Topiramate (A complete review)

Topiramate

In this blog article, we will discuss what Topiramate, or Topomax, is used for, as well as common side effects.  

What is Topiramate? 

Topiramate is an anticonvulsant drug. It is most commonly used to treat seizure disorders and is usually combined with other medications.

It may be used to treat primary generalized tonic-clonic seizures (seizures that involve the entire body) and partial onset seizures (seizures that involve only a certain part of the brain).

It is also used to treat children with Lennox-Gastaut Syndrome (a disorder involving seizures and developmental delays). 

Topiramate is also commonly used to prevent migraines, although they do not have a large effect in easing the effects of a migraine after the onset of a migraine occurs. 

Topiramate is sometimes used to manage alcohol addiction, as well as drug addictions (ie cocaine and methamphetamine).

It is currently being investigated as a potentially effective treatment for sleep disorders, for Bipolar Disorder, for Obsessive Compulsive Disorder, for Borderline Personality Disorder, and for Post-Traumatic Stress Disorder, as well as for weight loss, Binge Eating Disorder, and Bulimia Nervosa when combined with other drugs. 

Lithium, however is a medication, used to treat mania/bipolar disorder.

Topiramate (A complete review)

How does Topiramate work?

Topiramate is an anticonvulsant drug. During a seizure, neurons are firing at an abnormally rapid pace.

The exact mechanism of action of Topiramate is not completely clear, however it is known to work predominantly by lowering abnormal excitement in the brain.

It prevents neurons from firing as fast as they normally would during a seizure, thereby entirely preventing a seizure onset.

It is thought to lower this altered brain activity by inhibiting voltage-dependent sodium channels in neurons and by enhancing the inhibitory activity of the neurotransmitter GABA (gamma-aminobutyric acid). 

What are the side effects of Topiramate?

Some side effects of Topiramate may include:

-Headache

-Weakness

-Drowsiness

-Slowed reactions

-Anxiety

-Numbness, burning, or tingling in the extremities

-Muscle or bone pain

-Dry mouth

-Nosebleed

-Missed menstrual periods or excessive menstrual bleeding

-Uncontrollable shaking of parts of the body or uncontrollable eye movements

-Weight loss

-Constipation

-Heartburn

-Altered sense of taste

Some side effects, like those listed below, are rare, but if encountered, require a doctor’s attention immediately:

-Blurred vision, loss of vision, or double vision

-Eye pain or eye redness

-Confusion or memory problems

-Loss of coordination

-Fatigue

-Irregular heartbeat

-Chest pain

-Shortness of breath or trouble breathing

-Fast, shallow breathing

-Nausea or vomiting

-Diarrhea

-Stomach pain or loss of appetite

-Back or side pain

-Difficulty urinating, pain while urinating, or constant need to urinate

-Bloody, cloudy, or foul-smelling urine

Topiramate (A complete review)

Topiramate may also cause osteoporosis in adults. 

In children, Topiramate may cause rickets or delayed growth. It may also decrease the final height that children reach.

For these reasons, it is important to take calcium supplements while taking this drug.

Topiramate is also known to potentially lead to mood changes and suicidal thoughts.

It may cause metabolic acidosis: a buildup of too much acid in the blood and too many toxins that could ultimately lead to coma and death if left untreated.

Topiramate may also cause kidney stones and kidney damage. For this reason, it is important to drink plenty of water while taking Topiramate.

Topiramate has also been found to cause inadequate sweating, especially in children. In hot temperatures, perspiration is important to lower your body temperature.

Without the ability to secrete enough sweat, your body temperature could rise to dangerous levels.

In this regard, it is important to be cautious of children who are taking Topiramate. These children should be monitored during hot weather. 

Topiramate should be used with caution in patients who are pregnant.

It is considered a category D drug, which means that it may have an effect on the fetus; it may cause development of a cleft palate or cleft lip.

While evidence shows that Topiramate is not an absolute contraindication to pregnancy, it is still important to weigh the risks and benefits of taking this drug if you currently are or plan to become pregnant in the near future.

Note: It is important to discuss potential side effects of Topiramate with your doctor.

Do not rely on this as a comprehensive list. Your doctor will help decide if Topiramate is right for you.

If you are currently taking Topiramate and are concerned about any of these potential side effects, call your doctor right away.

Topiramate (A complete review)

How do I take Topiramate?

Topiramate usually comes in a capsule or tablet form.

For children unable to swallow a pill, the capsule could be opened or the tablet could be crushed, and the contents may then be mixed into food..

The tablet and the capsule should both be stored at room temperature, in a dry place, and the container should be tightly sealed.

The tablet and capsule usually come in a variety of dosages.

The tablet usually comes in a 25, 50, 100, or 200 mg dose, and the capsule usually comes in a 15 or 25 mg dose.

The dosage depends on what the Topiramate is being used for and if it is used in conjunction with other medications.

 Your doctor may also alter your dosage if you have been taking Topiramate for a certain period of time.

It is common to start with a lower dosage and work your way to a higher dosage.

This is to minimize side effects and to give your body time to adjust to taking this new medication. 

If you decide to stop taking Topiramate, your doctor will probably have you taper down the drug as well.

If you stop taking the medication without tapering, then it may actually result in a strong recurrence of symptoms (ie seizures in those using Topiramate to treat seizure disorders).

 Topiramate is usually taken once or twice a day, depending on what the Topiramate is being used for.

It is important to take Topiramate exactly the way your doctor prescribes it. Not taking enough may result in not achieving treatment.

