Topamax side effects and how to avoid them

Topamax side effects | Warnings | Interactions | How to avoid side effects

Topamax (topiramate) is a brand-name anticonvulsant drug that works in the brain to prevent seizures. It has been FDA-approved since 1996 for the treatment of epilepsy in both children and adults. Topamax is also commonly used to prevent migraine headaches in adults. It’s also used off-label to treat patients with bipolar disorder (also called manic depression) and assist with weight loss. The drug is usually prescribed in 25 mg to 400 mg doses.

Topamax is safe for long-term use when taken as prescribed. However, several common and potentially severe side effects have been reported by a small number of patients. There are also quite a few drugs that can cause harmful interactions or become ineffective when taken in conjunction with Topamax. Here’s everything you should know about safely taking Topamax, including what you can do to minimize the risk of developing severe side effects.

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Common side effects of Topamax

Most of the side effects associated with Topamax are considered mild to moderate. Many will disappear or subside as you adjust to the medication. If you experience any of these symptoms, notify your doctor immediately because they might indicate more severe side effects.  These are the most common Topamax side effects, according to the manufacturer:

• Loss of appetite, changes in taste, weight loss, stomach pain, and even anorexia
• GI side effects (nausea, diarrhea, indigestion)
• Tiredness
• Paresthesia (tingling or prickling sensations)
• Speech problems
• Cognitive dysfunction (trouble with memory and thinking)
• Upper respiratory tract infection
• Dizziness
• Nervousness
• Slow reactions
• Visual changes (blurred, cloudy vision, involuntary eye movements)
• Fever
• Decreased sensitivity or numbness

Does Topamax make you sleepy?

Taking Topamax can make you very drowsy and even dizzy. You should avoid driving, using heavy machinery, or doing other tasks that require alertness until you know how this medication affects you. Because it can cause drowsiness, Topamax is often taken at night.

Does Topamax cause brain fog?

Patients often experience brain fog, or a decrease in cognition, when beginning Topamax. Some report an inability to quickly process information, language problems, or think clearly. For some, this symptom resolves as the body acclimates to dosing. Others may need to look for Topamax alternatives.

Does Topamax make your hair fall out?

According to the National Institutes of Health, hair loss is a possible side effect of topiramate, but the manufacturer of Topamax does not list it as a common. Hair usually grows back quickly if you stop treatment. 

Serious side effects of Topamax

There are also serious side effects to be aware of when taking Topamax. These side effects usually require hospitalization or medical help, and may result in permanent injury or be life-threatening. 

• Metabolic acidosis (tiredness, loss of appetite, irregular heartbeat, brain fog)
• Excess ammonia in the blood (when Topamax is taken with medicine containing valproic acid)
• New or worsening depression, anxiety, or suicidal thoughts/behaviors (occurring in 1 in 500 patients)
• Decreased sweating but increased body temperature
• Glaucoma
• Stevens-Johnson syndrome (severe skin rash, blisters, peeling skin)
• Stunted growth in children
• Sudden withdrawal seizures (if Topamax is stopped suddenly)

Can Topamax change your personality?

Anticonvulsants like Topamax, can also profoundly affect mood, contributing to mental illnesses like anxiety, depression, or mania. Topamax can have several neurocognitive and neuropsychiatric side effects, including this case of Topamax-induced dissociative disorder. Patients should be aware of drastic changes in mood or emotion and seek medical attention if they experience significant personality changes.

Can Topamax cause permanent memory loss?

Topamax may be associated with dementia and should be used with caution in older patients. Still, it has not been well established that Topamax can cause permanent memory loss.

Topamax and metabolic acidosis

Topamax may cause an excessive amount of acid in the bloodstream, called metabolic acidosis. When this occurs, the body produces acid too quickly, and the kidneys cannot keep up with filtering it out. For this reason, patients with impaired kidney function or kidney disease should be monitored closely when taking Topamax.

In extreme cases, metabolic acidosis can lead to kidney damage, shock, or even death. This condition can also cause soft or brittle bones and kidney stones, slow the growth rate in children, and harm a baby during pregnancy. Common metabolic acidosis symptoms include rapid breathing, low blood pressure, lethargy and confusion, and loss of appetite. 

Topamax and eye problems

Topamax can cause severe eye conditions that may result in blindness. Acute myopia, which causes nearsightedness, can cause headaches or blurred vision because of increased pressure in the eye. Patients also reported several instances of secondary angle closure glaucoma, which, if left untreated, can lead to vision loss. Patients taking Topamax should seek medical advice if they ever experience eye pain or discomfort. 

Topamax warnings

Do not take Topamax if you:

• are allergic to it or any of the ingredients in it
• consume alcohol within 6 hours of taking Topamax
• have or have had any of these conditions: 
  • Glaucoma or other eye problems
  • Kidney disease
  • Metabolic acidosis
  • Lung disease or breathing problems
  • Mood problems, depression, suicidal thoughts or actions
  • Growth disorders
  • Soft or brittle bones (osteoporosis, osteomalacia)
• are planning to become pregnant or if you are breastfeeding

Suicidal behavior and ideations

As an anticonvulsant, Topamax has a direct influence on brain activity. About 1 in 500 patients taking antiepileptic drugs like Topamax have reported that they experienced suicidal thoughts and tendencies, especially when starting treatment or changing dosage levels. 

