What are the side effects of Topamax (topiramate)?

From the Guidelines

Topamax (topiramate) can cause several side effects, including cognitive dysfunction, paresthesia, headache, fatigue, nausea, dizziness, or mood problems, as reported in a recent study 1.

Common Side Effects

• Cognitive dysfunction
• Paresthesia
• Headache
• Fatigue
• Nausea
• Dizziness
• Mood problems

Serious Side Effects

• Kidney stones
• Increased risk of glaucoma
• Metabolic acidosis
• Suicidal thoughts or behavior
• Birth defects if taken during pregnancy
• Decreased effectiveness of hormonal contraceptives

Dose-Dependent Side Effects

• Higher doses causing more pronounced effects
• Many side effects are most noticeable when starting the medication or increasing the dose, and often improve over time

Recommendations

• Doctors typically start with a low dose (usually 25mg daily) and gradually increase to the target dose over several weeks
• Staying well-hydrated is important to reduce the risk of kidney stones
• If experiencing concerning side effects, patients should contact their healthcare provider rather than stopping the medication abruptly, as suggested by recent guidelines 1 and studies 1.

From the FDA Drug Label

TOPIRAMATE may cause the following side effects which can be serious: metabolic acidosis. Metabolic acidosis is a condition that happens when there is too much acid in your blood. Metabolic acidosis can cause symptoms such as tiredness, loss of appetite, irregular heartbeat, and impaired consciousness. eye problems. Serious eye problems include: a sudden decrease in vision (acute myopia) with or without eye pain and a blockage of fluid in the eye causing increased pressure in the eye (secondary angle closure glaucoma) decreased sweating (oligohidrosis) and increased body temperature (fever). effects on thinking and alertness. TOPIRAMATE may affect thinking skills and cause confusion, problems with concentration, attention, memory, and/or speech TOPIRAMATE may cause depression or mood problems, tiredness, and sleepiness. dizziness or loss of muscle coordination in patients who take TOPIRAMATE alone or with other seizure medicines. high blood ammonia levels and effects on mental activities kidney stones. tingling of the arms and legs (paresthesia) is a common side effect of TOPIRAMATE. Other side effects with TOPIRAMATE include loss of appetite, nausea, a change in the way foods taste, diarrhea, weight loss, nervousness, aggression, upper respiratory tract infection.

The side effects of Topamax (topiramate) include:

• Metabolic acidosis: a condition with too much acid in the blood, causing symptoms like tiredness, loss of appetite, and irregular heartbeat
• Eye problems: serious issues like sudden vision decrease, eye pain, and increased eye pressure
• Decreased sweating and fever: especially in children, requiring close monitoring
• Effects on thinking and alertness: confusion, concentration problems, and speech issues
• Depression or mood problems: tiredness, sleepiness, and other mental health concerns
• Dizziness or loss of muscle coordination: alone or with other seizure medicines
• High blood ammonia levels: affecting mental activities
• Kidney stones: decreased risk with plenty of fluids
• Tingling of arms and legs: a common side effect
• Other side effects: loss of appetite, nausea, taste changes, diarrhea, weight loss, nervousness, aggression, and upper respiratory tract infection 2

From the Research

Common Side Effects of Topamax

• Weight loss
• Diarrhea
• Dizziness
• Sleepiness
• Fatigue
• Coordination issues
• Mental health issues like memory problems, confusion, and speech or language difficulties 3

Ophthalmic Side Effects

• Choroidal effusion syndrome
• Angle-closure glaucoma
• Myopic shift
• Retinal problems
• Uveitis
• Visual field defects
• Myokymia
• Neuro-ophthalmology complications 3

Renal Side Effects

• Increased risk of kidney stone formation due to systemic metabolic acidosis, lower urinary citrate excretion, and increased urinary pH 4
• Nephrolithiasis, with a prevalence of symptomatic nephrolithiasis of 10.7% in topiramate-treated patients 5
• Asymptomatic nephrolithiasis detected by CT scan in 20% of topiramate-treated patients with no history of symptomatic stone disease 5

Other Side Effects

• Paresthesia
• Confusion
• Fatigue
• Dizziness
• Change in taste
• Acute glaucoma
• Metabolic acidosis
• Hepatotoxicity
• Teratogenicity 6