TM Owner Janssen
Topamax 100mg Tablet
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Indications & Clinical Uses
- Topamax (topiramate) 100 mg tablets contain topiramate, an anticonvulsant used alone or with other medicines to control partial-onset seizures and primary generalised tonic-clonic seizures in adults and children aged 2 years and older, and as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome.
- Topamax is also approved, typically at doses up to 100 mg per day, for the prevention of migraine headache in adults; it is not a treatment for a migraine attack already under way.
- Topiramate is available generically worldwide as well as under the Topamax brand, marketed in the United States by Janssen Pharmaceuticals.
- The 100 mg strength is one of four tablet strengths (25, 50, 100 and 200 mg); Topamax is also supplied as 15 mg and 25 mg Sprinkle Capsules for patients who cannot swallow tablets - the two forms are not interchangeable strength-for-strength.
- Topamax tablets are taken by the patient at home, usually twice daily.
Side Effects
- Topamax has no boxed warning.
- The most common side effects, some affecting more than 1 in 10 people, include tingling in the hands and feet (paresthesia), drowsiness, dizziness, slowed thinking and difficulty concentrating or finding words, fatigue, and loss of appetite with weight loss; for migraine prevention, taste disturbance and diarrhoea are also frequent.
- Like other antiepileptic drugs, Topamax carries a warning that it can increase the risk of suicidal thoughts or behaviour, so any new or worsening depression, anxiety or unusual thoughts should be reported at once.
- It can also cause kidney stones, metabolic acidosis (a build-up of acid in the blood, sometimes silent), decreased sweating with fever in hot weather (especially in children), and rarely a sudden-onset eye problem with blurred vision and eye pain that needs same-day medical attention.
- Report any of these urgent symptoms to your healthcare provider immediately.
Precautions & Warnings
- Before starting Topamax, tell your healthcare provider about kidney stones, metabolic acidosis risk factors, glaucoma, depression, liver or kidney disease, and osteoporosis risk, since topiramate can reduce bone density with long-term use.
- Topamax can cause fetal harm, including a higher risk of cleft lip/palate and babies born small for their gestational age; use effective, reliable contraception, because Topamax can also make hormonal contraceptives less effective, particularly at doses above 200 mg per day, increasing the chance of breakthrough bleeding and unplanned pregnancy.
- Drink plenty of fluids to reduce kidney stone risk, and avoid a ketogenic diet or other carbonic-anhydrase inhibitors without medical advice.
- Topamax can slow thinking, impair concentration and cause drowsiness, so do not drive or use machinery until you know how it affects you.
- Never stop Topamax suddenly, as this can trigger seizures; any dose change should be gradual and medically supervised.
Avoid Interactions
- Topamax reduces the effectiveness of hormonal contraceptives (the pill, patch or ring) at higher doses, so discuss a back-up or non-hormonal method with your provider.
- Combining Topamax with alcohol, sedatives, opioids or other central nervous system depressants increases drowsiness and impaired thinking.
- Taking it with valproic acid (another antiepileptic) can raise ammonia levels and cause hypothermia or confusion, sometimes without a rise in liver enzymes.
- Other carbonic-anhydrase inhibitors and a ketogenic diet add to the risk of kidney stones and metabolic acidosis.
- Lithium levels may need monitoring when combined with high-dose Topamax.
- Topiramate can also raise or lower levels of other antiepileptic drugs such as phenytoin, and its own clearance can be altered by enzyme-inducing medicines like carbamazepine.
- Tell your healthcare provider and pharmacist about every prescription, over-the-counter medicine, herbal product and supplement you take.
References
Frequently Asked Questions
Topamax 100 mg (topiramate) treats partial and generalised tonic-clonic seizures in adults and children from age 2, either alone or alongside other antiepileptic drugs. It's also used, usually at lower doses, to prevent migraine headaches in adults. It does not stop a migraine that has already started.
Topamax tablets are swallowed whole with water, usually twice a day, with or without food; doses are started low and increased gradually. Never crush or chew them - the taste is unpleasant. Do not stop Topamax suddenly, as this can trigger seizures; any change needs your provider's guidance.
Common Topamax side effects are tingling hands and feet, drowsiness, dizziness, slowed thinking and weight loss. Like other antiepileptics, it can raise the risk of suicidal thoughts. Watch for sudden blurred vision and eye pain, reduced sweating with fever, or signs of a kidney stone, and get medical help urgently.
Avoid alcohol and other sedating drugs with Topamax, as drowsiness adds up. It can make birth control pills less effective at doses above 200 mg a day, so use a back-up method. Avoid ketogenic diets and other carbonic-anhydrase inhibitors, which raise the risk of kidney stones and metabolic acidosis.
If you miss a Topamax dose, take it as soon as you remember unless your next dose is close, then skip it - never double up. Missing doses can increase seizure risk, so set reminders and keep taking Topamax at evenly spaced times each day.
Topamax can harm an unborn baby, raising the risk of cleft lip/palate and small-for-gestational-age infants, so it's used in pregnancy only if the benefit outweighs the risk. Because it can also reduce contraceptive pill effectiveness, discuss reliable contraception and pregnancy planning with your provider before stopping or starting Topamax.
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