Due to these predispositions, patients should be continually monitored and seek medical attention if they experience anxiety, panic attacks, onset of or increased depression. Though rare, Topamax can also cause mood or behavior changes, like aggression or violence, agitation, apathy, mania, or irritability. Tell a healthcare professional about any of these changes.

Topamax and pregnancy

If you are pregnant or planning to become pregnant, you should inform your doctor as soon as possible. Topamax increases the risk of oral cleft birth defects like cleft lip and cleft palate by 16 times. Using Topamax during pregnancy can also cause heart, lung, skull, and skeletal abnormalities like malformed limbs. Other birth defects may include persistent pulmonary hypertension of the newborn (PPHN), spina bifida, and other neural tube defects, which can be life-threatening.

Consequently, it’s necessary to take certain precautions to decrease the risk of these potential complications by managing Topamax doses with other medications during pregnancy. Suddenly discontinuing medications like Topamax during pregnancy is not recommended, so don’t adjust your dosage or stop taking it without talking to your doctor. Topamax should only be used to treat conditions that could be life-threatening in pregnant patients.

Topamax interactions

There are many over-the-counter and prescription drugs that interact with Topamax. The side effects of those drug interactions range from mild to severe, rendering one or the other more or less effective. Ask a doctor before taking Topamax if you’re on one of the following medications:

• Birth control pills: Topamax may reduce the potency and effects of oral contraceptives or menopause drugs containing estrogen. A barrier form of birth control like a condom or diaphragm with spermicide a better form of protection while taking Topamax.
• Seizure drugs: Tegretol (carbamazepine), Dilantin (phenytoin), Depakote (valproate), lamotrigine, and phenobarbital may decrease the levels and effects of the Topamax in your body. Taking Depakote (valproate) in conjunction with Topamax can raise the levels of ammonia in your blood. If this occurs, you may experience confusion, disorientation, or have difficulty thinking.  
• Carbonic anhydrase inhibitors: Drugs like acetazolamide, dichlorphenamide, methazolamide, and dorzolamide can increase the risk of kidney stones when they are taken with Topamax.
• Allergy medicine: Certain allergy drugs like diphenhydramine, chlorpheniramine, hydroxyzine may increase the risk of side effects like dizziness, sleepiness, or trouble concentrating.
• Pain relievers: Patients taking Topamax may experience increased drowsiness, dizziness, or trouble thinking when prescribed in conjunction with pain drugs like hydrocodone, oxycodone, morphine, or hydromorphone.  
• Bipolar medication: Topamax may increase levels of lithium in the body when taken together.
• Diabetes drugs: Glyburide or pioglitazone may be less effective in controlling blood sugar to treat diabetes. Taking metformin with Topamax can also be risky, especially if the patient has metabolic acidosis. 

Can you drink caffeine with Topamax?

Topamax can increase caffeine’s excretion rate, which may reduce its efficacy in the body, but it’s generally a safe combination.

What should I eat while taking Topamax?

You can take Topamax with or without food. Since one of the most severe side effects of taking Topamax is metabolic acidosis, avoid eating a ketogenic (low carbohydrate, increased protein) diet. Eating foods that promote ketosis may increase the risk of kidney stones, which can further tax your kidneys.

How to avoid Topamax side effects

For more drug information, read the Topamax medication guide before starting your treatment.

1. If you experience any side effects, consult your healthcare provider. Consistent serum tests to routinely check kidney and liver function, for example, can also reduce the risk of severe complications. 
2. Be aware of all drug interactions. Some drugs like oral contraceptives aren’t as effective when taken with Topamax, and others, like allergy medicine, can exacerbate Topamax side effects.
3. Don’t take Topamax within six hours of consuming alcohol. 
4. Avoid operating heavy machinery, driving, or performing other dangerous tasks if Topamax makes you drowsy or dizzy. 
5. Drink lots of fluids and make an effort to avoid dehydration and constipation. This can help to reduce the risk of kidney stone formation, which can help prevent metabolic acidosis. 
6. Avoid following a ketogenic diet to prevent kidney stone development and potential metabolic acidosis. 
7. Seek urgent medical attention if you notice any sudden changes in mood or the development of depression or suicidal thoughts. 
8. If you are a woman on oral contraceptives, consider using an additional barrier form of protection to prevent pregnancy. That is one of the most effective ways to avoid the risk of severe birth defects associated with taking Topamax.
9. If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip it and take the upcoming dose. Don’t take a double amount to make up for a missed dose.
10. Don’t stop taking Topamax suddenly, as that may cause seizures, even if you haven’t had them in the past. If you need to stop taking Topamax, your doctor will gradually decrease your dose to safely wean you off the medication.

When to see a doctor for Topamax side effects

Many Topamax side effects can be severe and life-threatening. Inform your healthcare professional and seek medical attention right away if you begin to experience any of them, especially those considered serious.