Table of ContentsView AllTable of ContentsUsesTopamax for Weight LossHow Much to TakeSide EffectsOther Options
Table of ContentsView All
View All
Table of Contents
Uses
Topamax for Weight Loss
How Much to Take
Side Effects
Other Options
Topamax (topiramate) is ananticonvulsantor a drug used to treatseizures. It is also approved to preventmigraine headaches.
This article explores the use of Topamax for weight loss, how it works, how to take it, potential side effects, and more.
Getty Images / Grace Cary
Uses of Topamax
The FDA approved Topamax for:
The drug topiramate is also available in combination with the medicationphentermineas one drug product called Qsymia, which is FDA-approved to treat obesity.
Qsymia is meant to be used in people with abody mass index(BMI) of 30 kilograms per square meter or greater, or a BMI of 27 or higher if the individual also has an obesity-related condition such astype 2 diabetes,high blood pressure, orhigh cholesterol.
Topamax alone is not FDA-approved to treat obesity. However, a healthcare provider may still prescribe it instead of Qsymia when they want the benefits that topiramate brings without the effects of phentermine, either because an individual can’t take phentermine or if they are experiencing side effects.
Furthermore, topiramate may be enough to help some people lose weight and avoid the use of extra medication they don’t need.
BMI is a dated, flawed measure. It does not take into account factors such asbody composition, ethnicity, sex, race, and age. Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.
Researchers Say Waist-to-Hip Ratio Should Replace BMI—Here’s Why
Research on Topamax’s Use for Weight Loss
Multiple clinical trials have shown that Topamax can lead to significant weight loss when combined with a reduced-calorie diet and exercise regimen.
All participants also had similar lifestyle plans, including diet adjustments and regular exercise.
After 24 weeks, the placebo group lost an average of 2.6% of their body weight. The topiramate groups saw their weight drop from 4.8% to 6.3%, depending on their dosage.
Another study consisted of 854 people ages 18 to 75 years with a BMI of 27 to 50. All participants were assigned to weight loss programs involving diet and exercise adjustments as well as either placebo or varying doses of Topamax for a full year.
At 60 weeks, the placebo group lost 1.7% of their baseline body weight, while the Topamax groups lost 7 to 9.7%. The Topamax group also showed improved blood pressure and insulin requirements.
What Is “Off-Label” Use?When a healthcare provider uses an FDA-approved drug for an unapproved use, that use is considered off-label. When the FDA approves a drug for any use, they deem it safe for its intended uses. This doesn’t mean that the drug has no side effects but that its benefits outweigh side effects risks based on clinical trials for certain diseases or conditions.However, providers are generally able to use their medical expertise to prescribe FDA-approved drugs for unapproved uses as long as they judge that the drug is medically appropriate for you. They may do this because another drug is unavailable or you have tried other medications for a condition or disease, and they have not worked well enough.
What Is “Off-Label” Use?
When a healthcare provider uses an FDA-approved drug for an unapproved use, that use is considered off-label. When the FDA approves a drug for any use, they deem it safe for its intended uses. This doesn’t mean that the drug has no side effects but that its benefits outweigh side effects risks based on clinical trials for certain diseases or conditions.However, providers are generally able to use their medical expertise to prescribe FDA-approved drugs for unapproved uses as long as they judge that the drug is medically appropriate for you. They may do this because another drug is unavailable or you have tried other medications for a condition or disease, and they have not worked well enough.
How Does Topamax Work for Weight Loss?
Dosage: How Much to Take for Weight Loss
The most common doses of Topamax used in clinical trials associated with significant weight loss were 96 mg or 192 mg per day, but some doses used were higher or lower.
It may also be necessary to start with a lower dose of Topamax and slowly increase (or titrate) to a higher level based on your tolerance and possible side effects.
Your healthcare provider will use their best judgment and work with you to determine the best starting dose and titration schedule for Topamax.
Is There a Best Time of Day to Take Topamax?
What time of day and how often you take Topamax will depend on whether you’re taking the regular or extended-release (ER) formulation. Regular tablets and capsules may need to be taken up to twice a day, once in the morning and once at night. ER formulations only need to be taken once a day, ideally at the same time each day.
Your healthcare provider may suggest taking Topamax in the morning when you wake up to prevent trouble sleeping at night. However, the drug tends to make some people sleepy, in which case taking it at night before bed would be a better option.
You can take Topamax with or without food. Studies have shown that taking Topamax with food may extend the time needed for the drug to reach peak concentration in your blood, but it does not affect how much of the drug your body absorbs. So, you’ll be able to take it without regard to meals and snacks.
A Word From VerywellTopamax can be considered a weight loss option when the individual’s other comorbidities also benefit from its use. For example, since Topamax works to lower the seizure threshold, it may be an option for someone who also has a seizure disorder. Topamax is also sometimes used as add-on therapy for some psychiatric conditions (e.g., PTSD) or for migraines, so it may also work well for individuals who fall into that category.—LINDSAY COOK, PHARMD, MEDICAL EXPERT BOARD
A Word From Verywell
Topamax can be considered a weight loss option when the individual’s other comorbidities also benefit from its use. For example, since Topamax works to lower the seizure threshold, it may be an option for someone who also has a seizure disorder. Topamax is also sometimes used as add-on therapy for some psychiatric conditions (e.g., PTSD) or for migraines, so it may also work well for individuals who fall into that category.—LINDSAY COOK, PHARMD, MEDICAL EXPERT BOARD
Topamax can be considered a weight loss option when the individual’s other comorbidities also benefit from its use. For example, since Topamax works to lower the seizure threshold, it may be an option for someone who also has a seizure disorder. Topamax is also sometimes used as add-on therapy for some psychiatric conditions (e.g., PTSD) or for migraines, so it may also work well for individuals who fall into that category.
