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Topiramate

toe pyre' a mate

Brand name(s): Topamax®

Why is this medication prescribed?

Topiramate is used with other medications to treat certain types of seizures in patients with epilepsy or Lennox-Gastaut syndrome (a disorder that causes seizures and developmental delays). Topiramate is used to treat patients who continue to have seizures even when they take other anti-seizure medications. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.

How should this medicine be used?

Topiramate comes as a tablet and a sprinkle capsule to take by mouth. It is usually taken with or without food twice a day in the morning and evening. Take topiramate at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take topiramate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Topiramate tablets have a bitter taste and lose their effectiveness quickly when broken, so you should swallow them whole. Do not split, chew, or crush them.

Your doctor will probably start you on a low dose of topiramate and gradually increase your dose, not more than once every week.

Topiramate may control your seizures but will not cure your condition. Continue to take topiramate even if you feel well. Do not stop taking topiramate without talking to your doctor. If you suddenly stop taking topiramate, you may have severe seizures. Your doctor will probably decrease your dose gradually.

The sprinkle capsules may be swallowed whole or opened and poured over food. To take the sprinkle capsule with food, follow these steps:

• Prepare a teaspoonful of soft food such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt.
• Hold the capsule upright over the food. You should be able to read the word 'TOP' on the capsule.
• Twist off the clear part of the capsule and pour the entire contents onto the spoonful of food.
• Swallow the entire mixture immediately without chewing.
• Have a drink to wash down the mixture and to be sure that you swallow all of it.

Other uses for this medicine

Topiramate is also sometimes used to treat cluster headaches and infantile spasms (a condition that causes uncontrolled stiffening of the body in babies). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking topiramate,

• tell your doctor and pharmacist if you are allergic to topiramate or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: acetazolamide (Diamox); antidepressants; antihistamines; cholestyramine (Questran); dichlorphenamide (Daranide); digoxin (Lanoxin, Digitek); ipratropium (Atrovent); iron; isoniazid (INH, Nydrazid); medications for irritable bowel disease, mental illness, motion sickness, Parkinson's disease, ulcers, or urinary problems; metformin (Glucophage); methazolamide; oral contraceptives (birth control pills); other medications for seizures such as carbamazepine (Tegretol), and phenytoin (Dilantin, Phenytek); salicylate pain relievers such as aspirin, choline magnesium trisalicylate (Trisalate), choline salicylate (Arthropan), diflunisal (Dolobid), magnesium salicylate (Doan's, others), and salsalate (Argesic, Disalcid, Salgesic); sedatives; sleeping pills; tranquilizers; valproic acid (Depakene, Depakote); and zonisamide (Zonegran). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you or any family members have or have ever had kidney stones, if you drink or have ever drunk large amounts of alchohol, and if you have or have ever had diabetes; glaucoma (a type of eye disease); nearsightedness; any disease that affects your breathing such as asthma or chronic obstructive pulmonary disease (COPD); or liver or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking topiramate, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking topiramate.
• you should know that topiramate may make you drowsy, dizzy, confused, or unable to concentrate. Do not drive a car or operate machinery until you know how this medication affects you.
• ask your doctor about the safe use of alcoholic beverages while you are taking topiramate. Alcohol can cause seizures or make seizures worse.
• if you are taking oral contraceptives (birth control pills), tell your doctor if unexpected bleeding or spotting occurs. Topiramate can decrease the effectiveness of oral contraceptives.
• you should know that topiramate can prevent you from sweating and make it harder for your body to cool down when it gets very hot. This happens most often in warm weather and to children who take topiramate. Avoid exposure to heat, drink plenty of fluids and tell your doctor if you have a fever, headache, muscle cramps, an upset stomach, or are not sweating as usual.
• you should know that you may be more likely to develop a kidney stone while you are taking topiramate. Drink 6-8 glasses of water every day to prevent kidney stones from forming.

What special dietary instructions should I follow?

Talk to your doctor about increasing the amount of food you eat if you lose weight while you are taking topiramate.

Talk to your doctor before changing your diet or beginning any type of weight loss program. Do not follow a ketogenic diet (a high-fat, low-carbohydrate diet used to control seizures) or any other high-fat, low-carbohydrate diet, such as the Atkin's diet, while taking this medication.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. You may have seizures if you miss doses of topiramate.

What side effects can this medication cause?

Topiramate can cause hypoglycemia (low blood sugar), especially in children. If you have any of these symptoms, eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, and call your doctor immediately. Symptoms of low blood sugar include:

• shakiness
• dizziness
• rapid heartbeat
• sweating or confusion
• blurred vision
• headache
• numbness or tingling of the mouth
• weakness
• fatigue
• pale color
• sudden hunger

Topiramate may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• slow thinking or movements
• difficulty concentrating
• speech problems, especially difficulty thinking of specific words
• memory problems
• lack of coordination
• trouble walking
• confusion
• nervousness
• aggressive behavior
• irritability
• mood swings
• depression
• headache
• extreme tiredness
• drowsiness
• weakness
• extreme thirst
• weight loss
• constipation
• diarrhea
• gas
• heartburn
• change in ability to taste food
• swelling of the tongue
• overgrowth of the gums
• dry mouth
• increased saliva
• trouble swallowing
• nosebleed
• teary or dry eyes
• back, muscle, or bone pain
• missed menstrual periods
• excessive menstrual bleeding
• skin problems or changes in skin color
• dandruff
• hair loss
• growth of hair in unusual places
• runny nose
• difficulty falling or staying asleep

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• blurred vision
• eye pain
• double vision
• tingling in fingers or toes
• shaking hands that you cannot control
• restlessness, inability to sit still
• crossed eyes
• worsening of seizures
• slow heart rate
• pounding or irregular heartbeat
• chest pain
• trouble breathing
• fast, shallow breathing
• inability to respond to things around you
• upset stomach
• vomiting
• stomach pain
• loss of appetite
• excessive hunger
• unintentional loss of urine
• difficult or painful urination
• unusual bruising or bleeding
• sore throat, fever, chills, and other signs of infection
• muscle weakness
• bone pain

Topiramate may cause osteoporosis (a condition in which bones can break more easily) in adults and rickets (abnormal, curved bone growth) in children. Topiramate may also slow the growth of children. These conditions can be caught early and prevented through regular laboratory tests. Talk to your doctor about the risks of taking topiramate.

Topiramate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Tablets should be stored at room temperature and away from excess heat and moisture (not in the bathroom). Sprinkle capsules should be stored at or below 77° F. Never store broken tablets or mixtures of sprinkles and soft food. These should be used right away or thrown away. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• seizures
• drowsiness
• speech problems
• blurred vision
• double vision
• trouble thinking
• tiredness
• loss of coordination
• loss of consciousness
• coma
• fainting
• dizziness
• stomach pain
• upset stomach
• vomiting
• excessive hunger
• agitation
• depression
• shortness of breath
• confusion
• loss of appetite
• pounding or irregular heartbeat
• fast, shallow breathing
• inability to respond to things around you
• muscle weakness
• bone pain

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to topiramate.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Last Revised - 04/01/2004

American Society of Health-System Pharmacists, Inc. Disclaimer

The MedMaster™ Patient Drug Information database provides information copyrighted by the American Society of Health-System Pharmacists, Inc., Bethesda, Maryland Copyright© 2004. All Rights Reserved.

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