Topiramate is an antiepileptic medicine that can be given alone or as adjunct therapy. It is used for generalized tonic-clonic seizures and partial onset seizures. Topiramate is also indicated for migraine prophylaxis. Tablets: 25 mg, 50 mg, 100 mg, and 200 mg; Sprinkle Capsules: 15 mg and 25 mg
• Alone to treat seizures in adults and children over age 6
• With other medicines to treat seizures in adults and children aged 2 years and above
• To prevent migraine headaches in adults
The recommended dose is
If you take Topiramate tablets only for epilepsy
• Adults – starting dose of 25mg at night. The dose will be slowly increased to a maintenance dose, usually 100 – 200mg a day in 2 divided doses. Maximum dose of 500mg a day in 2 divided doses.
• Children over 6 years of age – starting dose of 0.5-1mg per kg of body weight at night increasing slowly to a maintenance dose, usually 100mg a day.
If you take Topiramate tablets with another epilepsy medicine
• Adults – starting dose of 25-50mg at night. The dose will be slowly increased to a maintenance dose, usually 200-400mg a day in 2 divided doses.
• Children over 2 years of age – starting dose of 1-3mg per kg of body weight at night increasing slowly to a maintenance dose, usually 5-9mg per kg of body weight a day in 2 divided doses.
Prevention of migraines
• Adults – starting dose of 25mg at night. The dose will be slowly increased to a maintenance dose of 100mg a day in 2 divided doses.
• Children – Not recommended for use in children. Swallow whole. Do not chew. Take with or without food. To prevent kidney stones while taking Topiramate tablets, drink plenty of fluids during the day.
Warnings and precautions
Talk to your doctor or pharmacist before taking topiramate tablets if you:
• have a history of blood and body fluid abnormality (metabolic acidosis)
• have liver problems
• have eye problems, especially glaucoma
• have a growth problem
• are on a high fat diet (ketogenic diet)
• are taking topiramate tablets to treat epilepsy and you are pregnant or a woman of childbearing potential
You may lose weight if you use topiramate so your weight should be checked regularly when using this medicine. If you are losing too much weight or a child using this medicine is not gaining enough weight, you should consult your doctor. A small number of people being treated with anti-epileptic medicines such as topiramate have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor.
Topiramate tablets may in rare cases cause high levels of ammonia in the blood (seen in blood tests) which can lead to a change in brain function, especially if you are also taking a medicine called valproic acid or sodium valproate. Since this may be a severe condition, tell your doctor immediately if the following symptoms occur. – Difficulty thinking, remembering information, or solving problems – being less alert or aware – feeling very sleepy with low energy
Other medicines and topiramate tablets
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, Topiramate tablets and certain other medicines can affect each other. Sometimes the dose of some of your other medicines or this medicine will have to be adjusted. Especially, tell your doctor or pharmacist if you are taking:
• Other medicines that impair or decrease your thinking, concentration, or muscle coordination (e.g. central nervous system depressant medicines such as muscle relaxants and sedatives).
• Birth control pills. This medicine may make your birth control pills less effective. You should talk to your doctor about the best kind of contraception to use while you are taking topiramate tablets. Tell your doctor if your menstrual bleeding changes while you are taking birth control pills and topiramate.
Other medicines you should discuss with your doctor or pharmacist include other antiepileptic medicines, risperidone, lithium, hydrochlorothiazide, metformin, pioglitazone, glyburide, amitriptyline, propranolol, diltiazem, venlafaxine, flunarazine and St. John’s Wort (Hypericum perforatum; a herbal preparation used to treat depression).
Topiramate tablets with food, drink and alcohol
You can take Topiramate tablets with or without food. To prevent kidney stones whilst being treated with Topiramate tablets, drink plenty of fluids during the day. You should avoid drinking alcohol when taking Topiramate tablets.
The active substance in Topiramate tablets (topiramate) passes into human milk. Effects have been seen in breastfed babies of treated mothers, including diarrhoea, feeling sleepy, feeling irritable, and poor weight gain.
Therefore, your doctor will discuss with you whether you abstain from breast-feeding or whether to abstain from treatment with Topiramate tablets. Your doctor will take into account the importance of the medicine to the mother and the risk for the baby. Mothers who breast‑feed while taking Topiramate tablets must tell the doctor as soon as possible if the baby experiences anything unusual.
Migraine prevention: Topiramate tablets can harm an unborn baby. You must not use Topiramate tablets if you are pregnant. You must not use Topiramate tablets for migraine prevention if you are a woman of childbearing potential unless you are using effective contraception.
Talk to your doctor about the best kind of contraception and whether Topiramate tablets is suitable for you. Before the start of treatment with Topiramate tablets a pregnancy test should be performed.
Treatment of epilepsy: If you are a woman of childbearing potential you should talk to your doctor about other possible treatments instead of Topiramate tablets. If the decision is made to use Topiramate tablets, you should use effective contraception. Talk to your doctor about the best kind of contraception to use while you are taking Topiramate tablets. Before the start of treatment with Topiramate tablets a pregnancy test should be performed.
Talk to your doctor if you wish to become pregnant. As with other anti‑epileptic medicines, there is a risk of harm to the unborn child if Topiramate tablets is used during pregnancy. Make sure you are very clear about the risks and the benefits of using Topiramate tablets for epilepsy during pregnancy.
If you take Topiramate tablets during pregnancy, your baby has a higher risk for birth defects, particularly, cleft lip (split in the top lip) and cleft palate (split in the roof of the mouth). Newborn boys may also have a malformation of the penis (hypospadia). These defects can develop early in pregnancy, even before you know you are pregnant.
If you take Topiramate tablets during pregnancy, your baby may be smaller than expected at birth. Talk to your doctor if you have questions about this risk during pregnancy.
Driving and using machines
Dizziness, tiredness and vision problems may occur whilst taking Topiramate tablets. Do not drive or use any tools or machines without talking to your doctor first. Topiramate tablets contain lecithin (soya oil) Topiramate 50mg, 100mg and 200mg tablets contain lecithin (soya oil). If you are allergic to peanuts or soya, do not use this medicinal product.