topiramate Side Effects and Adverse Reactions

Side Effects and Adverse Reactions


As a member of the carbonic anhydrase inhibitor anticonvulsant drug class of medications, the most common side effects of topiramate may include intermittent numbness and tingling (paresthesias), altered sense of taste (dysosmia), memory loss, and weight loss.  These mild adverse reactions are not typically serious, and they tend to be temporary, intermittent, and dose-dependent.  For most patients these may diminish over or resolve over a period of days, and they are more likely to occur with higher doses of the medication.  If these side effects continue, consult with your physician about lowering your dose of topiramate or possibly discontinuing the medication altogether.  These adverse symptoms should always resolve with lowering or discontinuing the medication, and they should never be permanent.  To help reduce the likelihood of these more common adverse reactions, make sure to drug plenty of water each day, and take topiramate on a regimented schedule at the same times each day.

While serious side effects from topiramate are uncommon, patients using topiramate should be aware that approximately one out of every one hundred patients taking topiramate (about 1 percent) will develop kidney stones (nephrolithiasis).  Most patients who develop kidney stones do not experience serious or life-threatening complications from the kidney stones.  In fact, some patients with epilepsy have decided – in consultation with their neurologist – to continue treatment with topiramate for prevention of seizures even after they have experienced nephrolithiasis.  Patients with a history of kidneys stones (nephrolithiasis) should consult with their neurologist prior to beginning treatment with topiramate to determine whether or not other medications may be safer and more effective for treating their diagnosis.  A history of nephrolithiasis should be considered a relative-contraindication rather than an absolute contraindication.  As a neurologist who has prescribed topiramate since 1996, I have encountered a handful of patients who have developed kidney stones, and none of them have experienced any type of serious complication.  I have been surprised that many of these patients forgot that topiramate can cause kidney stones even though I make a specific effort to mention this to every patient before starting therapy with topiramate.  Often other physicians, even urologists who specialize in treating kidney stones, are not aware that topiramate can cause kidney stones.

Topiramate can rarely cause acute angle closure glaucoma.  If you have a history of glaucoma, you should consult with your neurologist and ophthalmologist before taking topiramate.

Topiramate is a pregnancy category D medication, meaning that there is evidence that there is risk to the fetuses of women taking topiramate.  For some women – particularly those with potentially life-threatening epilepsy – the potential benefits of treatment with topiramate may outweigh the risks to the unborn baby.  Do not start or stop taking topiramate during pregnancy without first consulting with your doctor.  Most neurologists instruct women of child-bearing age who are prescribed topiramate to take the vitamin folic acid in conjunction with topiramate and to use adequate, reliable birth control.  Topiramate can make hormonal contraceptive medications such as birth control pills less effective, particularly when prescribed at doses equal to or greater than 100 milligrams twice a day.  Women of child-bearing age who are sexually active are encouraged to use a barrier method of birth control (such as a condom or diaphragm with spermicidal gel) even along with the hormonal contraceptive to prevent pregnancy.  Tell your doctor immediately if you become pregnant during treatment with topiramate.

Topiramate can pass into breast milk and consequently may harm a nursing baby.  Before taking topiramate, tell your physician if you are breast-feeding a baby.


topiramate Indications and Usage topiramate Dosage and Availability

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