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Topiramate is indicated for the prevention of migraine in adults. 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 medications can be important.

How does topiramate work?

The precise way Topiramate works to prevent migraine is unknown. It is thought that the medication blocks sodium channels and increases the activity of neurotransmitters in the brain. This likely inhibits some of the receptors in nerve cells, which reduce electrical activity and contribute to the development of migraine.

What are the brand names for topiramate?

Topiramate is a generic drug sold under several different brand names in the US and Canada:

  • Topamax
  • Trokendi XR
  • Topiragen
  • Qudexy XR

What are the possible side effects of topiramate?

Many clinical trials evaluated the safety and efficacy of Topiramate. The most common side effects experienced by those taking Topiramate include:

  • Decreased sweating
  • Fever and flushing
  • Vision problems
  • Metabolic acidosis (increased level of acid in your blood)
  • Numbness or tingling in the fingers and toes (paresthesia)
  • Anorexia
  • Weight loss
  • Diarrhea
  • Nausea
  • Feeling weak, drowsy, or tired
  • Upper respiratory infections
  • Speech and memory difficulties

This is not an exhaustive list of all potential side effects of Topiramate. For more information, consult your doctor or healthcare provider. If you notice any new or worsening side effects when taking Topiramate, contact your doctor or healthcare provider immediately.

Important questions for your doctor before taking topiramate

Topiramate tablets are taken by mouth with water or other liquids. Topiramate is taken twice a day in a divided dose for effectiveness in reducing the frequency of migraine. The recommended maximum of 100 mg should not be exceeded in any 24-hour period. The medication is generally most effective after 1 month of use. Before starting Topiramate talk with your doctor if you:

  • Have a history of hypersensitivity to topiramate
  • Have used alcohol within 6 hours prior, or plan to use alcohol within 6 hours after dosing
  • Have acute myopia and secondary angle closure glaucoma
  • Have visual field defects
  • Have a history of oligohydrosis (decreased sweating) and hyperthermia (fever)
  • Have a history metabolic acidosis
  • Have taken antiepileptic drugs
  • Have taken other carbonic anhydrase inhibitors
  • Have taken valproic acid
  • Have taken anti-depressants
  • Have a history of depression or thoughts of suicide
  • Have a history of kidney or liver impairment
  • Have weak, brittle or soft bones
  • Have lung or breathing problems
  • Are planning on having surgery
  • Are on a high fat diet/low carbohydrate diet
  • Are pregnant or planning to get pregnant. Topiramate can cause fetal harm when administered to a pregnant woman.

Individuals with the above conditions should be monitored closely while taking Topiramate.

Dosing information

Topiramate tablets come in 4 strengths: 25 mg, 50 mg, 100 mg, and 200 mg. The recommended maintenance dose varies by indication and age group.

The recommended total daily dose of Topiramate as treatment for prophylaxis of migraine is 100 mg administered in a divided dose. Some patients may experience a benefit at a total daily dose of 50 mg/day; while others have taken up to 200 mg/day. Topiramate is generally titrated according to the following schedule:

  • Week 1: 25 mg – no dose in the AM and 25 mg in the PM
  • Week 2: 50 mg – 25 mg in the AM and 25 mg in the PM
  • Week 3: 75 mg – 25 mg in the AM and 50 mg in the PM
  • Week 4: 100 mg- 50 mg in the AM and 50 mg in the PM

A physician, individual medical circumstances, and clinical outcome will guide the dose and titration rate. Longer intervals between dose adjustments can be used.

Topiramate tablets should be swallowed whole and can be taken at night with or without food. Avoid taking with alcohol. All tablets should be stored at room temperature.

Do not suddenly stop taking Topiramate without talking to your doctor, as serious complications can arise.

Keep track of migraine attacks for topiramate effectiveness

Keep track of when you have migraine attacks and when you take Topiramate so you can monitor its effectiveness, and communicate with your doctor about how the medication is working for you.

Before taking Topiramate make sure to tell your doctor about all the medicines you take, including prescription and nonprescription, vitamins, and herbal supplements. Topiramate and other medicines may impact each other, causing side effects.

Because Topiramate can cause dizziness, weakness, and drowsiness, do not drive a car, use machinery, or do anything requiring you to be fully alert when taking this medication.

For additional details, read the full prescribing information of Topiramate.

Written by: Linda Saxl Minton | Last reviewed: August 2019
  1. TOPIRAMATE prescribing information available at: Accessed 5/1/18.