Epilepsy can be a complex disorder.

Frequently Asked Questions

Some essential questions about TOPAMAX as a treatment for epilepsy are answered below.

 

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How often do I take TOPAMAX?

Follow your healthcare professional’s instructions. TOPAMAX is usually taken twice a day for epilepsy. Your healthcare professional will prescribe the dosage that’s right for you.

Set up a routine that works for you. Choose convenient times that fit into your daily routine, such as when you brush your teeth in the morning and at night. Some people use a medication check-off chart or an inexpensive container system to help them keep track.

Keep up with your routine. Even when your seizures are controlled, keep taking TOPAMAX as directed to help prevent them from occurring. Check with your healthcare professional if you have any questions about changing your treatment.

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How is TOPAMAX dosed?

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.

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What happens if I skip a dose?
It’s important to be consistent. Controlling your seizures can depend on taking your medicine exactly as your healthcare professional has prescribed. Taking your medicine at the same time every day helps keep a steady level of medicine in your bloodstream; missing a dose can cause these levels to drop too low, allowing seizures to occur.

Ask your healthcare professional what to do if you miss a dose. Never try to "catch up" by taking twice your normal dose: this may release too much drug into your bloodstream and cause side effects. ^ Return To Top
Can I use TOPAMAX if I am taking other medicines?

TOPAMAX can be used with many other medicines. This is good news—but you still need to pay careful attention to your medicines, and let your healthcare professional know what else you’re taking.

If you take hormonal contraceptives, tell your healthcare professional. The effectiveness of hormonal contraceptives (such as the Pill) may be reduced by certain antiseizure medicines, including some dosages of TOPAMAX. You should also tell the healthcare professional who prescribed the hormonal contraceptive that you are taking TOPAMAX.

If you take medicines that contain valproic acid, tell your healthcare professional. Using TOPAMAX and valproic acid at the same time has been linked to increased levels of ammonia in the blood, sometimes associated with vomiting and changes in alertness. Your healthcare professional will probably want to discontinue one of the medicines.

Tell your healthcare professional about any supplements you take. Before starting any new medicine, tell your healthcare professional about everything you are taking, including nonprescription drugs, food supplements, vitamins, or herbal products. Just because something is not prescribed by a healthcare professional does not mean it’s free of side effects and that it won’t affect other medicines.

Keep your healthcare professional informed of side effects. When people take antiseizure medicines, they sometimes experience side effects—such as dizziness, fatigue, or sleepiness. Side effects are most likely to appear when your body is just getting used to a new antiseizure medicine. Your healthcare professional can help guide you through this period and explain what you can do to reduce the impact of certain side effects.

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Are there treatments I should avoid when taking TOPAMAX?

Talk with your healthcare professional about any other medicines you take. Among the most important medicines to discuss are those that can cause kidney stones. Kidney stones have occurred in people taking TOPAMAX.

Let your healthcare professional know if you are on the ketogenic diet. Some children may be on the ketogenic diet—a special high-fat, low-carbohydrate diet that helps to control seizures. This diet can also cause kidney stones and should be discussed with your healthcare professional.

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Are there foods, drinks, or activities I should avoid when taking TOPAMAX?
There are no specific foods you need to avoid. Be sure to drink plenty of water to reduce the risk of developing kidney stones and to prevent getting overheated during vigorous exercise or in very warm settings.

Avoid alcohol. In general, people who have seizures should avoid alcohol. Alcohol can trigger seizures or make them more severe.

Stay active—but check with your healthcare professional first. Many people who experience seizures can lead physically active lives. Talk with your healthcare professional to see what activities are right for you. It’s especially important to get a healthcare professional’s advice before you engage in activities such as biking, skiing, skateboarding, or skydiving.

Don’t drive right away. Because of certain possible side effects, people on TOPAMAX are advised not to drive or operate machinery until they have gained enough experience on TOPAMAX to know whether it unfavorably affects their abilities. You will also need to meet the legal requirements of your state. Most states require a seizure-free period before people with epilepsy can drive. Be sure to talk to your healthcare professional before undertaking any of these activities.

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What are the most common side effects when TOPAMAX is used in combination with other antiseizure medicines?

Side effects more commonly found in adults. When TOPAMAX is added to other antiseizure medicines, the most common side effects in adults are sleepiness, dizziness, coordination problems, speech disorders, a delay between thought and action called psychomotor slowing, abnormal vision (including double vision), difficulty with memory, and tingling sensations in the hands and feet. Women taking birth control pills along with TOPAMAX may experience increased breakthrough bleeding, and the birth control may not be as effective.

Side effects more commonly found in children. In children over the age of 2, taking TOPAMAX along with other antiseizure medicines, the most common side effects are fatigue, sleepiness, loss of appetite, nervousness, difficulty with concentration/attention, difficulty with memory, aggressive reaction, and weight decrease. In hot weather, children may experience decreased sweating, leading to an increase in body temperature. The safety and effectiveness of TOPAMAX in children younger than 2 years of age has not been established.

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What additional safety information should I know about?

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 fever 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

As monotherapy, the most common side effects of TOPAMAX ® (in the 400 mg/day group and at a higher rate, ≥ 5%, than the 50 mg/day group) in adults were tingling in arms and legs, weight decrease, loss of appetite, sleepiness, and difficulty with memory; and in children, fever, weight decrease, mood problems, cognitive problems, infection, flushing, and tingling in arms and legs.

