Key takeaways
- To help your body adjust and minimize side effects, your doctor will likely start you on a low dose of topiramate and gradually increase it over several weeks.
- Whether you’re taking it for migraine prevention or seizure control, taking your dose at the same time every day helps keep the medication levels steady in your system.
- Drinking plenty of water while taking topiramate is essential for helping to prevent kidney stones, a known risk of the medication.
Topiramate is an anticonvulsant medication used to treat certain types of seizures and to help prevent migraine headaches. Because it can affect the brain and body in complex ways, doctors usually start treatment with a low dose and gradually increase it. This process, known as titration, helps your body adjust to the medication and reduces the risk of side effects.
- Drug forms: oral tablet, oral sprinkle capsule, oral liquid solution
- Strengths:
- tablets: 25 milligrams (mg), 50 mg, 100 mg, 200 mg
- sprinkle capsules: 15 mg, 25 mg
- liquid solution: 25 mg per milliliter (mL)
- Typical starting dosage: 25 mg to 50 mg per day
- Typical maintenance dosage: 100 mg to 400 mg per day, depending on the condition being treated
The dosage your doctor prescribes will depend on several factors. These include:
- the condition you’re using topiramate to treat
- your age
- other health conditions you may have (such as kidney problems)
- other medications you take
Dosage for migraine prevention
Topiramate is approved by the Food and Drug Administration (FDA) to help prevent migraine headaches in adults and adolescents aged 12 years and older. It is not used to treat a migraine attack once it has already started.
To prevent migraine, the recommended target dose is 100 mg per day, taken in two doses (50 mg in the morning and 50 mg in the evening).
A typical 4-week titration schedule for migraine prevention looks like this:
| Week | Morning dose | Evening dose | Total daily dose |
|---|---|---|---|
| 1 | none | 25 mg | 25 mg |
| 2 | 25 mg | 25 mg | 50 mg |
| 3 | 25 mg | 50 mg | 75 mg |
| 4+ | 50 mg | 50 mg | 100 mg |
Dosage for epilepsy (seizures)
Topiramate is used to treat focal onset seizures and primary generalized tonic-clonic seizures. It can be taken alone (monotherapy) or with other seizure medications (adjunctive therapy).
Monotherapy (adults and children ages 10 years and older):
The recommended maintenance dose is 400 mg per day, taken as 200 mg twice daily. The dose is usually increased over 6 weeks:
- weeks 1 through 4: increased by 50 mg per day each week
- weeks 5 through 6: increased by 100 mg per day each week
Adjunctive therapy (adults and adolescents ages 17 years and older):
If you’re taking topiramate with other medications, the typical maintenance dose for focal onset seizures or Lennox-Gastaut syndrome is 200 mg to 400 mg per day. For primary generalized tonic-clonic seizures, the dose is usually 400 mg per day.
Children’s dosage
For children ages 2 to 9 years (monotherapy) or 2 to 16 years (adjunctive therapy), the dosage is based on their body weight. A doctor will calculate the dose in milligrams per kilogram (mg/kg) of weight.
Typically, the titration begins at a low dose (around 1 to 3 mg/kg per day) and is increased every 1 to 2 weeks until the effective maintenance dose is reached.
- Kidney problems: Topiramate is cleared from the body by the kidneys. If you have moderate to severe kidney disease, your doctor will likely prescribe half the usual adult dose and increase it more slowly.
- Hemodialysis: Because dialysis removes topiramate from the blood, you may need a supplemental dose on dialysis days.
- Liver problems: If you have liver disease, your body may process topiramate more slowly, requiring careful monitoring.
You can take topiramate with or without food, but it’s best to take it at the same times each day. It’s very important to drink plenty of fluids (water) while taking topiramate to reduce the risk of developing kidney stones.
- Tablets: Swallow them whole. Do not crush or chew them, as they have a very bitter taste. If you have difficulty swallowing tablets, ask your doctor or pharmacist for suggestions, or check out these tips for swallowing pills.
- Sprinkle capsules: You can swallow these whole or open them and sprinkle the contents onto a small amount (about a teaspoon) of soft food, like applesauce. Swallow the mixture immediately without chewing.
If you miss a dose of topiramate, take it as soon as you remember. However, if it’s within 6 hours of your next scheduled dose, skip the missed dose and take your next one at the usual time.
Do not take two doses at once to make up for a missed one. If you miss more than one dose, call your doctor for guidance.
Taking too much topiramate can lead to serious symptoms. These include:
- convulsions (seizures)
- extreme drowsiness or lethargy
- speech problems or blurred vision
- agitation or coordination problems
If you think you’ve taken too much topiramate, call 911 or your local emergency number immediately, or contact America’s Poison Centers at 800-222-1222.
No. You should never stop taking topiramate abruptly, as this can cause rebound seizures, even if you don’t have epilepsy. Your doctor will provide a dosing schedule to gradually taper your dose over several weeks.
Yes, weight loss and decreased appetite are common side effects of topiramate. While sometimes prescribed off-label for weight management, you should only use it for this purpose under strict medical supervision. (With off-label use a drug is prescribed to treat a condition it hasn’t been approved for by the FDA.)
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