What is topiramate used for?

From the Guidelines

Topiramate is primarily used to treat epilepsy, prevent migraine headaches, and as part of a combination therapy for weight loss in adults with obesity. It's an anticonvulsant medication that works by decreasing abnormal electrical activity in the brain. For epilepsy, typical dosing starts at 25-50 mg daily and gradually increases to 200-400 mg daily in divided doses, while for migraine prevention, dosing usually starts at 25 mg daily and increases to 100 mg daily in divided doses 1. Topiramate is also sometimes prescribed off-label for bipolar disorder, weight loss, alcohol dependence, and certain pain conditions. Some key points to consider when using topiramate include:

• The medication works through multiple mechanisms including blocking sodium channels, enhancing GABA activity, antagonizing glutamate receptors, and inhibiting carbonic anhydrase.
• Patients should know that topiramate requires gradual dose adjustment, may cause kidney stones, can decrease the effectiveness of hormonal contraceptives, and requires adequate hydration during use.
• Treatment duration varies by condition but is typically long-term for epilepsy and may be reassessed after 6-12 months for migraine prevention.
• Common side effects include tingling sensations, fatigue, dizziness, decreased appetite, and cognitive effects like memory or concentration problems.
• In the context of weight loss, topiramate is often used in combination with phentermine, with a typical starting dose of 3.75 mg/23 mg daily and gradual increases to 15 mg/92 mg daily 1. It's essential to carefully evaluate the benefits and risks of topiramate, particularly in patients with a history of cardiovascular disease, uncontrolled hypertension, or those taking other medications that may interact with topiramate 1.

From the FDA Drug Label

TOPIRAMATE is a prescription medicine used: alone to treat seizures in patients 10 years and older with other medicines to treat seizures in adults and children over age 2

Topiramate is used to treat seizures in patients 10 years and older, and in combination with other medicines to treat seizures in adults and children over age 2 2.

• Key uses of topiramate include:
  • Treating seizures alone in patients 10 years and older
  • Treating seizures with other medicines in adults and children over age 2 2

From the Research

Uses of Topiramate

• Topiramate is used for the treatment of epilepsy, including partial-onset and generalized-onset seizures 3, 4, 5, 6, 7.
• It is also effective as a prophylactic against migraine headaches 3, 4.
• Topiramate is approved by the Food and Drug Administration (FDA) for epilepsy treatment and migraine prophylaxis 4.
• In combination with phentermine, topiramate is FDA-approved for weight loss in patients with a body mass index (BMI) > 30 4.

Dosage and Administration

• The target dose of topiramate for adults is 100 mg/day for initial monotherapy of new-onset seizures 3.
• Adjunctive use with enzyme-inducing drugs and use for refractory seizures requires higher dosages, though the optimum dose for most patients does not exceed 400 mg/day 3.
• The current target dosing for topiramate monotherapy is 400 mg/day and 100 mg/day to treat epilepsy and migraines, respectively 4.

Side Effects

• Commonly reported side effects include paresthesia, confusion, fatigue, dizziness, and change in taste 4.
• More uncommon and serious adverse effects can include acute glaucoma, metabolic acidosis, nephrolithiasis, hepatotoxicity, and teratogenicity 4.
• Weight loss, renal stones, and impairment of cognitive functions may also occur 3, 5.