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At a glance

Topiramate is used to treat epilepsy (seizures) and to prevent migraines. It is also used in the treatment of Lennox-Gastaut syndrome. It controls seizures by decreasing abnormal and excessive activity of nerve cells in the brain.

Indications
  • Epilepsy/Seizures
  • Prevention of migraine
  • Lennox-Gastaut syndrome
Pharmacology

Topiramate stimulates GABA-A receptor activity and reduces glutamate activity at AMPA and kainate receptors. It also blocks voltage-dependent sodium channels. These actions decrease neuronal excitability, preventing seizures and migraines.

Dosage

Adult Dose (Oral):

  • Epilepsy monotherapy: 25 mg nightly initially; increase by 50 mg/day weekly; up to 200 mg twice daily
  • Epilepsy adjunctive therapy: 25-50 mg/day initially; 100-200 mg twice daily
  • Migraine prophylaxis: 25 mg nightly for 1 week; titrate to 50 mg twice daily over 4 weeks
  • Renal impairment: Halve the dose
Side effects

Common Side Effects:

  • Abdominal pain
  • Diarrhea
  • Dizziness
  • Fatigue
  • Fever
  • Loss of appetite
  • Memory impairment
  • Nausea
  • Sleepiness
  • Weight loss
Use in pregnancy

Use in Pregnancy: Unsafe; definite evidence of risk to the developing baby; consult your doctor.

Pregnancy Category: C — always consult a doctor before taking during pregnancy.

Precautions & warnings
  • May decrease alertness; do not drive
  • Regular monitoring of serum bicarbonate levels required
  • Drink plenty of fluids to reduce risk of kidney stones
  • Do not stop medication suddenly
  • Report sudden mood changes or suicidal thoughts
Overdose effects

Symptoms: Severe metabolic acidosis.

Treatment: Gastric lavage, activated charcoal, supportive care; hemodialysis is effective.

Storage conditions

Keep below 30°C, away from light and moisture; keep out of reach of children.

Topiramate — see the full informationPharmacology, precautions, pregnancy, overdose and the rest on the generic page
⚠️ This information is for educational purposes only — not a substitute for medical advice. Consult a registered physician before taking any medicine.