As with any drug, there are hazards involved with Topamax. If you are worried about side effects, speak with your doctor. And there are some more serious side effects to be mindful about. However, as weight reduction is quite personal, each person’s experience may differ. Depending on how you are reacting to the drug, your doctor may decide to increase your dosage after 12 weeks (3 months). One of the most distressing and unique side effects of TPM use is word-finding problems with slowed mental processing and attention and memory difficulties. Overall, the review found that the current studies on the subject support that the off-label use of TPM is beneficial for treating alcohol use disorders. This review found that TPM significantly impacted reducing drinks per day, drinks per drinking day, and the number of heavy drinking days, as well as increasing the percentage of days abstinent. A 2015 literature review compiled information from studies of off-label TPM use for alcohol use disorders. Content clinically reviewed and medically verified by licensed experts to meet California Prime Recovery’s highest standards of trust, transparency, and evidence-based care. Our programs are clinically supervised by licensed mental health and addiction professionals with decades of experience. However, it should only be used for this purpose under medical supervision. It can take a few days to a few weeks for Topamax to start working, depending on the condition being treated. Its effectiveness in reducing baseline weight and improving BMI has been proven in clinical trials, particularly when used alongside a reduced-calorie diet or ketogenic diet. Topiramate, commonly known by its brand name Topamax, is a prescription medication initially developed for treating epilepsy and migraines. Topiramate - topiramate tablet, film coated package insert. Eprontia - topiramate solution package insert. Common side effects of Topamax include tingling in the arms and legs, nausea, and lack of appetite. Topamax (topiramate) is FDA approved to treat epilepsy and prevent migraines, but it has other off-label uses that people may not know about. The most common side effects of Topamax include dizziness, sleepiness, memory problems, confusion, nervousness, weight loss, flushing, and fever.2 Yes, one of the side effects of Topamax use is potential weight loss due to appetite suppression.1 However, it should not be used for this purpose; misusing Topamax to lose weight may be indicative of disordered eating. Just because a medication like Topamax has been approved for weight loss, that doesn’t mean using it is without its risks, both physical and psychological. And if an individual is following the keto diet to lose weight, taking Topamax for weight loss could be especially dangerous due to the severe body weight changes, as well as the risk of metabolic acidosis, which occurs when there’s a buildup of acid in the body. All presented data suggest that up to 10% of patients treated with topiramate, either for epilepsy or migraine, may complain of cognitive problems but such prevalence may be significantly reduced using topiramate in monotherapy and adopting individualized doses and titration schedules. Metabolic acidosis Creatinine exits the body as a waste product in urine. Healthy kidneys filter creatinine out of the blood. A creatinine test is a measure of how well the kidneys are doing their job of filtering waste from the blood. They can help you choose the most suitable medication based on your medical history, weight loss goals, and potential side effects. The time it takes to lose weight with Topamax (topiramate) varies by individual, but most people begin to notice weight loss within a few weeks to a few months of starting the medication. The medication demonstrates effectiveness in reducing body weight across various dosages while also maintaining weight loss over time. Topamax may also improve insulin sensitivity in people taking antipsychotic medications, such as olanzapine (Zyprexa). Other studies show that Topamax may help lower levels of leptin, a hormone that tells your body to store fat. It’s unknown exactly how Topamax works for weight loss. As mentioned, you can take Topamax for weight loss on its own, but this is considered an off-label use. This combination is available under the brand name Qsymia (phentermine / topiramate ER). Twelve patients (60%) responded to topiramate, and the time to response ranged from 2 to 4 weeks. The efficacy of topiramate as an adjunct treatment in patients with mood disorders has been demonstrated. None of the patients discontinued topiramate because of side effects. Keep a list of them to show your healthcare provider and pharmacist each time you get a new medicine. However, coverage can vary by plan, so it’s essential to check with your provider for details on what services are included and whether certain treatment centers or specialists are within their network. Under the Mental Health Parity and Addiction Equity Act (MHPAEA), insurance providers must offer comparable coverage for mental health conditions, like eating disorders, as they do for physical health issues. Always consult a healthcare provider before using Topamax for this purpose. However, it must be used cautiously, as Topamax can also cause side effects that affect mood and cognition, which could complicate recovery from an eating disorder. It is important to consult a