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Topamax is the brand name of topiramate, an anticonvulsant drug used to prevent seizures and reduce the frequency of migraines.

While its exact mechanism of action is unknown, studies suggest Topamax might alter the production or action of neurotransmitters in the brain, suppressing the abnormal activity of the nerves in the brain that cause seizures or preventing the abnormal activity from spreading to other nerves. Other research has suggested that it might suppress the nerves directly, thereby making them less likely to fire.

The Food and Drug Administration (FDA) approved Topamax to treat seizures in 1996.

In 2004, Topamax received FDA approval for the prevention of migraines. Manufactured by Janssen Pharmaceuticals, Topamax is now the number-one prescribed medication for migraine prevention in the United States.

It's used to stop migraine headaches from occurring in those 12 and older. It cannot be used to treat a headache that has already begun, but it may help to reduce the number of painful migraine.

Topamax and Weight Loss

Doctors occasionally prescribe Topamax off-label to control binging and purging and promote weight loss in people with eating disorders such as bulimia nervosa and binge-eating disorder.

The drug is seen as an alternative when first-line therapy with selective serotonin reuptake inhibitors (SSRIs) have failed to achieve results.

It is unclear why Topamax is effective for these uses; however, it is believed that the same properties that enable it to control migraines and seizures also work to inhibit the brain networks that cause food cravings.

Although there have been a number of studies supporting the efficacy of Topamax for weight loss, there remain some concerns regarding its long-term safety. In addition, the drug has troubling, sometimes serious side effects.

As a result, it is not the first-choice treatment for weight loss in patients with eating disorders.

According to guidelines published by the American Psychiatric Association (APA), Topamax is recommended only when other treatments have been ineffective. The APA also notes that because it causes weight loss, Topamax may be problematic if you are of normal weight or are under weight.

Topamax should only be used as prescribed, and under the supervision of a healthcare professional. If you have an eating disorder, ask your doctor if Topamax is an option for you.

Topamax (Topiramate) Warnings

Topamax can lead to serious eye problems that, if left untreated, could cause permanent vision loss. These include a sudden decrease in vision that may be accompanied by eye pain and redness, as well as a blockage of fluid in the eye resulting in secondary angle closure glaucoma.

Topamax might decrease sweating and increase your body temperature resulting in a fever. Some people may need to be hospitalized if this occurs.

Using this medicine could increase the level of acid in your blood, causing metabolic acidosis. Symptoms may include loss of appetite, feeling tired, changes in your heartbeat, or having problems thinking clearly.

If metabolic acidosis is not treated, it could cause brittle or soft bones leading to osteoporosis or other conditions. It might also result in kidney stones or slow the rate of growth in children.

In a small number of people, Topamax has been known to cause suicidal thoughts or actions, new or worse anxiety, irritability, and depression as well as feelings of agitation, restlessness, aggression, panic attacks, mania, and insomnia.

This medication could also cause sleepiness and impact your ability to think, causing confusion and problems with concentration, attention, memory, and speech.

Don't stop taking Topamax without talking to your doctor first. Suddenly quitting could lead to serious health problems.

To help your doctor decide if he/she should prescribe Topamax, you must disclose all your medical conditions and determine whether you are allergic to the drug. Tell your doctor if you have the following conditions:

  • Kidney disease,a history of kidney stones, or are on dialysis
  • Have severe breathing problems
  • Glaucoma or other eye conditions
  • Osteoporosis
  • Osteomalacia, a growth disorder and liver disease
  • History of mood disorders like depression or suicidal thoughts and actions
  • Diarrhea

Pregnancy and Topamax (Topiramate)

If you are using birth control pills, you should be aware that Topamax could make them less effective. It's a good idea to add condoms or a diaphragm with spermicide to your birth control regimen to help prevent pregnancy.

Taking Topamaz during pregnancy can increase the risk that your baby will develop cleft lip or a cleft palate. However, if you are using the medication to prevent seizures and become pregnant, it's important that you tell your doctor right away. You should not stop taking Topamax unless your physician advises you to do so.

If you become pregnant while on this medication, consider registering with the North American Antiepileptic Drug Pregnancy Registry (888-233-2334), which collects information about the safety of antiepileptic drugs during pregnancy.

Be sure to tell your doctor if you are breastfeeding since Topamax could pass into your milk and harm your child.


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