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Aug 23, 2023


Anti-seizure Drug

What do you need to know about topiramate

What is Topiramate?

Topiramate is a medication approved for the treatment of a seizure disorder (epilepsy) under three different criteria.

  • Treatment as an individual medication for management of focal onset or primary tonic-clonic seizures for individuals aged 2 years and older, or
  • Treatment as an adjunctive medication for individuals (adults and children aged 2–16) who experience focal onset or primary generalized tonic-clonic seizures, or
  • Treatment as an adjunctive medication for individuals ages 2 years and older with Lennox-Gastaut syndrome-associated seizures.

Lennox-Gastaut is a very severe form of epilepsy. It typically presents at a young age (under 4 years old). Patients with this condition can experience many different types of seizures, including both tonic-clinic and absence seizures, as well as others.

Interestingly, topiramate has also been approved by the FDA for prevention of migraine headaches when an individual does not respond to therapies that typically resolve a migraine as it occurs.

What is a seizure disorder?

Seizures are episodes of uncontrolled electrical activity in the brain, which can manifest in a number of different ways. For example, an absence seizure presents as individuals becoming unresponsive and “staring off into space”. On the other hand, tonic-clonic seizures (otherwise known as grand-mal seizures) are more visually apparent, and manifest as both tonic (stiffness) and clonic (jerking/twitching) uncontrollable muscle movements.

A seizure disorder is a condition in which an individual is predisposed to experiencing seizures. For example, epilepsy is a specific seizure disorder diagnosed when an individual has had two or more unprovoked seizures.

Seizures can be very dangerous when left uncontrolled, and therefore medication management is essentially always necessary when someone has been diagnosed with a seizure disorder.

Learn more about Types of Seizures

Typical side effects

Topiramate has a number of possible side effects. With this medication, side effects tend to be related to dose, and a higher dose tends to result in more severe side effects. The most common side effects of topiramate include:

  • Tingling in hands and feet
  • Tiredness
  • Headache
  • Drowsiness
  • Dizziness
  • Increased incidence of upper respiratory tract infection
  • Weight loss
  • Depression
  • Nausea
  • While not everyone experiences any/all these effects, it is important to be aware of possible changes to your body that occur following initiation of a new medication.

    Learn more about Risks of anti-seizure medications

    Serious (rare) dangers of taking topiramate

    Alterations to Brain Function

    Sometimes topiramate can cause changes or damage to the brain. This is sometimes called “encephalopathy” which refers to any change to the function or physical structure to the brain. Symptoms of encephalopathy include:

    • changes to mental function
    • sluggishness
    • nausea and vomiting.

    Encephalopathy typically occurs after initiation of topiramate or following a dose increase. It is therefore important to monitor yourself for any changes to your mental status while taking this medication.

    Increased body temperature

    There have been rare reports of abnormally increased body temperatures (called “hyperthermia”) during treatment with topiramate. This increased temperature causes increased sweating, and rarely, has led to hospitalizations and even death. It is therefore important for individuals taking topiramate, particularly children, to be monitored for abnormal increases in body temperature.

    Metabolic acidosis

    Typically, your body has a balance of both “acidic” and “basic” components to ensure your body stays appropriately stabilized. However, topiramate sometimes causes a decrease in the basic components in the blood, which can cause a dysregulation and therefore the blood to be abnormally acidic. This can be very dangerous. It is therefore recommended to measure a baseline level of the acidity of the blood and do regular follow-ups throughout treatment. Some symptoms to monitor for include tiredness, weight loss, and rapid/deep breathing.

    Visual changes

    Various changes in eye health and sight have been observed within the first month following administration of topiramate. These changes include alterations in visual activity and glaucoma (increased internal eye pressure). If you experience any blurriness or pain in your eyes, it is therefore important to speak with a healthcare provider.


    There are many medications that can possibly interact with topiramate due to the specific way it is broken down in our bodies. This is the case for many other anti-seizure medications, as well as other medications such as oral contraceptives, digoxin, and metformin when taken in combination with topiramate. There is often an increase or decrease in concentrations of either or both medications when taken in combination, which must be taken into consideration in terms of dose adjustment when starting topiramate.

    There are also medications that must be completely avoided in combination with topiramate due to dangers with the combination. This includes:

    • Valproic acid
      Coadministration of valproic acid with topiramate increases the risk of a number of adverse effects. For example, the combination of medications has been associated with higher risk of developing encephalopathy as well as increased risk of hypothermia (decreased body temperature).
    • Alcohol
      Due to the similar depressant actions to the central nervous system of both topiramate and alcohol, drinking alcohol while taking topiramate can cause too much depression of the nervous system and therefore be dangerous. It is therefore recommended to avoid alcohol completely while taking topiramate, especially within 6 hours of administration, if you are taking topiramate extended release.

    Pregnancy or breastfeeding

    Topiramate is not the first choice of anti-seizure medication for women of childbearing potential due to the possible physical risks to the fetus. If you are taking this medication to prevent seizures and do become pregnant, it is important to speak to a healthcare provider about the choice between staying on the medication despite the possible risks to the fetus versus the dangers of being taken off effective medication. However, if taking topiramate for migraine prevention, it is almost always recommended to cease medication therapy, as in terms of safety, the benefit does not outweigh the risks.

    Though there are not many thorough studies on the topic, it is thought that topiramate is excreted into breastmilk from the mother’s blood. From observation, it has been thought that babies breastfed by individuals taking topiramate experience an increase in diarrhea and drowsiness. Therefore, once again, the benefit of medication for the woman must be weighed against the risk to the baby.

    Get your topiramate prescription for less when you buy a longer supply

    Topiramatee is on our Wholesale Price List. Each medication on the list is available for $37 for 6 months or $70 for a year without insurance. That's less than $6/month cash price.

    Since topiramate is typically taken long-term, it is both convenient and cost-effective to buy your medication in longer supply. You are not only able to reduce your frequency of trips to the pharmacy, but you also then avoid paying multiple pharmacy dispensing fees from multiple prescription pickups throughout the year.

    We are able to price our prescriptions this way because we buy our medications from accredited wholesalers rather than insurance companies. This way, we are able to bypass the step that is usually responsible for hiking up drug costs for consumers. You are therefore able to get your medications from Marley Drug at prices competitive with even the best insurance plans.

    To learn more about how you can get your oxcarbazepine prescription from Marley Drug, just call us at 1-800-810-7790.

    Prices mentioned in this article are based on average retail price at major box chain pharmacy in the U.S. as of January 21, 2023.


    1. Topiramate (generic Topamax)– Access data FDA-Approved Drugs [Internet]. [Released 2009; Amended 10/2012; accessed 01/2023].
    2. “Lennox-Gastaut Syndrome.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, Accessed 13 January 2023.

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