healthcare provider before using Topamax for eating disorders to ensure it is appropriate for your specific condition. Do not stop taking this medicine unless told to do so by your doctor. Always take this medicine exactly as your doctor has told you. This medicine contains less than 1 mmol sodium (23mg) per tablet, that is to say essentially ‘sodium-free’. Dizziness, tiredness, and vision problems may occur during treatment with Topamax. Your doctor will take into account the importance of the medicine to the mother and the risk for the baby. Participants included youth seen in the weight management clinic who did not opt out of having their EHR reviewed for the purposes of research via the Consent for Services form that all patients and/or caretakers complete. Our group previously showed a mean 6-month 4.9% BMI reduction among 28 adolescents prescribed topiramate plus lifestyle modification in a pediatric weight management clinic (19). Despite the fact that topiramate is commonly prescribed in pediatric weight management clinics, little is known about its effectiveness in this clinical setting, or about potential person-specific characteristics that may predict those more or less likely to experience benefit. Therefore, your doctor will discuss with you whether you abstain from breast-feeding or whether to abstain from treatment with Topamax. Effects have been seen in breastfed babies of treated mothers, including diarrhoea, feeling sleepy, feeling irritable, and poor weight gain. The active substance in Topamax (topiramate) passes into human milk. You should not stop your treatment without discussing this with your doctor. If you are planning to become pregnant you should discuss your epilepsy treatment with your doctor as early as possible before you become pregnant. Acetazolamide, another sulfa-derived drug, should be used cautiously as it may exacerbate the problem . Topical and oral eye pressure-lowering medicines along with mydriatic eye drops (atropine) are recommended. Early diagnosis and discontinuation of the offending medication are critical in treating TiACG. Contractions are episodic and self-limited, sometimes lasting seconds to hours or even weeks . The precise mechanism of drug-induced visual field defects is not well-understood. There is currently no evidence of duration or dose-dependent relationship between TPM use and uveitis . The subjects for this randomized, double-blind, placebo-controlled, parallel group study were recruited from the Institute of Endocrinology and Metabolism, Firouzgar Hospital, Tehran, Iran. Pharmacotherapy is typically initiated if the patient has been unsuccessful in attaining their weight loss target after 6 months of lifestyle modification, but it must be used in conjunction with a program that includes dietary changes and physical activity. Pharmacotherapy is usually reserved for patients with a BMI greater than 30 kg/m2 without complications or a BMI greater than 27 to 30 kg/m2 with concomitant weight-related complications. Common side effects, as described in the phentermine-prescribing information, for short-term (12–14 weeks) use include dry mouth, insomnia, headache, dizziness, fatigue, tachycardia, and palpitations 18–20. Indications and contraindications of approved phentermine and topiramate agents The drug is a weak substrate or uptake inhibitor of the serotonin transporter 43,44 and has minimal effects on plasma serotonin in vivo. This medication may cause difficulty falling asleep or staying asleep if it is taken in the evening. Phentermine and topiramate come as extended-release capsules to take by mouth. Phentermine and topiramate must be used along with a reduced calorie diet and exercise plan. Save my name, email, and website in this browser for the next time I comment. Consult your doctor to see if there are any other treatments that may be a better fit for you. For people ages 10 and older who are taking Topamax by itself for seizure management, the recommended dosage is 400 mg per day. Below, we review recommended Topamax dosages for the medication’s approved uses. You’ll likely start with a lower dosage to reduce the risk of side effects. As mentioned, your specific Topamax dosage will be based on your age and health condition(s). Specific Topamax dosages are based on the health condition(s) you have and how old you are. Women of childbearing age should use effective contraception and discuss pregnancy plans with their healthcare provider before starting this medication. The gradual titration schedule is crucial because it allows your body to adapt and helps identify the minimum effective dose for your situation. Never adjust Topamax dosing on your own, as this medication requires careful medical supervision. However, some patients may require higher doses for effectiveness, while others achieve results at lower doses. Additionally, topiramate may increase metabolic rate slightly and can affect how the body processes carbohydrates and fats. It’s also sometimes prescribed off-label for weight loss and mood stabilization. While topiramate’s specific mechanism of action regarding weight loss remains uncertain, various hypotheses suggest it may help by reducing calorie intake and impacting food reward pathways. While Topamax can be an effective medication for weight loss, it may not be suitable for everyone. EQUIP included 1267 severely obese adults (≤70 years of age and BMI ≥35 kg/m2; patients