Topiramate (Topamax) Prescription

Topamax (Topiramate) is a prescription anticonvulsant (anti-epileptic drug). It is used to treat epilepsy (prevent seizures) in adults and children who are at least 2 years old.

Topamax is also used to prevent migraine headaches and reduce the number of attacks. It will not treat a headache that has already begun. It is also an effective option for the preventive treatment of episodic and chronic cluster headache.

Prescription for weight loss: Does it work?

There is good evidence that Topiramate promotes weight loss and suppresses the appetite1-6. However, the drug is not FDA approved as obesity treatment. Ortho-McNeil prematurely stopped a large phase III program for Topamax as a weight-loss medication because of emotional and cognitive side effects.

Nevertheless, the research data shows that Topiramate may be useful to manage excess weight. In most studies, about 60% of people experienced weight loss1-6. Topamax may promote weight reduction of up to 15-18% of the baseline weight.

Weight loss on topiramate has been reported in people suffering from bipolar disorder who gained weight due to psychotropic medications3. The small study found that Topamax may be effective for SSRI-induced weight gain4. Results of another study suggest that Topamax may be effective for maintaining weight following a low-calorie diet5.

The exact mechanism of action regarding weight loss is still uncertain. It seems to be related to: increase of energy expenditure, reduction in the activity of salivary enzymes responsible for taste, reduction in leptin and corticosteroid concentrations, and reduction of glucose and insulin levels.

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Topamax for Bipolar disorder

Topiramate appears to show promise as an addition to the medications used to treat bipolar disorder. Research data suggests a 50-65% response for refractory bipolar mania, and a 40-56% response for refractory bipolar depression. Side effects of topiramate in bipolar individuals include attention, concentration and memory problems, fatigue, sedation, transient paraesthesias, nausea, and anorexia.

How to take

• Topamax can be taken with or without food. Avoid breaking the tablets as the medication has a bitter taste.
• The drug may increase the risk of developing kidney stones. To prevent this problem, be sure to take Topiramate with plenty of fluids.
• Topiramate has been known to cause a potentially serious condition known as metabolic acidosis (an increase of acid in the blood). Contact your doctor immediately if you experience symptoms of metabolic acidosis such as rapid breathing, an irregular heartbeat, confusion, lethargy, fatigue, or loss of appetite.
• Seek emergency medical attention if you have a sudden change in vision and pain around or behind the eyes. Topamax has been known to trigger severe nearsightedness along with increased pressure inside the eye. The problem usually occurs within 1 month of starting treatment.

Topamax dosage recommendations

Seizures
Topamax therapy usually begins with a dose of 50 mg once daily during the first week. The daily dosage is then increased each week until, by the eighth week, the patient is taking 200 mg twice a day. If you are also taking Dilantin or Tegretol, the dosage of Topamax may need adjustment.

Prevention of Migraine Headaches
The recommended total daily dose is 100 mg a day, taken in two divided doses. Your doctor will increase the dose slowly over 4 weeks.
The usual regimen is as follows: Week 1: No morning dose; take 25 mg at night. Week 2: Take 25 mg in the morning and again at night. Week 3: Take 25 mg in the morning and 50 mg at night. Week 4: Take 50 mg in the morning and again at night.

The usual Topiramate daily dose for children 2 to 16 years of age is 5 to 9 mg for every 2.2 pounds of body weight, divided into two doses. Topamax therapy usually begins with a dose of 25 mg (or less) once daily during the first week. The daily dosage is then increased each week until the doctor is satisfied with the patient's response. It may take eight weeks to reach the ideal dose.

For people with poor kidney function, the dosage is usually cut in half. Likewise, the doctor may adjust your dosage if you have liver problems.

Read the manufacturer's patient information sheet when you start treatment with Topiramate or Topamax, particularly when you buy the medication without a prior prescription from your doctor.

• 1. McElroy SL, Frye MA, Altshuler LL A 24-week, randomized, controlled trial of adjunctive sibutramine versus topiramate in the treatment of weight gain in overweight or obese patients with bipolar disorders. Bipolar Disord. 2007 Jun;9(4):426-34.
• 2. Leombruni P, Lavagnino L, Fassino S. Treatment of obese patients with binge eating disorder using topiramate: a review. Neuropsychiatr Dis Treat. 2009;5:385-92. PubMed
• 3. Tremblay A, Chaput JP. The effect of topiramate on energy balance in obese men: a 6-month double-blind randomized placebo-controlled study with a 6-month open-label extension. Eur J Clin Pharmacol. 2007 Feb;63(2):123-34.
• 4. Van Ameringen M, Mancini C, Pipe B, Campbell M, Oakman J. Topiramate treatment for SSRI-induced weight gain in anxiety disorders. J Clin Psychiatry. 2002 Nov;63(11):981-4. PubMed
• 5. Astrup A, Caterson I, Zelissen P, Guy-Grand B, Carruba M, Levy B, Sun X, Fitchet M. Topiramate (Topamax): long-term maintenance of weight loss induced by a low-calorie diet in obese subjects. Obes Res. 2004 Oct;12(10):1658-69. PubMed
• 6. Klein KM, Theisen F, Knake S, Oertel WH, Hebebrand J, Rosenow F, Hamer HM. Topiramate, nutrition and weight change: a prospective study. J Neurol Neurosurg Psychiatry. 2008 May;79(5):590-3.