Topiramate

General Information and Indications:

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.

Information For Users:

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, ask your doctor or pharmacist If you have any questions. Take topiramate exactly as directed. Do not take more or less of it or take it more often than prescribed by your health care provider.

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 slowly increase your dose, not more than once every week.

Topiramate may control your seizures but will not cure your condition. Continue taking topiramate even if you feel well. Do not discontinue taking topiramate without informing 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:

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

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.

Special precautions:

o Inform your doctor or pharmacist if you have allergy to topiramate or any other medications.
o Inform 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.
o Inform 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.
o Inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking topiramate, call your doctor.
o if you are having surgery, including dental surgery, Inform your doctor or dentist that you are taking topiramate.
o 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.
o ask your doctor about the safe use of alcoholic beverages while you are taking topiramate. Alcohol can cause seizures or make seizures worse.
o if you are taking oral contraceptives (birth control pills), Inform your doctor if unexpected bleeding or spotting occurs. Topiramate can decrease the effectiveness of oral contraceptives.
o 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 Inform your doctor if you have a fever, headache, muscle cramps, an upset stomach, or are not sweating as usual.
o 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.

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.

Possible Adverse Effects:

Topiramate can cause hypoglycemia (low blood sugar), especially in children. Eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, and call your doctor without delay if you have any of the symptoms of hypoglycemia:

o shakiness
o lightheadedness or dizziness
o sweating
o confusion
o nervousness or irritability
o sudden changes in behavior or mood
o headache
o numbness or tingling around the mouth
o weakness
o pale skin
o sudden hunger
o clumsy or jerky movements
o seizures

Topiramate may have other adverse effects. Inform your doctor if any of the following symptoms are severe or do not go away:

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

Some adverse effects could be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor without delay:

o blurred vision (Impaired vision)
o eye pain
o double vision (diplopia)
o tingling in fingers or toes
o hand tremor, shaking hands
o restlessness, inability to sit still
o crossed eyes
o worsening of seizures
o slow heart rate
o pounding or irregular heartbeat
o chest pain
o problem with breathing
o fast, shallow breathing
o inability to respond to things around you
o upset stomach
o vomiting
o stomach pain
o loss of appetite (anorexia)
o excessive hunger
o unintentional loss of urine
o difficult or painful urination
o unusual bruising or bleeding
o sore throat, fever, chills, and other signs of infection
o muscle weakness
o 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.

Possible Symptoms of Overdose:

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

Brand Name(s):

o Topamax®