with T2DM were excluded) . Topiramate, like other carbonic anhydrase inhibitors, may produce CNS and peripheral nervous system (PNS) effects, such as paraesthesias, acute myopia, blurred vision, redness of the sclera, photophobia, and eye discomfort resulting from secondary angle-closure glaucoma, as well as psychiatric and neurologic disturbances, including fatigue, somnolence, depression, and difficulties with concentration and memory 65,66. Topiramate may decrease food intake via effects of carbonic-anhydrase inhibition on taste 67,68, or through its effects on GABA transmission, since GABA-A receptor activation and the interaction between GABA and leptin pathways are known to mediate effects on appetite and metabolism. It is suggested that topiramate acts on kainate/alpha-amino-3-hydroxy-5-methylisoxozole-4-propionic acid glutamate receptors. It should be noted that there were reports of valvular heart disease when phentermine was used in combination with fenfluramine or dexfenfluramine 28,30–33,59. A detailed discussion about her medications was held. Ms. E, a 38-year-old Native American woman with a 12-year history of schizoaffective disorder, was seen at a continuing day treatment program. Lithium carbonate was raised to 900 mg at bedtime, and fluoxetine was continued at 20 mg/day. She was not experiencing any side effects from the topiramate. They may suggest a lower topiramate dosage. Paresthesia is more commonly reported in people taking topiramate for migraines than those taking it for seizures. Paresthesia is the medical term for a “pins and needles” sensation felt in the hands or feet. Topamax was withdrawn due to adverse events compared with 11% on placebo. Other studies have shown that Topamax reduces food intake by its interaction in the hypothalamus in the brain’s appetite center, as well as stimulating energy expenditure directly. It is unique because very few drugs reduce cravings. Topamax is an approved prescription drug that has been used for treating seizures and migraine headaches since 1996 and migraine headaches since 2004. It is especially important that you not take topiramate tablets that have been broken for any length of time because tablets that are broken may lose their effectiveness over time. Hone-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Hone telehealth platform. Research-backed tools, tactics, and techniques to maximize your health, delivered to your inbox every Monday. Dr. James R. Staheli is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia. This comprehensive assessment helps you and your healthcare provider evaluate whether Topamax is working for you. If you experience significant cognitive effects that interfere with daily functioning, discuss this with your provider. Periodic monitoring of kidney function is important because topiramate can affect kidney function and increase kidney stone risk. Many people find that combining medication with behavioral support produces the best long-term outcomes. Working with a therapist or counselor experienced in weight management can help identify triggers for overeating, develop coping strategies, and build sustainable habits. Its weight loss effects are considered a secondary benefit that emerged during clinical trials for other conditions. However, because alcohol use on its own can trigger migraines, talk to your healthcare provider about if it’s safe to have a drink while taking these medications. It generally isn’t recommended to drink alcohol with blood pressure medications. A variety of other medications are used to prevent migraines, like blood pressure medications, antidepressants, and a newer category of medications called monoclonal antibodies. If you’ve been taking topiramate for a long period of time, your provider will gradually lower your dose over the course of 2 to 8 weeks. Increased blood pressure may be categorized as elevated, stage 1 or stage 2 depending on the specific numbers. Ideal blood pressure is categorized as normal. The American College of Cardiology and the American Heart Association divide blood pressure into four general categories. High blood pressure is called hypertension. Topiramate exhibits linear and predictable pharmacokinetics over the recommended dosage range of 15 to 400 mg per day . Concomitant ingestion of food slows the time required to reach peak plasma concentrations but does not substantially alter the extent of absorption. Insomnia, irritability, anxiety, headache, attention disturbances, depression, parched mouth, and nephrolithiasis were the adverse events that led to the discontinuation of treatment in all three clinical trials. Wilding et al. investigated the long-term efficacy and safety of TPM in obese patients. Is combining phentermine and topiramate a common approach when using topamax for weight loss? A 24-week, multicenter, double-blind, placebo-controlled, parallel-design study examined the efficacy and safety of topiramate (400 mg) monotherapy in patients with essential tremor reporting concentration and memory difficulties in only 3% of patients Ondo et al. 2006. A randomized, double-blind, placebo-controlled study of topiramate in chronic migraine reported paraesthesias in 53% of patients treated with topiramate versus 6% of attention problems Diener et al. 2007. Interestingly, a double-blind, randomized, controlled study of topiramate and amitriptyline, either alone or in combination, reported that