—LINDSAY COOK, PHARMD, MEDICAL EXPERT BOARD
Topamax can cause a range of side effects. One important note is that your prescriber should take a baseline serum bicarbonate blood level before starting you on Topamax, as the drug can affect acid-base levels. This measurement is available as part of anelectrolyteor metabolic lab panel.
If you have any kidney disease or are at risk for kidney disease, your healthcare provider should also take a baselineglomerular filtration rate(GFR), This is a measure of kidney function against which they can compare future readings to monitor whether Topamax affects your kidneys.
Other potential side effects include:
Precautions: Who Should Not Take Topamax?
Topiramate is not appropriate for every population. You may need to avoid taking it if you have:
Other Options for Obesity Treatment
Lifestyle interventions without using medication should typically be the first weight loss choice for people with obesity. Many of these intervention programs exist within a variety of treatment settings, with a variety of providers and protocols, but in general, they aim to:
Although responses and success rates will vary greatly from person to person, these programs are generally shown to be successful.
Pharmacotherapy, or using medication to treat obesity, is indicated for people who have a BMI of 30 or greater or 27 or greater with weight-related comorbidity if they have not had enough success with weight loss after trying lifestyle interventions alone.
However, take note that antiobesity medications are indicated as add-ons to healthy lifestyle habits, not replacements. Current FDA-approvedobesity drugsinclude:
Weight loss achieved with these drugs ranges from 3% to 9% of initial body weight.
Both can lead to fast and stable weight loss for many people. Some people, however, fail to achieve their weight loss goal even with a successful surgery. For others, weight loss tends to plateau after about one year, or people begin to regain weight after one to two years due in part to nutritional and exercise habits following surgery.
The best chance at a successful bariatric surgery is to go into it with realistic expectations, readiness for behavior changes, knowledge about nutritional and exercise requirements to keep weight off, and to plan on utilizing a team of healthcare providers after surgery for continued support.
Summary
Side effects can be a limiting factor in taking Topamax. They may include paresthesias, impaired memory or concentration, mood changes, and sleepiness.
Weight loss as a percentage of baseline body weight ranged from a 4.8% to a 9.7% decrease in multiple clinical trials that included Topamax. Therefore, it may be a good option for many people trying to lose weight as a drug treatment option along with dietary and exercise lifestyle interventions.
6 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.Wajid I, Vega A, Thornhill K, et al.Topiramate (Topamax): evolving role in weight reduction management: a narrative review.Life (Basel). 2023;13(9):1845.FDA.Topamax prescribing information.FDA.Qsymia prescribing information.FDA.Understanding unapproved use of approved drugs “off label”.Cohen JB, Gadde KM.Weight loss medications in the treatment of obesity and hypertension.Curr Hypertens Rep. 2019;21(2):16. doi:10.1007/s11906-019-0915-1Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA.Precision medicine in weight loss and healthy living.Prog Cardiovasc Dis.2019;62(1):15-20.
6 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.Wajid I, Vega A, Thornhill K, et al.Topiramate (Topamax): evolving role in weight reduction management: a narrative review.Life (Basel). 2023;13(9):1845.FDA.Topamax prescribing information.FDA.Qsymia prescribing information.FDA.Understanding unapproved use of approved drugs “off label”.Cohen JB, Gadde KM.Weight loss medications in the treatment of obesity and hypertension.Curr Hypertens Rep. 2019;21(2):16. doi:10.1007/s11906-019-0915-1Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA.Precision medicine in weight loss and healthy living.Prog Cardiovasc Dis.2019;62(1):15-20.
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.
Wajid I, Vega A, Thornhill K, et al.Topiramate (Topamax): evolving role in weight reduction management: a narrative review.Life (Basel). 2023;13(9):1845.FDA.Topamax prescribing information.FDA.Qsymia prescribing information.FDA.Understanding unapproved use of approved drugs “off label”.Cohen JB, Gadde KM.Weight loss medications in the treatment of obesity and hypertension.Curr Hypertens Rep. 2019;21(2):16. doi:10.1007/s11906-019-0915-1Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA.Precision medicine in weight loss and healthy living.Prog Cardiovasc Dis.2019;62(1):15-20.
Wajid I, Vega A, Thornhill K, et al.Topiramate (Topamax): evolving role in weight reduction management: a narrative review.Life (Basel). 2023;13(9):1845.
FDA.Topamax prescribing information.
FDA.Qsymia prescribing information.
FDA.Understanding unapproved use of approved drugs “off label”.
Cohen JB, Gadde KM.Weight loss medications in the treatment of obesity and hypertension.Curr Hypertens Rep. 2019;21(2):16. doi:10.1007/s11906-019-0915-1
Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA.Precision medicine in weight loss and healthy living.Prog Cardiovasc Dis.2019;62(1):15-20.
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