Salek T, Andel I, Kurfurstova I.Topiramate induced metabolic acidosis and kidney stones - a case study.Biochem Med (Zagreb). 2017;27(2):404-410. doi:10.11613/BM.2017.042Hesami O, Hosseini SS, Kazemi N, et al.Evaluation of ocular side effects in the patients on topiramate therapy for control of migrainous headache.J Clin Diagn Res. 2016;10(3):NC01-4. doi:10.7860/JCDR/2016/16263.7339Meseeha MG, Attia MN, Kolade VO.Topiramate as a rare cause of reversible Fanconi syndrome and acute kidney injury: a case report and literature review.J Community Hosp Intern Med Perspect. 2016;6(1):30510. doi:10.3402/jchimp.v6.30510Additional ReadingLoder E, Burch R, Rizzoli P.The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelines. Headache. 2012 Jun;52(6):930-45. doi: 10.1111/j.1526-4610.2012.02185.xSilberstein SD, Neto W, Schmitt J, Jacobs D & MIGR-001 Study Group.Topiramate in Migraine Prevention: Results of a Large Controlled Trial.Arch Neurol. 2004 Apr;61(4):490-495. doi: 10.1001/archneur.61.4.490Silberstein SD.Topiramate in Migraine Prevention. Headache. 2005 Apr;45 Suppl 1:S57-65. doi: 10.1111.j.1526-4610.2005.4501005.xU.S. Food and Drug Administrtion.Medication Guide: Topamax. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020505s038s039,020844s032s034lbl.pdf
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.Topamax label. July 2020.Cross JH, Riney CJ.Topiramate. In: Shorvon S, Perucca E, Engel J, eds.The Treatment of Epilepsy. 1st ed. Wiley; 2015:642-651. doi:10.1002/9781118936979.ch50Silberstein SD.Topiramate in migraine prevention: a 2016 perspective.Headache. 2017;57(1):165-178. doi:10.1111/head.12997Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.Li B, Johari P, Camacho Ruiz C.Topiramate (Topamax) for migraine prophylaxis.Academic Emergency Medicine. 2021;28(11):1341-1343. doi:10.1111/acem.14242Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines.Headache. 2012 Jun;52(6):930-45. doi:10.1111/j.1526-4610.2012.02185.xNHS.Common questions about topiramate.NHS.How and when to take topiramate.Salek T, Andel I, Kurfurstova I.Topiramate induced metabolic acidosis and kidney stones - a case study.Biochem Med (Zagreb). 2017;27(2):404-410. doi:10.11613/BM.2017.042Hesami O, Hosseini SS, Kazemi N, et al.Evaluation of ocular side effects in the patients on topiramate therapy for control of migrainous headache.J Clin Diagn Res. 2016;10(3):NC01-4. doi:10.7860/JCDR/2016/16263.7339Meseeha MG, Attia MN, Kolade VO.Topiramate as a rare cause of reversible Fanconi syndrome and acute kidney injury: a case report and literature review.J Community Hosp Intern Med Perspect. 2016;6(1):30510. doi:10.3402/jchimp.v6.30510Additional ReadingLoder E, Burch R, Rizzoli P.The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelines. Headache. 2012 Jun;52(6):930-45. doi: 10.1111/j.1526-4610.2012.02185.xSilberstein SD, Neto W, Schmitt J, Jacobs D & MIGR-001 Study Group.Topiramate in Migraine Prevention: Results of a Large Controlled Trial.Arch Neurol. 2004 Apr;61(4):490-495. doi: 10.1001/archneur.61.4.490Silberstein SD.Topiramate in Migraine Prevention. Headache. 2005 Apr;45 Suppl 1:S57-65. doi: 10.1111.j.1526-4610.2005.4501005.xU.S. Food and Drug Administrtion.Medication Guide: Topamax. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020505s038s039,020844s032s034lbl.pdf
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Food and Drug Administration.Topamax label. July 2020.Cross JH, Riney CJ.Topiramate. In: Shorvon S, Perucca E, Engel J, eds.The Treatment of Epilepsy. 1st ed. Wiley; 2015:642-651. doi:10.1002/9781118936979.ch50Silberstein SD.Topiramate in migraine prevention: a 2016 perspective.Headache. 2017;57(1):165-178. doi:10.1111/head.12997Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.Li B, Johari P, Camacho Ruiz C.Topiramate (Topamax) for migraine prophylaxis.Academic Emergency Medicine. 2021;28(11):1341-1343. doi:10.1111/acem.14242Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines.Headache. 2012 Jun;52(6):930-45. doi:10.1111/j.1526-4610.2012.02185.xNHS.Common questions about topiramate.NHS.How and when to take topiramate.Salek T, Andel I, Kurfurstova I.Topiramate induced metabolic acidosis and kidney stones - a case study.Biochem Med (Zagreb). 2017;27(2):404-410. doi:10.11613/BM.2017.042Hesami O, Hosseini SS, Kazemi N, et al.Evaluation of ocular side effects in the patients on topiramate therapy for control of migrainous headache.J Clin Diagn Res. 2016;10(3):NC01-4. doi:10.7860/JCDR/2016/16263.7339Meseeha MG, Attia MN, Kolade VO.Topiramate as a rare cause of reversible Fanconi syndrome and acute kidney injury: a case report and literature review.J Community Hosp Intern Med Perspect. 2016;6(1):30510. doi:10.3402/jchimp.v6.30510
Food and Drug Administration.Topamax label. July 2020.