the combination of the two drugs is not only more effective then the single treatment but also better tolerated with fewer adverse events Keskinbora and Aydinli, 2008. Alcohol withdrawal makes it more likely for you to have a seizure, especially if you drank a heavy amount or if you’ve drunk consistently for a long time. The most serious risk of drinking alcohol for people with epilepsy is alcohol withdrawal, which is what your body experiences after you stop drinking. But before mixing alcohol with topiramate, there are some important factors to keep in mind. Topiramate is a medication used to treat seizures or prevent migraines. Similar to semifluid, tripeptide is a GLP-1 receptor agonist that is used to treat obesity and type 2 diabetes. Semifluid reduces hunger, slows stomach emptying, and regulates blood sugar levels to prolong feelings of fullness. It’s crucial to remember that in these studies, Topamax was used in conjunction with dietary and lifestyle modifications. Qsymia contains phentermine, a stimulant that may make it difficult for you to fall asleep. Your doctor will decide on the appropriate dosage and frequency for you because there isn’t an approved dosage for weight reduction. Although topiramate’s effects on weight reduction can differ from person to person, most patients experience weight loss within the first few weeks of medication.Never hesitate to ask your medical team any questions or concerns that you have.The medication must be tapered gradually under medical supervision—abrupt discontinuation can cause withdrawal effects and potential seizures.Paradoxical topiramate-induced hyperphagia successfully treated with phentermine in a woman with migraine.Similar to semifluid, tripeptide is a GLP-1 receptor agonist that is used to treat obesity and type 2 diabetes.Topamax’s impact on weight loss is multifaceted, involving appetite suppression and changes in taste perception.Therefore, your doctor will discuss with you whether you abstain from breast-feeding or whether to abstain from treatment with Topamax. This article will delve into the specifics of using Topamax for weight loss, including the recommended dosage and factors that influence it. However, it has also gained popularity for its off-label use in aiding weight loss. Topamax, known generically as topiramate, is a medication that has been widely used for treating epilepsy and preventing migraines. Call your doctor for medical advice about side effects. If you notice any other effects, check with your healthcare professional. These data were confirmed in a separate 2011 study showing that TPM induces weight loss and improves insulin sensitivity in dietary obese rats compared to sibutramine . Tremblay et al. report substantial body energy loss due to decreased macronutrient intake while patients were on topiramate, which led to lower body fat stores . A review by Verotti et al. endorses the ability of TPM to induce weight loss, which is most significant in patients with a high BMI. Her respective weight and BMI, which were 109 kg and 42.5 kg/m2 before starting treatment, decreased to 98.6 kg and 38.5 kg/m2 after 4 months of treatment. After the first 2 weeks of treatment, weekly binge eating decreased from 8 to 1, and the episodes completely remitted within 30 days of the onset of treatment. The initial topiramate dose was 25 mg bid for 2 weeks, followed by an increase of 25 mg every week until she reached the target dose of 75 mg bid, which was maintained for 4 months. Appolinario and colleagues17 described the effects of topiramate on a woman diagnosed with BED in the absence of neuropsychiatric comorbidity. The adverse events most commonly reported by patients receiving topiramate were paresthesia (48.6%), taste disturbance (24.3%), dysuria (13.5%), and leg pain (10,8%). Because of the risk of birth defects, phentermine and topiramate is available only through a special restricted distribution program.However, for obese or overweight individuals with type 2 diabetes, high blood pressure, or high cholesterol who also need to exercise, the FDA has approved Qsymia.The mean body weight was reduced by 3.9% of the baseline at three months and 7.3% of the baseline at one year.Trichomegaly can be congenital or acquired secondary to medications or chronic illnesses.Fourteen patients lost weight during the 16-week study.Topiramate extensively binds to red blood cells.This lowers blood pressure and increases the supply of blood and oxygen to the heart.Your body gets rid of topiramate mainly through your kidneys. Understanding of the various weight-loss medications available, indications, common side effects and limitations in specific patient populations allows general practitioners (GPs) to decide if, and which, pharmacotherapy is appropriate when managing patients with obesity. On commencement of weight-loss medications, patients should be reviewed closely for the first three months (four months for medications such as liraglutide and topiramate that require gradual dose escalation) to assess safety, tolerability and efficacy. Analysis of randomised controlled trials (RCTs) indicates weight loss at six months of 3.6 kg, compared with placebo.9 More recently, phentermine 15 mg was shown to induce a weight loss of 4.5 kg over placebo after six months of therapy (Table 1).10 Phentermine is available in a slow-release resin preparation in doses of 15, 30 and 40 mg, and given as a single