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Topamax® (toe-PA-max)


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Topamax (topiramate)
Brand and Generic Names

Topamax® (toe-PA-max) is the brand name of this medicine

Topiramate (toe-PIE-ra-mate) is the generic name of this medicine

This drug comes in 15mg sprinkle capsules, 25 mg tablets and 25 mg sprinkle capsules, 50 mg tablets, 100 mg tablets, and 200 mg tablets. See the section called “How Should I Take Topamax?” for that information.
What is topiramate and what does it treat?

Topiramate is an anticonvulsant drug approved for the treatment of seizures (epilepsy) in adults and children. It can be used alone, or in combination with other anticonvulsants alone or in combination with other anticonvulsants. It is also approved for use in preventing migraine headaches in adults.

While not approved by the FDA for other illnesses, Topamax has been tried and studied in the treatment of tremors, nerve pain, eating disorders, alcohol dependence, and most especially bipolar disorder (manic-depressive illness). A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: “high” or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees). A depressive episode, or depression, is when a person experiences several of the following symptoms at the same time: “low” or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating, thoughts of death (suicidal thinking).

For any of these illnesses Topamax may or may not work for you. If you and your doctor decide to try Topamax you should give the drug a good chance to work (at least two months) before deciding if it is right or wrong for you.
What is the most important information I should know about Topamax?

Bipolar disorder requires long-term treatment. Only your healthcare provider can determine the length of Topamax treatment that is right for you.

Unlike for other drugs used to treat bipolar disorder (e.g., lithium, valproic acid), Topamax does not have blood levels that we try to achieve. However, from time to time, your doctor may ask that you give blood samples to check for specific kinds of side effects.

In order for Topamax to work properly, it should be taken every day in regularly spaced doses as ordered by your doctor. This is to maintain a steady level of drug in your body. Do not stop taking the medication, even when you feel better.

Topamax may be prescribed by itself or along with other medications to help manage your Bipolar mood symptoms.

Topamax has not been studied in pregnant women. Studies in pregnant animals using doses much larger (by weight) than humans have taken tell us that Topamax may cause birth defects in unborn babies, as well as causing problems in pregnant patients. Women should talk to their doctors and pharmacists if they are pregnant, or thinking about or trying to become pregnant, and a soon as they find out they are pregnant if that happens.
What should I discuss with my healthcare provider before taking Topamax?

* You should tell your doctor if you have taken Topamax before and if you are allergic to it you should tell your doctor and pharmacy what exactly the drug did to you before taking even one dose.
* Symptoms that are most bothersome to you about your condition
* If you have thoughts of suicide
* Any medical problems you have, especially involving the kidneys (including kidney stones)
* If you are pregnant, plan to become pregnant, or are breast-feeding
* Medications you have taken in the past to treat bipolar disorder
* All other medications you are currently taking and any medication allergies you have
* Any medication side effects that you may have experienced in the past, or are currently experiencing
* If you drink alcohol or use illegal drugs

How should I take Topamax?

Take this medicine every day exactly as your doctors tell you to. Do not take more or less of it, and do not take it more or less often than your doctor says. If you do not understand the instructions your doctor or pharmacist give you it is very important that you stop them and ask for more information.

Do not stop taking Topamax unless you first talk to your doctor or pharmacist. This drug does not cure you so it only helps you as long as you keep taking it.

Topamax may be taken with or without food, on a full or an empty stomach. Don’t crush, or chew the tablets. You may notice a bitter taste, this is normal. If you are taking capsules they may be opened and the contents (little beads) sprinkled on a small amount (teaspoonful) of soft food (such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt) and swallowed immediately without chewing.
What happens if I miss a dose?

If you miss a dose of this medicine, take it as soon as possible.

If it is almost time for your next dose, skip the missed dose and start back to your regular dosing schedule. Do not double up your Topamax to catch up on doses you have forgotten to take; this doesn’t help and it may cause you to have side effects.

If you miss more than one or two days of the medication start back but also call your doctor’s office and tell them.
What should I avoid while taking Topamax?

This medicine may cause some people to have blurred vision, or double vision. If you have this problem while on Topamax call your doctor right away.