If you missed a dose, try to take it as soon as you remember. If it has been over 6 hours since you missed your dose, it may be safest to skip the dose entirely and to notify your doctor.

Do NOT take an extra dose. If you take more than prescribed, there may be unhealthy consequences.

Signs of Topiramate Overdose:

Seizures

-Speech problems

-Double vision or Blurred vision

-Fatigue

-Loss of coordination

-Loss of consciousness

-Depression

-Agitation

-Stomach pain

-Loss of appetite

-Nausea or Vomiting

-Irregular heartbeat

-Fast, shallow breathing

If you experience any of these symptoms, or if you think you overdosed on your medication, call poison control and call your doctor.

If you know someone who has overdosed and has had a seizure, has collapsed, is unresponsive, or has trouble breathing, it is important to call 911 immediately.

When does Topiramate get absorbed and secreted?

After you swallow Topiramate, it gets broken down and digested in the liver.

Topiramate usually reaches the highest concentration in your blood within about 2-4 hours after being ingested.

It normally takes about 4 days of taking Topiramate for it to achieve a steady concentration. Topiramate is then processed as waste by the kidneys and excreted in the urine.

About 70 to 80% of the drug is excreted unchanged in the urine. Topiramate has a half- life of 21 hours.

Because of the importance of the liver and the kidneys in processing and excreting the drug, those who have pre- existing kidney or liver problems should speak with their doctor and find out if Topiramate is right for them. 

Topiramate (A complete review)

Frequently Asked Questions (FAQs) about Topiramate:

Why is Topiramate used for weight loss?

Because the mechanism of Topiramate is not fully clear, experts are also not completely sure as to why Topiramate helps treat weight loss and certain eating disorders, like binge eating disorder or bulimia nervosa.

Short-term, small controlled clinical trials have been performed that show Topiramate to be more effective in treating eating disorders than the placebo, however there is still plenty more research to be done.

Experts have speculated that the calming and inhibitory effects that Topiramate has on the brain may in fact suppress food cravings.

Many do not opt to take Topiramate due to its many side effects.

The effect of Topiramate on appetite suppression may produce a negative effect for those intending to lose weight and who may also suffer from anorexia nervosa.

Topiramate is mostly taken for patients with bulimia nervosa when no other medications have proven to be effective. 

Does Topiramate help you sleep?

Topiramate has been reported to help with sleep disorders, mainly nocturnal eating syndrome, sleep related eating disorder (SRED), and somnambulism (sleepwalking).

The exact mechanism in which Topiramate helps with these sleep disorders is not fully known.

If you are interested in taking Topiramate for one of the aforementioned sleep disorders, you should speak with your doctor to see if it is right for you. 

Interested in learning more about Topiramate?

Check out these additional recommended readings!

Topiramate; Second Edition by G.J. Blokdijk

This book is a good resource to help you determine whether or not Topiramate is right for you.

It discusses the drug in further depth in regards to how it may work specifically for you and your condition.

It may help with weighing your options and with developing questions to ask your doctor. 

Focus On: 30 Most Popular Anticonvulsants: Modafinil, Pregabalin, Topiramate, Acetazolamide, Levetiracetam, Phenibut, Oxcarbazepine, Potassium Bromide, Charlotte’s Web (cannabis), Primidone, etc

This E- book focuses on the most popular anticonvulsants out there.

It involves a collection of articles that discusses each medication, providing a valuable resource for anyone looking to learn more about the most common anticonvulsant drugs being used right now.

It is a good resource for those who are not sure what medication may be right for them.

It provides the fundamentals you may need to feel more confident before you decide with your doctor about what medication may be right for you. 

Profiles of Drug Substances, Excipients, and Related Methodology Volume 44 by Harry G. Brittain

This E- book provides comprehensive reviews on various drugs, including Topiramate and drugs that are similar to Topiramate.

It is a great read if you are interested in expanding your knowledge to learn more about other drugs.

It discusses drug characterization, drug experiments, as well as review articles.  

References

1.     Mathew, Thomas, et al. “Topiramate-Induced Somnambulism in a Migraineur: a Probable Idiosyncratic Adverse Effect.” Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, American Academy of Sleep Medicine, 15 Apr. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311419/. (accessed on Apr. 27, 2020)

2.     National Center for Biotechnology Information. PubChem Database. Topiramate, CID=5284627, https://pubchem.ncbi.nlm.nih.gov/compound/Topiramate (accessed on Apr. 27, 2020)

3.     “Topiramate.” Epilepsy Foundation, https://www.epilepsy.com/medications/topiramate (accessed on Apr. 27, 2020)

4.     “Topiramate for Weight Loss and Eating Disorders.” Topiramate for Weight Loss and Eating Disorders, May 2011, https://www.consumerreports.org/cro/2012/04/eating-disorders-may-be-treated-by-topamax/index.htm

5.     “Topiramate: MedlinePlus Drug Information.” MedlinePlus, U.S. National Library of Medicine, 15 Dec 2017. https://medlineplus.gov/druginfo/meds/a697012.html (accessed on Apr. 27, 2020)

6.     “Use of Topiramate in Pregnancy and Risk of Oral Clefts.” Centers for Disease Control and Prevention,Centers for Disease Control and Prevention, 8 Nov 2019. https://www.cdc.gov/ncbddd/birthdefects/features/birthdefects-topiramate-keyfindings.html (accessed on Apr. 27, 2020)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behavior, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.