daily dose early in the day. As a weight loss medicine, it is important to continue the medication to maintain its effects and avoid abruptly stopping it without consulting a doctor, as this could lead to potential health risks. While results vary, some individuals experience moderate weight loss, especially when combined with other medications like phentermine (as in the combination drug Qsymia). It is most effective when tailored to the individual’s condition and monitored closely by a healthcare provider. It is often prescribed as part of a broader weight management plan that includes diet and exercise. It may also increase energy expenditure and reduce cravings for unhealthy foods, particularly those high in sugar and carbohydrates. Although the specific mechanism of action concerning weight loss remains uncertain, various hypotheses have been reported. Obesity has emerged as a widespread disease with epidemic proportions, necessitating effective management to enhance the overall health outcomes of patients. Some people experience substantial weight loss and appetite suppression, while others see minimal changes. Regarding new AEDs, a multicenter, double-blind, randomized, prospective study compared lamotrigine and topiramate as an adjunctive therapy with carbamazepine or phenytoin Blum et al. 2006. Data about topiramate in comparison to older AEDs come from two multicenter, double-blind, randomized, parallel-group studies comparing topiramate with valproate as add-on therapy to carbamazepine Aldenkamp et al. 2000; Meador et al. 2003. This is further confirmed by the lack of association with the starting dose or the titration schedule Mula et al. 2003b, being reported also with very low doses (less than 100 mg) or in long-term treatment Lee et al. 2006. In fact, cognitive complaints decrease to 3–4% when topiramate is prescribed in monotherapy Arroyo et al. 2005 or flexible, individualized doses are adopted Krakow et al. 2007. Topiramate for weight loss (Topamax) In children, both age and body weight are factors. Alcohol can affect how this formulation releases medication throughout the day. Taking topiramate with alcohol can also make any side effects you experience more intense. Your child’s dosage will depend on a number of factors, most notably their age, body weight, and the type of seizures they have. Alongside a reduced-calorie diet and even a ketogenic diet, Topamax has been shown to support weight loss, helping patients reduce their baseline body weight and improve body mass index (BMI).Or they may recommend medications or other products to relieve paresthesias.Qsymia can take longer, with typical results in the first 8 weeks of treatment.One published study assessed the effects of chronic TPM administration in rabbits.Creatinine usually enters the bloodstream and is filtered from the bloodstream at a rate that tends to be constant.Originally developed as an antiepileptic drug, Topamax has found multiple uses beyond its initial purpose.People who decide to use medication like topiramate for weight loss are typically influenced by the insidious nature of diet culture.Potential reasons for these differences include generally better compliance in clinical trials involving obesity interventions, and that participants in such trials tend to be primarily white, female, and have minimal co-morbidities (i.e., no significant depression and/or anxiety, hemoglobin A1c ≤10%, etc.), often not the case in clinical settings (25).Similarly, if the medication produces satisfactory weight loss and is well tolerated, it should not be discontinued empirically. When topiramate solution, IR tablets, or sprinkle capsules are taken as a monotherapy for epilepsy, the typical dosage for adults is 400 mg daily (taken in 200 mg doses twice a day). If you’re just getting started on topiramate, you’ll likely start with a low dose and increase it over time — usually weekly. They can be taken on their own (known as monotherapy), or as an add-on treatment along with other medications. Taking more than your prescribed dose of topiramate can lead to serious side effects. A healthy blood sodium level is between 135 and 145 millimoles per liter (mmol/L). It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body's fluid balance. Depending on the extent and duration of these symptoms, your healthcare professional may recommend seeking immediate medical care. In other cases of hyponatremia, you may need intravenous electrolyte solutions and medications. Ask what the results mean for your health or treatment plan. Further, the precision of our estimates may have been affected by secular trends in obesity interventions stemming from COVID-19. We did find that 15% of those prescribed topiramate plus lifestyle modifications were from non-primary English language speaking families, and as surveys were only available in English until 2021 this led to higher percentages of those not completing surveys being from such families, potentially limiting generalizability. In our clinical setting, there were several potential reasons as to why intake surveys may not have been completed, including that a patient was scheduled off the clinic waitlist and did not have time to complete prior to the initial appointment, forgot to bring survey to the appointment, or survey was not entered into the database. More specifically in terms of not having a BMI within the analysis window, this was due to having