Controlling seizures and preventing migraines with topiramate
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The bottom line
Topiramate is prescribed for treatment of seizures and prevention of migraines. Side effects include dizziness, drowsiness, mood changes, other CNS effects, and decreased appetite. More serious effects include kidney stones, acidosis, vision changes, and suicidal thoughts. Topiramate has many drug interactions. It should not be taken when pregnant and can cause birth defects.
Prevention Tips
Store topiramate away and out of reach of children.
Take as prescribed.
Do not take more than prescribed or more often than prescribed.
Do not double your doses if you miss a dose.
Store at room temperature, away from heat and moisture. Do not put in direct sunlight.
Discuss possibility of drug interactions with your doctor or pharmacist.
Contact your doctor immediately if you develop eye problems, pain in back or side with burning pain when urinating, feel very confused, have thoughts of self-harm, or feel an irregular heartbeat with rapid breathing.
Take an approved anticonvulsant or migraine prevention drug if pregnant or planning a pregnancy.
Do not stop taking this medication suddenly since this may cause your seizures to return.
This Really Happened
A 5-year-old boy presented to the emergency department exhibiting lethargy, slurred speech, hallucinations, and intermittent agitation. He had urinary incontinence. All diagnostic tests for acute encephalopathy were normal. The urine drug screen was negative, but the saliva toxicology screen was significant for a high topiramate level. It was not the boy’s medication. It was determined he ingested his mother’s topiramate which she was taking for weight loss. The child’s symptoms completely resolved over a two-day observation period.
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What topiramate prescribed for?
Topiramate is prescribed for the treatment of epilepsy including partial-onset seizures and generalized tonic-clonic seizures. It is also used to prevent migraine headaches. It is prescribed off-label for weight loss, alcohol dependence, and essential tremors.
How does topiramate work?
Topiramate increases the inhibitory neurotransmitter GABA, antagonizes glutamate (an excitatory neurotransmitter) receptors, and blocks sodium channels. All these actions decrease abnormal electrical activity in the brain.
What are the side effects of topiramate?
Side effects of topiramate include dizziness, drowsiness, fatigue, trouble concentrating, trouble finding words, memory problems, nervousness, and mood changes. It can also cause numbness or tingling in the arms and legs, a metallic taste, nausea, diarrhea, and decreased appetite. More serious side effects include kidney stones, metabolic acidosis (decrease in blood pH), sudden vision changes (angle closure glaucoma), and suicidal thoughts. Children may experience slowed growth as well as fever and decreased sweating.
Is topiramate a controlled substance?
No, topiramate is not a controlled substance. It is available by prescription as immediate-release tablets, extended-release capsules, oral solution, and sprinkle capsules. Brand names include Topamax, Qudexy XR, and Tokendi XR. Generic formulations are also available.
What should I avoid while taking topiramate?
Avoid alcohol, CNS depressants, and opioids that can worsen dizziness and drowsiness. If you drink alcohol and take an extended-release formulation, it can change how the drug is released from the capsule.
Topiramate interacts with many drugs. Taking it with carbonic anhydrase inhibitors such as the anticonvulsant zonisamide and the glaucoma drug acetazolamide increases the risk of metabolic acidosis and kidney stones. Metformin (used for diabetes) also increases metabolic acidosis risk.
Topiramate may decrease the effectiveness of oral contraceptives. Taking some drugs with topiramate (such as the anticonvulsant valproic acid and psychotherapeutic drugs amitriptyline and lithium) increase the risk of side effects. It is not recommended in pregnancy since it can cause birth defects (cleft lip/palate), low birth weight, preterm delivery, and neurodevelopmental issues.
What should I do if someone accidentally takes topiramate or takes too much topiramate?
Accidentally taking one pill is unlikely to result in significant toxicity. If you forget to take a dose, take it as soon as you realize that you missed it. Do not double up on your dose to try to ‘catch up.’ If you take an overdose of topiramate, depending on the dose, you may experience confusion, agitation, anxiety, sedation, slurred speech, difficulty walking, tremors, coma, seizures, decreased blood pressure, and metabolic acidosis. Seek medical attention if you are experiencing serious side effects or have taken an overdose.
If someone swallows topiramate or if you have a question about using topiramate safely, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
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