topiramate Overview

Generic Name: topiramate

Brand Names: Topamax, Topamax Sprinkle, Trokendi XR, Qudexy XR



Manufacturer: Ortho-McNeill-Janssen Pharmaceuticals, Inc., a division of Johnson and Johnson Corporation



The generic, prescription medication topiramate has been marketed in the United States as brand-name Topamax since receiving United States Food and Drug Administration approval during 1996.  Originally developed as an anti-epileptic (anti-convulsant or anti-seizure) medication, during the past two decades, medical uses of topiramate (Topamax) have expanded to include the prevention of migraine and other headaches, acting as a mood-stabilizer in bipolar disorder, treatment of certain forms of chronic pain, and for weight loss.  In 2012, the FDA approved the prescription medication Qsymia which is a combination of topiramate (Topamax) and the appetite suppressant phentermine (Fastin, Adipex-P) for weight loss and treatment of obesity.  Most neurologist prescribe topiramate for treatment of migraine headache far more often than for the treatment of epilepsy, largely because there are so many more people suffering from migraine headaches than from seizure disorders.

When prescribed for migraine headaches and epilepsy, topiramate does not begin working immediately.  Rather, the dose of topiramate must be gradually titrated and ramped up over a period of weeks until the patient has reached doses of the medication that are typically effective.  Titrating the medication gradually helps to significantly reduce the likelihood of more common adverse reactions.  Like most preventive (prophylactic) medications for migraine, topiramate does not work immediately, and it typically takes about four weeks to six weeks for the medication to begin reducing the frequency and severity of migraine headaches.  Topiramate is not intended to be an as needed medication for migraine headache or for seizures – topiramate is not effective for treating seizures or migraine headaches once they have occurred, but rather it is prescribed to reduce the likelihood of seizures or migraines from occurring.  Topiramate should not have any long-term effects on brain chemistry and function.  Consequently, when the medication is discontinued, migraine headaches or seizures may recur.  Consult your physician before starting or stopping or adjusting the dose of topiramate.

When prescribed for the prevention of migraine headaches, the typical dose of topiramate is 50 mg twice a day.  However, the effective dose from patient to patient may vary substantially.  In my experience, rare patients may experience a reduction in headache frequency and severity in dosages as low as 12.5 mg or 25 mg taken just once a day.  Most patients will need to take topiramate for at least four to six weeks before experiencing any reduction in the frequency and severity of headaches, and most patients will need to take at least 50 mg twice a day (total daily dose of 100 mg) to experience satisfactory improvement.  Some patients do not experience satisfactory improvement until reaching doses of between 100 mg twice a day (total daily dose of 200 mg) and 200 mg twice a day (total daily dose of 400 mg), and in rare cases, patients may take up to 400 mg twice a day (total daily dose of 800 mg).  Generally, I recommend that patients increase topiramate gradually in increments of 25 mg added once during the day and increasing their dose every one or two weeks.  Patients should titrate the dose as-needed until their headaches are adequately improved, but also as tolerated.  If patients experience adverse reactions to topiramate, they should notify their treating physician.  When patients experience unacceptable side effects, I typically recommend that they decrease their dose to the previously tolerated dose, rather than completely discontinuing the medication, particularly if they have experienced successful improvement in their migraines at lower dosages.

When topiramate is prescribed for epilepsy, the dosage may vary from patient to patient.  For epileptics using topiramate as monotherapy – meaning that topiramate is the only medication prescribed for preventing seizures – the typical dose is about 200 mg taken twice a day for a total dose of 400 mg a day.  However, some patients may experience adequate control of seizures taking only 100 mg twice a day (or even less), while other patients may require dosages of up to 400 mg twice a day (total dose of 800 mg per day).  When topiramate is prescribed as adjunctive therapy for epilepsy – when it is added on top of another anti-epileptic medication – the dosages necessary to control seizures may be significantly less than would be necessary for monotherapy.


topiramate Indications and Usage

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