no follow-up within our pre-specified window for data interpolation which could occur in those doing well on treatment (e.g., need to be seen less frequently), virtual visits which increased significantly since COVID-19, or BMI was otherwise missing from a visit. On commencement of weight-loss medications, patients should be reviewed closely for the first three months (four months for medications such as liraglutide and topiramate that require gradual dose escalation) to assess safety, tolerability and efficacy.WikiDoc does not promote the administration of any medication or device that is not consistent with its labeling.Limitations regarding the design of this study are the lack of a control group and randomization, and the fact that it was open-label; other limitations include the small sample size and the high attrition rate.This is based on the medication's half-life, which measures how long it takes for half of it to leave the body.Understanding these differences is essential for safe and effective use of Topamax for weight loss.To monitor this risk, your prescriber will ask you to do a blood test before you start topiramate (Topamax).At the end of the study period, the mean weight change was −6.8 kg in the topiramate group vs −0.9 kg in the placebo group. The mechanisms underlying the effect of topiramate on lowering HbA1c and FBS of diabetic patients are not clear yet. These results were unique and have not been seen in any studies.17,18,19The main limitations of this study were its short duration and the small sample size due to the non-co-operation state of some subjects. Blood pressure and hemoglobin A1C in ITT subjects, a comparison between drug and placebo groups; bolded P values are significant It can be used alone or together with other medications to treat certain types of seizures in people 2 years and older. We are committed to evidence-based addiction treatment, mental health care, patient safety, and long-term recovery. If you or a loved one are struggling with mental health challenges or substance abuse, reach out to California Prime Recovery today. Topiramate, for instance, is considered a valuable weight loss solution due to its multifaceted mechanisms, including reducing calorie intake and impacting metabolic pathways. Or your prescriber may recommend taking a medication or supplement for metabolic acidosis or switching to another medication altogether. These can help them keep an eye on the acid level of your blood. People with certain health conditions, such as kidney disease or severe lung problems, may be at higher risk. If you believe you’re experiencing symptoms of metabolic acidosis, seek medical care right away. In most cases, topiramate only causes mild imbalances. Get medical help right away if your child breaks a bone while taking this medication. In studies, some children taking topiramate (Topamax) had signs of having weaker bones. You can also be at risk if you take medications called carbonic anhydrase inhibitors, like acetazolamide. Weight loss is a side effect consistently reported in the medical literature in patients treated with topiramate. In a Fox et al. randomized controlled trial comparing topiramate 75 mg daily with placebo following a meal-replacement run-in phase, among 30 adolescents, 25% in the topiramate group reported experiencing paresthesias versus 0% in the placebo group; however, the incidence of other side effects was generally similar between groups and there were no concerning changes in neurocognitive function (27). Specifically, when a medication is marked as “not taking” or “discontinued,” the specific rationale may be missing, and even if the rationale is listed as “side effects,” often the specific side effect is missing as this is a free-texted element that takes time to enter in a busy clinical setting. Finally, results from this study came from a single academic health center-based pediatric weight management clinic located in the Midwestern portion of the U.S. and, therefore, it is unclear how generalizable our findings are to other pediatric weight management clinics in the U.S. or worldwide. As our EHR does not directly link to pharmacy data (e.g., to assess how often patients are refilling medications), we could not determine adherence. Topiramate is an anticonvulsant drug used for the treatment of epilepsy and prophylaxis of migraine. AK engages in unpaid consulting and educational activities for Boehringer Ingelheim, Novo Nordisk, Vivus, and Eli Lilly, and receives donated drug and placebo from Novo Nordisk and Vivus for National Institutes of Diabetes and Digestive and Kidney Diseases NIDDK-funded clinical trials. Future prospective studies, including clinical trials, are needed to evaluate “real-world” effectiveness and to identify and confirm potential predictors of response to topiramate plus lifestyle modification therapy in pediatric clinical settings. These findings suggest that topiramate with lifestyle modification may be an effective option among youth treated in a pediatric weight management clinical setting. However, these are generally dose dependent, particularly at higher doses (around 400 mg daily), while doses used for obesity management are often lower (around 50–100 mg daily) (23, 59, 67). That said, one observational study among adults with obesity prescribed semaglutide showed results that were relatively comparable to those seen in a randomized controlled