In combination with other antiepileptic drugs (AEDs), the most common side effects of TOPAMAX ® in adults (200 to 400 mg/day) were sleepiness, dizziness, loss of muscle coordination, speech disorders and related problems, psychomotor slowing, abnormal vision, difficulty with memory, tingling in arms and legs, and double vision; and in children (5 to 9 mg/kg/day), fatigue, sleepiness, loss of appetite, nervousness, difficulty with concentration/attention, difficulty with memory, aggressive reaction, and weight decrease.

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.

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What should I do if I think I’m having a side effect?

Discuss all side effects with your healthcare professional. Your healthcare professional has probably talked with you about the side effects that might occur. Some side effects that begin when you first start TOPAMAX may disappear on their own. However, if you have any questions or concerns about your medicine or if you’re feeling anything different from what your healthcare professional described, call your healthcare professional’s office.

Don’t assume you know the cause. Remember, the source of a side effect may not be as obvious as you might think. If you are taking TOPAMAX in addition to another antiseizure medicine, side effects may not be due to TOPAMAX. It may be the drug combination that is the cause.

Stay on track. The best way to reduce the chance of side effects is to follow your healthcare professional’s instructions carefully.

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Could I experience hair loss while taking TOPAMAX?

Hair loss (alopecia) has been reported as a side effect of TOPAMAX. In clinical trials, hair loss occurred in up to 5% of children taking TOPAMAX for epilepsy. There is not enough information to predict the duration and severity of this side effect for individual patients.

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Could I experience eye problems while taking TOPAMAX?

Call your healthcare professional right away if you have a loss in vision eye pain, or any new eye symptoms. These problems can lead to permanent vision loss if not treated right away. Your healthcare professional will probably stop TOPAMAX and may recommend other therapy.

Before taking TOPAMAX, tell your healthcare professional if you have eye problems, especially glaucoma. TOPAMAX may cause eye problems which can be serious. Serious eye problems include any decrease in vision (acute myopia or maculopathy) with or without eye pain, and a blockage of fluid in the eye causing increased pressure in the eye (secondary angle closure glaucoma).

  • Abnormal vision occurred in up to 13% of adults and double vision (diplopia) occurred in 10% of adults taking TOPAMAX at doses up to 1000 mg/day in clinical trials for epilepsy add-on therapy. In another clinical trial, abnormal vision and double vision both occurred in 2% of adults taking TOPAMAX 200 mg/day.

  • Several vision disorders, including eye abnormality, abnormal vision, double vision, abnormal tearing (lacrimation), and nearsightedness (myopia), were reported in ≤2% of children aged 2-16 years.

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Should TOPAMAX be taken with food or on an empty stomach?
TOPAMAX can be taken with or without food. Many people take their medicine at breakfast and dinner or when they brush their teeth. TOPAMAX is available in tablets or sprinkle capsules that may be opened and sprinkled onto food or swallowed whole. ^ Return To Top
If my seizures stop, how long will I have to keep taking TOPAMAX?

Ask your healthcare professional. Your healthcare professional is the best judge of how long treatment with TOPAMAX and other antiseizure medicines should continue. These drugs help to prevent seizures from occurring. Discontinuing therapy may make your seizures return. Do not discontinue your antiseizure medicine without discussing it with your healthcare professional first.

Keep your goals in mind. You and your healthcare professional will only want to stop treatment when the risk of seizures is acceptably low. Remember, never stop taking your medicines without talking to your healthcare professional first. Abruptly stopping antiseizure medicine can trigger seizures in some patients.

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How should TOPAMAX be stored?
Keep your medicine in a safe place, away from extreme conditions. Store TOPAMAX tablets at room temperature (59°F to 86°F) in a tightly closed container, such as the prescription bottle the drugstore gave you; TOPAMAX sprinkle capsules should be kept at or below 77°F in a tightly closed container. All antiseizure medicines should be protected from moisture. Most importantly, keep your TOPAMAX in a convenient place that helps you remember to take it. As with any medication, keep out of the reach of children. ^ Return To Top
I still have questions. Where can I get answers?

Your healthcare professional should be your primary source for all medical questions. For practical answers on living with epilepsy, get in touch with other people who are living with epilepsy, and learn about what has worked for them. Online communities and local organizations are a good place to start. Please see our Important Organizations and Resources page for more.

If you are still having seizures while taking an antiseizure medicine, your healthcare professional may choose to add TOPAMAX to your treatment.

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About TOPAMAX®

TOPAMAX® is approved as initial monotherapy in patients 2 years of age and older with partial-onset or primary generalized tonic-clonic seizures.

Safety and effectiveness in patients who were converted to monotherapy from a previous regimen of other anticonvulsant drugs have not been established in controlled trials.

TOPAMAX® is approved as add-on therapy for patients 2 years of age and older with primary generalized tonic-clonic seizures, partial-onset seizures, or seizures associated with Lennox-Gastaut syndrome.

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 fever 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

As monotherapy, the most common side effects of TOPAMAX ® (in the 400 mg/day group and at a higher rate, ≥ 5%, than the 50 mg/day group) in adults were tingling in arms and legs, weight decrease, loss of appetite, sleepiness, and difficulty with memory; and in children, fever, weight decrease, mood problems, cognitive problems, infection, flushing, and tingling in arms and legs.

In combination with other antiepileptic drugs (AEDs), the most common side effects of TOPAMAX ® in adults (200 to 400 mg/day) were sleepiness, dizziness, loss of muscle coordination, speech disorders and related problems, psychomotor slowing, abnormal vision, difficulty with memory, tingling in arms and legs, and double vision; and in children (5 to 9 mg/kg/day), fatigue, sleepiness, loss of appetite, nervousness, difficulty with concentration/attention, difficulty with memory, aggressive reaction, and weight decrease.

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.

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This site was last modified on: Feb 13 2012 at 11:05:00 EST