It also makes some people feel clumsy, or dizzy, or drowsy, or have trouble in thinking. Be careful about doing things that take good concentration until you find out how Topamax affects you. Alcohol and any other medicine that can cause drowsiness may make this worse.

Topamax can make you sweat less making it easier for you to become overheated. Be careful when you are in hot places not to let yourself get overheated.

You should avoid becoming dehydrated; in other words drink plenty of water every day. This will help prevent kidney stones and help you keep from becoming overheated.
What happens if I overdose?

If you take too much of this medicine you will feel sleepy, have slow thinking, loss of appetite, maybe abnormal heart rate, and problems seeing clearly.
What are the possible side effects of Topamax?

Like all drugs Topamax has side effects. Most of these will get better or even go away completely as your body gets used to the medicine.

Everyone responds differently so let your doctor, pharmacist, and other healthcare professionals know how the medication is effecting you.

Remember the lists of side effect below are only possible problems. Nobody gets them all and very few people get the more serious side effects. This list is to help you know when to contact your doctor or pharmacist. It is not meant to scare you.
More common side effects are:

Clumsiness or unsteadiness; confusion blurred vision, tingling sensations; dizziness; drowsiness; generalized slowing of mental and physical activity; memory problems; nervousness; speech or language problems; trouble in concentrating or paying attention; unusual tiredness or weakness.
Less common side effects are:

Mood or mental changes, including aggression, agitation, apathy, irritability, and mental depression, increased eye pressure; continuous, uncontrolled back-and-forth or rolling eye movements, stomach pain; fever, chills, or sore throat; loss of appetite; changes in the way food tastes, weight loss; menstrual changes.
Rare side effects are:

Sexual problems, painful urination; eye pain; hearing loss; itching; loss of bladder control; nosebleeds; pale skin; red or irritated eyes; ringing or buzzing in ears; blisters; allergy (skin rash; swelling; troubled breathing), yellow eyes or skin, easy bruising.
Are there any risks for taking this medication for long periods of time?

None are known, this medicine is meant to be taken for a long time. In fact, you should not suddenly stop taking Topamax without talking to your doctor first. Your doctor may want gradually lower your dose rather than just stopping Topamax all at once.
What other drugs interact with this medication?

Oral contraceptives (birth control pills) may not work properly if you take them while you are taking topiramate. Unplanned pregnancies may occur. You should use a different or additional means of birth control while you are using Topamax. If you have any questions about this, check with your doctor or pharmacist.

Other drugs that we know interact with Topamax include: acetazolamide (Diamox®), carbamazepine (Tegretol®), dichlorphenamide (Daranide®), dorzolamide (Trusopt®), ethinyl estradiol (is in many different birth control pills, for example: Loestrin®, LoOvral®, Demulen®), evening primrose oil (a natural medicine), fosphenytoin (Cerebyx®), ginkgo ( a natural medicine) , mestranol (Norinyl®, Ortho Novum®), metformin (Glucophage®), methazolamide (Naptazane®), phenobarbital , phenytoin (Dilantin®), and valproic acid (Depakene®, Depakote®)
How long does it take for Topamax to work?

It is also very important not to decide if the medicine is working or not working without giving it a fair chance. It will take several weeks for you and your doctor to see big enough changes to decide if Topamax is the right drug for you. It is very important to tell your doctor, pharmacist, and other health care professionals how you feel things are going during the first two months after you start taking Topamax or after your dose has been changed.

Updated by W. Klugh Kennedy, Pharm.D., BCPP
(February 2006)

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NAMI wishes to thank the College of Psychiatric and Neurological Pharmacists for producing this fact sheet.

Reviewed by Dr. Ken Duckworth, NAMI Medical Director

For further information. Please contact the pharmaceutical company listed below.

Ortho-McNeil Neurologics

1000 Route 202 South
PO Box 300
Raritan, NJ 08869-0602

(800) 526-7736

www.ortho-mcneilneurologics.com

Free or low-cost medications provided by pharmaceutical companies

Some pharmaceutical companies offer medication assistance programs to low-income individuals and families. These programs typically require a doctor’s consent and proof of financial status. They may also require that you have either no health insurance, or no prescription drug benefit through your health insurance. Please contact the pharmaceutical company directly for specific eligibility requirements and application information.

Topamax Rx Assistance Program: 1-800-526-7736

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