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Dosage & Drug Interaction


Dosing With TOPAMAX

The rule with TOPAMAX is to "start low and go slow." That is, your healthcare professional will adjust your medication. You'll start with a low dose and then slowly increase the amount of TOPAMAX you take until you reach the dosage that works best for you. Like many other medications, TOPAMAX needs time to build up to the right level in your bloodstream before it is completely effective, so remember to be patient.

Your healthcare professional will determine your starting dose and when to make adjustments to your dose.

Be patient. TOPAMAX can take time to work.

Although you'll be taking TOPAMAX every day, it may take some time to work. In clinical studies, TOPAMAX was proven to help reduce the frequency of migraines. Some patients experienced fewer migraines after 1 month of treatment; however, it may take 2 to 3 months to realize the full benefit of TOPAMAX. That's why it's so important to continue to take your medication every day to give it the best chance to work.

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What if I miss a dose?

If you miss a single dose of TOPAMAX, take it as soon as you can. However, if you are within 6 hours of taking your next scheduled dose, wait until then to take your usual dose of TOPAMAX, and skip the missed dose. Do not double your dose. If you have missed more than one dose, you should call your healthcare professional for advice.

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TOPAMAX Dosing Details:

TOPAMAX can be taken with or without food.


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Drug interaction

Before starting any new medication, tell your healthcare professional about all the medicines you are currently taking, including nonprescription products, food supplements, vitamins, and herbal products.

If you're taking birth control pills, be sure to tell the healthcare professional who prescribed them that you're taking TOPAMAX. There's a possibility that birth control pills may be made less effective by TOPAMAX. Be sure to report any changes in bleeding patterns to your healthcare professional.


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Attention TOPAMAX Patients and Medical Professionals
Dispensing errors have been reported between TOPAMAX® (topiramate) tablets and TOPROL-XL® (metoprolol succinate) extended-release tablets.

Please be sure to check your tablets to ensure you are taking the right medicine.

*TOPROL-XL is a registered trademark of the AstraZeneca group of companies.

TOPAMAX® is approved for migraine prevention in adults only.
TOPAMAX® is not used to stop a migraine after it starts.

IMPORTANT SAFETY INFORMATION

Warnings and Precautions

TOPAMAX® may cause eye problems. Serious eye problems include: sudden decrease in vision with or without eye pain and redness; blockage of fluid in the eye causing increased pressure in the eye (secondary angle closure glaucoma). These eye problems can lead to permanent loss of vision if not treated. You should call your healthcare professional right away if you have any new eye symptoms.

TOPAMAX® may cause decreased sweating and increased body temperature (fever). People, especially children, should be watched for signs of decreased sweating and fever, especially in hot temperatures. Some people may need to be hospitalized for this condition. Call your healthcare provider right away if you have a high fever, a fever that does not go away, or decreased sweating.

TOPAMAX® can increase the level of acid in your blood (metabolic acidosis). If left untreated, metabolic acidosis can cause brittle or soft bones (osteoporosis, osteomalacia, osteopenia), kidney stones, can slow the rate of growth in children, and may possibly harm your baby if you are pregnant. Metabolic acidosis can happen with or without symptoms. Sometimes people with metabolic acidosis will: feel tired, not feel hungry (loss of appetite), feel changes in heartbeat, or have trouble thinking clearly. Your healthcare provider should do a blood test to measure the level of acid in your blood before and during your treatment with TOPAMAX®. If you are pregnant, you should talk to your healthcare provider about whether you have metabolic acidosis.

Like other antiepileptic drugs, TOPAMAX® may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Pay attention to any changes and call your doctor right away if you have any of these symptoms, especially if they are new, worse, or worry you: thoughts about suicide or dying, attempts to commit suicide, new or worse depression, new or worse anxiety, feeling agitated or restless, panic attacks, trouble sleeping (insomnia), new or worse irritability, acting aggressive, being angry or violent, acting on dangerous impulses, an extreme increase in activity and talking (mania), or other unusual changes in behavior or mood.

TOPAMAX® may affect how you think, and cause confusion, problems with concentration, attention, memory, or speech, depression or mood problems, tiredness, and sleepiness.
Do not stop taking TOPAMAX® without first talking to your doctor. Stopping TOPAMAX® suddenly can cause serious problems.

If you take TOPAMAX® during pregnancy, your baby has a higher risk for birth defects called cleft lip and cleft palate. These defects can begin early in pregnancy, even before you know you are pregnant. There may be other medicines to treat your condition that have a lower chance of birth defects. All women of childbearing age should talk to their healthcare providers about using other possible treatments instead of TOPAMAX®. If the decision is made to use TOPAMAX®, you should use effective birth control (contraception) unless you are planning to become pregnant. Tell your healthcare provider right away if you become pregnant while taking TOPAMAX®. You and your healthcare provider should decide if you will continue to take TOPAMAX® while you are pregnant. Metabolic acidosis may have harmful effects on your baby. Talk to your healthcare provider if TOPAMAX® has caused metabolic acidosis during your pregnancy. If you become pregnant while taking TOPAMAX®, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. You can enroll in this registry by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic drugs during pregnancy.

TOPAMAX® may cause high blood ammonia levels. High ammonia in the blood can affect your mental activities, slow your alertness, make you feel tired, or cause vomiting.

Taking TOPAMAX® when you are also taking valproic acid can cause a drop in body temperature (hypothermia) to less than 95ºF, feeling tired, confusion, or coma.

Adverse Reactions

The most common side effects of TOPAMAX® include: tingling in arms and legs, loss of appetite, nausea, taste change, diarrhea, weight loss, nervousness, and upper respiratory tract infection.

Tell your doctor about other medications that you are taking. Report any side effect that bothers you or that does not go away.

These are not all the possible side effects of TOPAMAX®. For more information, ask your healthcare professional or pharmacist.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see full US Prescribing Information and Medication Guide

March 4, 2011 - FDA Drug Safety Communication: TOPAMAX® (topiramate) use during pregnancy can cause fetal harm, including an increased risk for cleft lip and/or cleft palate. For information from the company click here. The FDA announcement can be found at www.fda.gov.
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