Is it necessary to discontinue topiramate (generic name) 50 mg twice a day, taken as monotherapy for weight control, prior to any type or length of surgery?

Perioperative Management of Topiramate 50 mg Twice Daily for Weight Control

Topiramate 50 mg twice daily does not need to be discontinued prior to surgery, regardless of surgery type or duration, but must be continued through the perioperative period to prevent seizure risk. 1, 2

Critical Safety Consideration: Risk of Seizure Precipitation

• Abrupt discontinuation of topiramate can precipitate seizures even in patients taking it for non-epilepsy indications such as weight management or appetite suppression ("food noise") 1
• This seizure risk applies universally—whether topiramate is prescribed for epilepsy, migraine prevention, or weight control 1
• The FDA label explicitly warns that stopping topiramate suddenly can cause seizures, making perioperative continuation essential 2

Perioperative Continuation Protocol

• Continue topiramate at your current dose (50 mg twice daily) throughout the entire perioperative period 1, 2
• Take your regular dose on the morning of surgery with a small sip of water (confirm with your anesthesiologist) 2
• Resume your normal dosing schedule as soon as you can tolerate oral medications postoperatively 2

Special Surgical Considerations

• For bariatric surgery specifically: Multiple studies demonstrate that topiramate is safely continued and even beneficial during the perioperative period for bariatric procedures 3, 4, 5
• Patients undergoing sleeve gastrectomy with BMI ≥50 kg/m² have successfully used topiramate preoperatively and postoperatively with enhanced weight loss outcomes 5
• One study showed topiramate combined with metformin achieved >8% total body weight loss preoperatively in super-obese patients without discontinuation for surgery 4

Anesthesia-Related Precautions

• Inform your anesthesiologist that you take topiramate, as it may enhance the sedative effects of anesthetic agents 2
• The FDA label notes topiramate can impair thinking, motor skills, and cause somnolence, which may interact additively with anesthesia 2
• Your anesthesia team should be aware of potential metabolic acidosis from topiramate's carbonic anhydrase inhibitor properties, though this is more relevant at higher doses 6, 2

Proper Discontinuation Protocol (If Ever Needed in Future)

• If discontinuation becomes necessary for any reason, never stop abruptly 1
• Taper by taking one capsule every other day for at least 1 week before complete cessation 1
• This gradual taper minimizes seizure precipitation risk 1

Common Pitfall to Avoid

• Do not assume topiramate is safe to stop just because you're taking it for weight control rather than seizures—the seizure risk from abrupt discontinuation exists regardless of indication 1
• The dose you're taking (100 mg total daily) is relatively low compared to typical epilepsy doses (200-400 mg/day), but the discontinuation risk remains 6, 1