Cross JH, Riney CJ.Topiramate. In: Shorvon S, Perucca E, Engel J, eds.The Treatment of Epilepsy. 1st ed. Wiley; 2015:642-651. doi:10.1002/9781118936979.ch50
Silberstein SD.Topiramate in migraine prevention: a 2016 perspective.Headache. 2017;57(1):165-178. doi:10.1111/head.12997
Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.
Li B, Johari P, Camacho Ruiz C.Topiramate (Topamax) for migraine prophylaxis.Academic Emergency Medicine. 2021;28(11):1341-1343. doi:10.1111/acem.14242
Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines.Headache. 2012 Jun;52(6):930-45. doi:10.1111/j.1526-4610.2012.02185.x
NHS.Common questions about topiramate.
NHS.How and when to take topiramate.
Salek T, Andel I, Kurfurstova I.Topiramate induced metabolic acidosis and kidney stones - a case study.Biochem Med (Zagreb). 2017;27(2):404-410. doi:10.11613/BM.2017.042
Hesami O, Hosseini SS, Kazemi N, et al.Evaluation of ocular side effects in the patients on topiramate therapy for control of migrainous headache.J Clin Diagn Res. 2016;10(3):NC01-4. doi:10.7860/JCDR/2016/16263.7339
Meseeha MG, Attia MN, Kolade VO.Topiramate as a rare cause of reversible Fanconi syndrome and acute kidney injury: a case report and literature review.J Community Hosp Intern Med Perspect. 2016;6(1):30510. doi:10.3402/jchimp.v6.30510
Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelines. Headache. 2012 Jun;52(6):930-45. doi: 10.1111/j.1526-4610.2012.02185.xSilberstein SD, Neto W, Schmitt J, Jacobs D & MIGR-001 Study Group.Topiramate in Migraine Prevention: Results of a Large Controlled Trial.Arch Neurol. 2004 Apr;61(4):490-495. doi: 10.1001/archneur.61.4.490Silberstein SD.Topiramate in Migraine Prevention. Headache. 2005 Apr;45 Suppl 1:S57-65. doi: 10.1111.j.1526-4610.2005.4501005.xU.S. Food and Drug Administrtion.Medication Guide: Topamax. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020505s038s039,020844s032s034lbl.pdf
Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine: A Summary and Comparison With Other Recent Clinical Practice Guidelines. Headache. 2012 Jun;52(6):930-45. doi: 10.1111/j.1526-4610.2012.02185.x
Silberstein SD, Neto W, Schmitt J, Jacobs D & MIGR-001 Study Group.Topiramate in Migraine Prevention: Results of a Large Controlled Trial.Arch Neurol. 2004 Apr;61(4):490-495. doi: 10.1001/archneur.61.4.490
Silberstein SD.Topiramate in Migraine Prevention. Headache. 2005 Apr;45 Suppl 1:S57-65. doi: 10.1111.j.1526-4610.2005.4501005.x
U.S. Food and Drug Administrtion.Medication Guide: Topamax. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020505s038s039,020844s032s034lbl.pdf
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