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Reviewed by: HU Medical Review Board | Last reviewed: April 2023

Topiramate is approved for the prevention of migraine in people ages 12 and older. It is taken by mouth as preventive therapy to reduce migraine frequency. For those with frequent migraine attacks, or migraine that do not respond to acute treatment, preventive drugs can be important.1,2

How does topiramate work?

The exact way topiramate works to prevent migraine is unknown. Studies show that topiramate blocks sodium channels and increases the activity of certain neurotransmitters in the brain. This likely blocks some of the receptors in nerve cells, which reduce electrical activity and contribute to the development of migraine.1

What are the brand names for topiramate?

Topiramate is a generic drug sold under several different brand names in the United States and Canada, including:2

What are the possible side effects?

The most common side effects of topiramate include:1

  • Numbness, burning, or tingling in fingers or toes
  • Not feeling hungry and weight loss
  • Nausea and stomach pain
  • Diarrhea
  • Nervousness
  • Upper respiratory tract infection
  • Speech problems
  • Feeling weak or drowsy
  • Dizziness
  • Slow reactions
  • Memory problems
  • Fever 
  • Vision problems

Contact your doctor right away if you have:1,2

  • Signs of serious eye problems, including a sudden change in vision or increased pressure in the eye
  • A high fever, a fever that does not go away, or decreased sweating
  • Mood or behavior changes, including thoughts about dying or suicide, new or worse depression, panic attacks, trouble sleeping, or aggression

These are not all the possible side effects of topiramate. Talk to your doctor about what to expect when taking topiramate. You also should call your doctor if you have any changes that concern you when taking topiramate.

Other things to know

Before starting treatment with topiramate, tell your doctor if you:1,2

  • Are allergic to topiramate or any other medicines
  • Have kidney problems
  • Have or have had metabolic acidosis
  • Have weak, brittle, or soft bones
  • Have eye problems, especially glaucoma
  • Have asthma or chronic obstructive pulmonary disease (COPD)
  • Drink alcohol
  • Have a growth problem
  • Have or have had liver problems
  • Have or have had mental health issues, including depression, abnormal moods, or thoughts of self-harm

Topiramate can harm an unborn baby. If you can become pregnant, you should use birth control during treatment and for some time after the last dose of topiramate. Topiramate may decrease how well certain types of birth control work. Talk to your doctor about your options for birth control while taking topiramate.1,2

Do not suddenly stop taking topiramate without talking to your doctor. Stopping this drug suddenly can cause serious side effects.1,2

Your doctor should do a blood test to measure the level of acid in your blood before or during your treatment with topiramate.1,2

Tell your doctor or dentist that you taking topiramate before having surgery or dental work.1,2

Topiramate makes it harder for you to sweat and cool down when you are hot. Avoid exposure to heat and drink plenty of fluids while taking topiramate.1,2

Topiramate can make you dizzy, drowsy, confused, and unable to concentrate. Do not drive a car or use machinery until you know how topiramate affects you.1,2

Topiramate can interact with other medicines, including aspirin, ibuprofen, and naproxen. Before beginning treatment for migraine, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.1,2

For more information, read the full prescribing information of topiramate.

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