Topiramate, Topiramate ER

Introduction

Written by Kirstyn Hill, PharmD, MPH
Medically reviewed by Amber Watson, PharmD
Updated on August 3, 2023

Topiramate (toe PYRE a mate) is a generic medication prescribed for treating certain types of seizures due to epilepsy. It’s also prescribed for helping to prevent migraine episodes. Topiramate belongs to a group of drugs called antiepileptics.

This article doesn’t provide coupons for all forms of topiramate. To find coupons for topiramate extended-release* oral capsule, see this article.

* “Extended release” means the drug is slowly released into your body over a long period of time. Other forms of topiramate are released into your body immediately.

Side effects of topiramate

Topiramate may cause mild or serious side effects. More common mild side effects of topiramate and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about topiramate’s side effects, see this article or ask your doctor or pharmacist. You can also refer to the prescribing information for topiramate listed in the “Resources” section.

Mild side effects

More common mild side effects reported with some forms of topiramate are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about topiramate’s side effects, refer to the prescribing information for topiramate listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of all forms of topiramate include:

• weight loss
• paresthesia (a feeling of “pins and needles” or tingling)
• low energy
• difficulty with memory
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for topiramate” section.

Serious side effects

Serious side effects of topiramate are listed below. These side effects may differ based on the form of topiramate you take.

This article doesn’t include all possible serious side effects of the drug. To learn more about topiramate’s side effects, refer to the prescribing information for topiramate listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, topiramate’s serious side effects include:

• eye and vision problems, such as vision loss
• suicidal behavior or thoughts
• decreased sweating, leading to fever
• metabolic acidosis (increased acid level in your blood)
• problems with thinking, memory, or attention
• kidney stones
• high ammonia level in your blood, which may lead to encephalopathy (a serious brain condition)
• serious skin reactions, such as Stevens-Johnson syndrome
• slowed growth in children
• decreased bone mineral density (weakened bones) in children*
• severe allergic reaction†

* In studies, this side effect occurred more often in children ages 6–9 years.

† For details about this side effect, see the “Interactions and warnings for topiramate” section.

Suicide prevention

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

• Call the 988 Suicide and Crisis Lifeline at 988.
• Text HOME to the Crisis Textline at 741741.
• Not in the United States? Find a helpline in your country with Befrienders Worldwide.
• Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

Common questions about topiramate

Below you’ll find answers to a few commonly asked questions about topiramate.

Can topiramate be used for weight loss?

When taken alone, topiramate is not approved for weight loss. However, some people lose weight while taking this drug. Studies reported weight loss as a more common side effect of topiramate. (For more information about topiramate’s side effects, see the “Side effects of topiramate” section.)

The brand-name drug Qsymia contains both topiramate and phentermine. This combination drug is approved to help with weight loss in adults and some children.

If you’d like to know more about topiramate and weight loss, talk with your doctor or pharmacist.

How does topiramate work? And how long does it take to start working?

Seizures or migraine episodes can occur when irregular signals in your brain communicate with the rest of your body. Topiramate works by helping to prevent nerve cells in your brain from sending such signals.

Topiramate takes about 5 days to build up in your body and start working. Your doctor will likely prescribe a low dose of topiramate at the start of your treatment. If there are no issues, they will slowly increase the dose to the right amount for your symptoms. As a result, it may take anywhere from 2 weeks to 2 months for the medication to work fully.

If you’d like to know more about how topiramate works, talk with your doctor or pharmacist.

Uses of topiramate

The Food and Drug Administration (FDA) approves prescription drugs such as topiramate for certain conditions. Approved uses for topiramate are described below.

Use for certain types of seizures

Doctors may prescribe topiramate to treat certain types of seizures in people with epilepsy. For this purpose, the oral tablets and oral capsules may be prescribed to adults and children ages 2 years and older. The extended-release* oral capsules may be prescribed for this use in adults and children ages 6 years and older.

Topiramate is prescribed together with other antiepileptic medications to treat:

• focal onset seizures (also known as partial onset seizures)
• primary generalized tonic-clonic seizures
• seizures resulting from Lennox-Gastaut syndrome

Doctors may also prescribe the drug alone to treat focal onset seizures or primary generalized tonic-clonic seizures.

