Topiramate for epilepsy

Examples

Generic Name	Brand Name
topiramate	Topamax

Topiramate is taken several times each day. Topiramate comes in tablets and capsules, which can be opened and sprinkled on food.

How It Works

It is not known exactly how topiramate prevents seizures.

Why It Is Used

Topiramate may be used alone or in combination with other antiepileptic drugs to control partial seizures in children ages 2 to 12.¹ It may also be used alone to treat children and adults with newly diagnosed epilepsy and generalized tonic-clonic seizures.²

How Well It Works

Topiramate seems to work as well as carbamazepine to treat partial seizures. It works as well as valproic acid to treat generalized tonic-clonic seizures.²

It may also help control seizures caused by Lennox-Gastaut syndrome.¹

Side Effects

Common side effects of topiramate include:

• Drowsiness.
• Dizziness.
• Fatigue.
• Lack of coordination.
• Loss of appetite.
• Inability to concentrate or speak clearly.
• Nervousness.

Topiramate has been linked in a small number of people to a potentially life-threatening condition called metabolic acidosis. Symptoms of metabolic acidosis include fatigue, lack of appetite, and rapid breathing (hyperventilation). If left untreated, metabolic acidosis can lead to death.

The U.S. Food and Drug Administration (FDA) has issued a warning on antiepileptic medicines and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take antiepileptic medicine should be watched closely for warning signs of suicide. People who take antiepileptic medicine and who are worried about this side effect should talk to a doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

• Side effects. While topiramate is tolerated well by most people and has few serious side effects, a small number of people who take the drug may develop kidney stones, decreased sweating with increased body temperature, or a type of glaucoma. Another warning links topiramate use to metabolic acidosis in some people.
• Drug interactions. Many medicines for epilepsy can interact with other medicines you may be taking. This means that your epilepsy medicine may not work as well, or it may affect the way another medicine you are taking works. Some of these interactions can be dangerous. It is important to tell your doctor about all the medicines, herbal pills, and dietary supplements you are taking. Topiramate may make birth control pills less effective. A woman taking topiramate may need to use another method of birth control to reduce her chances of becoming pregnant.
• Risk of birth defects. All medicines for epilepsy have some risk of birth defects. But the risk of birth defects needs to be carefully compared to other risks to the baby if the mother stops taking her epilepsy medicine. If you are thinking about becoming pregnant, it is important to plan ahead and talk with your doctor about the benefits and risks of taking epilepsy medicine during your pregnancy. It you are already pregnant, it is not too late. The best thing to do is talk to your doctor about your pregnancy before you make any changes to the medicines you are taking.
• Cost. Topiramate is expensive.
• Other concerns. For some people, topiramate may cause side effects or carry risks that are not yet fully known. Report any unexpected side effects or problems to your doctor.

It may take time and careful, controlled adjustments by you and your doctor to find the combination, schedule, and dosing of medicine to best manage your epilepsy. The goal is to prevent seizures while causing as few unwanted side effects as possible. After you and your doctor figure out the most effective medicine program for you, it is important that you follow it exactly as prescribed.

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Author:	Monica Rhodes	Last Updated: October 29, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Theresa O'Young, PharmD - Clinical Pharmacist Steven C. Schachter, MD - Neurology
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