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
Serious risks associated with TOPAMAX ^® include lowered bicarbonate levels in the blood resulting in an increase in the acidity of the blood (metabolic acidosis). Symptoms could include hyperventilation (rapid, deep breathing), tiredness, loss of appetite, irregular heartbeat or changes in the level of alertness. Call your doctor immediately if you get these symptoms. Your doctor may want to do simple blood tests. Chronic, untreated metabolic acidosis may increase the risk for kidney stones or bone disease.

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, 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.

Do not stop taking TOPAMAX ^® without first talking to your doctor. Stopping TOPAMAX ^® suddenly can cause serious problems.

Other serious risks include decreased sweating, increased body temperature, kidney stones, sleepiness, dizziness, confusion, difficulty concentrating, and increased eye pressure (glaucoma). Call your doctor immediately if you have any decrease in vision or eye pain. These problems can lead to blindness if not treated right away.

More common side effects are tingling in arms and legs, loss of appetite, tiredness, nausea, diarrhea, taste change and weight loss.

Tell your doctor about other medications you take.

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 U.S. Prescribing Information.