Topiramate and Hair Loss

Yes, topiramate can cause hair loss as a side effect, though it is relatively uncommon compared to other antiepileptic medications.

Evidence for Topiramate-Induced Hair Loss

Topiramate has been documented to cause hair loss in patients with epilepsy, with 13 reported cases in a comprehensive literature review of antiseizure medication-induced alopecia 1
Hair loss with topiramate is typically diffuse and non-scarring, with telogen effluvium being the most common mechanism 1
The FDA drug label for topiramate lists alopecia as a reported adverse reaction in post-marketing surveillance 2
In clinical practice, topiramate is recognized as one of several antiepileptic medications that can potentially cause hair loss, though at a lower frequency than valproate (which has the highest association with alopecia among antiepileptic drugs) 1

Medication-induced hair loss typically occurs through telogen effluvium, where hair follicles prematurely enter the resting (telogen) phase 3
Hair loss with topiramate generally begins within the first few months of treatment initiation, similar to other antiseizure medications 4
The hair loss is usually reversible upon dose reduction or discontinuation of the medication 1

When topiramate is used for migraine prophylaxis or epilepsy treatment, patients should be informed about the potential risk of hair loss as a side effect 5
In a comparative study between topiramate and divalproex sodium for migraine prevention, hair loss was not reported as a common side effect with topiramate, while approximately 24% of divalproex sodium users experienced hair loss 6
The most commonly reported side effects of topiramate include paresthesias, weight loss, and cognitive disturbances rather than hair loss 6
For patients concerned about cosmetic side effects, it's important to note that hair loss with topiramate appears to be less common than with valproate and some other antiepileptic medications 1, 7

If a patient experiences hair loss while taking topiramate, dose reduction may be considered if clinically appropriate 1
For patients requiring topiramate for seizure control or migraine prevention where alternatives are limited, the benefits of continued treatment may outweigh the cosmetic concerns of hair loss 5
Specialist dermatology consultation may be beneficial for patients experiencing significant hair loss to confirm the diagnosis and rule out other causes 1
Complete hair regrowth typically occurs after discontinuation of the medication or dose reduction 7

For patients with a history of or concern about medication-induced hair loss, alternative antiepileptic medications with lower reported incidence of alopecia might be considered when clinically appropriate 1
When topiramate is used for obesity management (as in phentermine-topiramate combinations), the risk of hair loss should be weighed against the potential benefits 5