Topiramate can help reduce the number of these types of seizures a person has. For this use, topiramate is usually prescribed as a long-term treatment.

Seizures are caused by atypical electrical activity in the brain. During a seizure, you may or may not be aware of the seizure and your surroundings. Symptoms of a seizure can include:

• muscle stiffness, twitching, or weakness
• repetitive movements, such as unusual facial movements
• strange sensations or changes in your vision, smell, or taste

* “Extended release” means the drug is slowly released into your body over a long period of time. Other forms of topiramate are released into your body immediately.

Use for helping to prevent migraine episodes

Doctors may prescribe topiramate oral tablets, oral capsules, or extended-release oral capsules for helping to prevent migraine episodes. The drug is prescribed for this purpose in adults and children ages 12 years and older. It’s usually prescribed as a long-term treatment.

Migraine is a condition that may result from atypical brain activity due to widening or narrowing of the blood vessels in the head. This can bring on what is known as a migraine episode, during which you experience symptoms such as headache.

Migraine episodes may last for a couple of hours to a few days. They may occur with or without an aura, which is a visual signal that a migraine episode is coming.

Topiramate may be prescribed alone or together with other medications to help prevent migraine episodes.

Interactions and warnings for topiramate

Below, you’ll find information about topiramate’s possible interactions and warnings.

Interactions of topiramate

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take topiramate, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for topiramate” section below.

Warnings for topiramate

Some people should not take topiramate, and others should take it cautiously.

Topiramate could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether topiramate is a safe option for you. These warnings may differ based on the form of topiramate you take.

Ask your doctor about specific warnings for topiramate, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Topiramate can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to topiramate or any of its ingredients, your doctor will likely recommend that you do not take topiramate. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to topiramate, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of topiramate

If you take topiramate by mouth, you should not take more topiramate than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much topiramate, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and topiramate

Information about topiramate and pregnancy and breastfeeding is described below.

Topiramate and pregnancy

Whether your doctor recommends taking topiramate during pregnancy depends on the condition you’re taking it for.

There are risks to taking topiramate during pregnancy for treating certain types of seizures. But there are also risks to having untreated seizure conditions while pregnant.

If you’re planning a pregnancy or can become pregnant, talk with your doctor about seizure treatment options during pregnancy. Together, you can discuss the risks and benefits of taking topiramate during pregnancy. Your doctor may also suggest birth control options to use during treatment with topiramate.

Topiramate should not be taken to help prevent migraine episodes while pregnant. If you’re looking for preventive treatment options you can take for migraine episodes during pregnancy, your doctor will likely recommend a different medication.

If you take topiramate during pregnancy, your doctor may suggest enrolling in the North American Antiepileptic Drug Pregnancy Registry. This registry monitors outcomes of taking topiramate during pregnancy. To learn more, call 888-233-2334 or visit the registry’s website.

Topiramate and breastfeeding

Whether your doctor recommends taking topiramate while breastfeeding depends on the condition you’re taking it for.

There are risks to taking topiramate for certain types of seizures while breastfeeding. For instance, topiramate may cause diarrhea or drowsiness in a child who is breastfed. But there are also risks to having untreated seizures during this time. (Keep in mind that topiramate is prescribed for treating certain types of seizures.)

If you’re planning to breastfeed, talk with your doctor about seizure treatment options. Together, you can discuss the risks and benefits of taking topiramate while breastfeeding. Your doctor may recommend other healthy ways to feed your child.

If you have migraine, your doctor will likely recommend a different medication for helping to prevent migraine episodes while breastfeeding.

What to ask your doctor

Let your doctor know if you have questions about topiramate or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• What happens if I miss a dose of topiramate?
• Does topiramate need to be taken with food?
• Am I at higher risk of side effects than others?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Topiramate tablets, for oral use; Topiramate capsules, for oral use. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/e4886adf-199d-4b19-a4ef-75f8f94cb54e/spl-doc
• Topiramate extended-release capsules, for oral use. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/11e0924b-fbee-4ec4-b1e4-22d7683b21ee/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.