Topiramate is the generic form of the drug Topamax. It was developed by Ortho-McNeil Pharmaceutical in 1997 as an anticonvulsant medication to treat seizures in individuals with epilepsy. It works by restoring normal electrical brain activity. Since it was first marketed, topiramate has been approved by the FDA for help in treating migraines and as an effective weight loss drug. Its effectiveness for treating addiction and mental health disorders is still under research. Topiramate side effects should be considered before taking the medication.

Introduction to Topiramate and Its Purpose

Topiramate has been effective for the treatment of bipolar disorder and for those with a dual diagnosis of drug addiction and bipolar disorder. For the treatment of mental health and addiction, topiramate helps control moods, stop cravings and prevent individuals from relapsing in recovery. It’s available in tablet or capsule form. Capsules can be taken whole or sprinkled on soft foods like yogurt or applesauce for easy use.

The starting dose for the treatment of seizures is 50 milligrams a day, which increases gradually to 400 milligrams a day. The drug has a half-life of 20 to 30 hours, and it takes about 4 days to build up to a consistent amount in the body.

Common Side Effects of Topiramate

Side effects are common and even expected when someone begins taking topiramate. However, if side effects get severe or affect your overall quality of life, you should speak to your physician immediately. You should avoid driving or other activities that require focus until you see how your body will react. The most common side effects include:

• Weight loss. Topiramate and phentermine have been used together to assist with weight loss in individuals who need to lose a modest amount of weight by suppressing the appetite. In a random clinical trial, topiramate demonstrated the ability to improve blood pressure, lower cholesterol and help patients achieve a weight loss of 5% to 10% in as little as 6 months when used in conjunction with lifestyle modifications such as diet and exercise.
• Tingling in the extremities. Topiramate affects an enzyme in the body called carbonic anhydrase, which is commonly present in nerve tissue. A pins and needles sensation, usually seen in migraine patients, may be felt in the hands and feet as you start taking the medication. The sensation gets better over time as your body begins to adjust to the medication. If the effect becomes bothersome, a change in dosage may be considered, or relief can be sought using capsaicin cream.
• Dizziness. Dizziness is another common side effect with topiramate, but the feeling typically diminishes within a few weeks as the body gets used to the medication. During the initial stages of treatment, avoid driving or operating any heavy machinery, and if dizziness occurs, the individual should sit down and rest until the feeling passes. If dizziness persists for more than a few weeks, it’s important to consult with a physician for a change in dosage.
• Extreme fatigue. Topiramate frequently has a sedative effect, which causes extreme drowsiness and a feeling of constant fatigue. Higher doses or initial use of the medication may trigger this effect. If drowsiness persists, your physician may switch you to an extended-release form of the medication. In rare instances, persistent drowsiness can indicate a condition known as metabolic acidosis.
• Brain fog. Individuals taking topiramate for migraine commonly experience brain fog. Larger doses may lead to confusion, trouble focusing and memory issues and may make speech difficult. Starting with a lower dose and gradually building up over time can help alleviate these problems. If symptoms persist, your physician may recommend an alternative medication.
• Vision problems. While rare, individuals taking topiramate may experience vision problems, especially those with severe migraines. Tunnel vision, peripheral vision loss, ocular pain and intense headaches should be reported to your health care provider.
• Suicidal thoughts. Antiepileptic medications such as topiramate have frequently been linked with suicidal ideation. If you experience any thoughts of hopelessness, it’s important to report them to your physician immediately. These have been shown to occur within 3 weeks of the initial dose and resolve after stopping the medication.
• Kidney problems. Some individuals can’t tolerate the drug, which makes some question the safety of topiramate. Those who experience an allergic reaction to the drug may develop Fanconi syndrome or acute kidney injury and kidney stones. If you’ve had past kidney problems, speak with your physician before starting the medication. An alternative drug may be recommended.

Safety Measures and Risk Management for Topiramate Adverse Reactions

Like many medications, addiction can occur even when you take topiramate as prescribed, and withdrawal symptoms can still occur when someone suddenly stops taking the drug. Tapering off the medication with a physician is recommended, as it can cause seizures even in those who’ve never had them before.

Never combine topiramate with any other medications unless under the supervision of a physician. Even birth control pills can react with topiramate.

Signs of an Overdose

As with any medication, an overdose of topiramate can happen even with patients who take the medication as prescribed.

Symptoms of a topiramate overdose include:

• Stomach pains
• Low blood pressure
• Difficulty concentration
• Fainting
• Difficulty waking

When to Seek Medical Assistance for Topiramate Side Effects

Patients should expect some common side effects when taking topiramate, but it’s important to identify the warning signs of unusual or severe symptoms. Mild side effects typically go away on their own and don’t require medication intervention, but if you experience any serious side effects, you should contact your physician or dial 911 when managing topiramate consequences. Adverse side effects include:

• Difficulty seeing or acute eye pain
• Back pain
• Burning sensation when urinating
• Irregular heartbeat
• Lack of sweat in hot weather
• Difficulty swallowing
• Trouble breathing or fast respiration rate
• Blue, gray or pale appearance of the lips or tongue
• Becoming limp or unresponsive
• Raised rash or blistering

Getting Help for Topiramate Side Effects

If you or someone you love is taking topiramate and is concerned about the medication risks and benefits, contact one of our counselors at Sunlight Recovery. We offer several options for addiction and mental health treatment and those going through recovery.