trial comparing semaglutide with placebo (both as lifestyle modification adjuncts) (63, 64).It is the only approved weight-loss medication that does not work primarily by suppressing appetite, and has a relatively good long-term safety record.Topamax can be used long-term under medical supervision, though regular monitoring is essential.For more information about the relationship between Hone and the medical practices, click here.Below, we review recommended Topamax dosages for the medication’s approved uses.That said, presence (vs. absence) of baseline depressive symptoms with 3- and 6-month, anxiety symptoms with 6-month, and binge eating tendencies with 12-month %BMIp95 changes, among others, all showed more meaningful associations with topiramate response.However, it should only be used for this purpose under medical supervision. Topamax (topiramate) is a prescription medication primarily used to treat epilepsy and prevent migraines. These are not all the side effects of topiramate. These common side effects of topiramate may happen in more than 1 in 100 people. Similar to previous studies, the adverse events included paresthesia, fatigue, and difficulty concentrating. It was a randomized, placebo-controlled trial with 531 obese subjects (a BMI from 27 to 50) with an established HTN. Tonstad et al. evaluated the safety and efficacy of TPM treatment in obese subjects with essential hypertension . Most adverse treatment events were related to minor central nervous system problems. Subjects receiving TPM at 96 mg lost 15.4% of their initial weight by week 44, and subjects receiving 192 mg of TPM lost 16.5% by week 44. The efficacy was evaluated by patients who completed one year of their assigned dose of 96, 192, or 256 mg/day of TPM. Around 80% of the enrolled patients lost over 8% of their initial body weight, and 293 were analyzed for efficacy. The initial study was planned for sixty weeks but was cut short due to enhanced tolerability of the medication and a new controlled-release formulation for the patients’ ease. Accordingly, those who lost greater than 8% of their initial weight received 96 mg/day and 192 mg/day or the placebo. Obese patients may experience greater weight loss with continued therapy longer than one year. The study found no significant difference in efficacy between these drugs for seizure control, though lamotrigine was better tolerated than the others. The study determined that TPM treatment improved insulin sensitivity in diabetic mice and skeletal muscle . Overall, body weight and metabolism are also constantly regulated by signals from leptin and insulin in the hypothalamus. Although the biological mechanism behind TPM-induced weight loss is not well-described, possible mechanisms include lowering calorie intake, decreased fat gain, and decreased triglycerides and cholesterol levels . It has also been used in neuropathic pain, substance use disorders, eating disorders, and weight loss . Your doctor may adjust your dose based on your progress, side effects, and overall health status during regular monitoring visits. It’s important to understand that higher doses don’t necessarily mean better weight loss results. The appetite-suppressing effects appear to develop gradually over several weeks as the body adjusts to the medication. Does topiramate (Topamax) cause hair loss? She’s also the founder of Unalome House, a holistic medical spa in Severna Park, MD. Testosterone is a hormone that’s crucial for men’s health. A combination of age, genetics, and pre-existing medical conditions determines your testosterone levels. However, reductions in BP and rate pressure product were seen suggesting that when used in conjunction with lifestyle modifications, the combination may represent a safe and effective therapy for the management of obesity. Laboratory data, including thyroid studies, complete blood count, and liver function test results, were within normal limits. Consent was obtained, and Ms. C was started on topiramate, 25 mg/day. Because of her numerous previous unsuccessful medication trials, the use of topiramate was discussed. Her weight was 180 lb (81 kg) before topiramate was added, and her DSM-IV diagnosis was schizoaffective disorder. Nu Image Medical® sets the standard for patients looking to receive quality expert medical care without boundaries. Nu Image Medical® has been providing patient services nationally since 2008, establishing itself not only as a leader in regenerative medicine but also in the telehealth industry. Our futuristic methods offer a new and updated approach to achieving optimum health and wellness, through our online digital health platform, also known as telemedicine. Nu Image Medical may not offer the medications or services mentioned in this article. Treatment Outcomes As the GDG were unable to gain clarity in this regard, they took the decision not to consider their trials when drawing up their conclusions.”9 Clearly, these studies need replication. Several trials have examined the effect of topiramate on posttraumatic stress disorder (PTSD). Some substance abuse disorders (SUDs) may benefit from topiramate for prevention of relapse. There appears to be some confusion regarding the efficacy of topiramate in bipolar disorder. The information provided in this blog is for educational purposes only and is not a substitute for professional medical advice. These common side effects are normal and can typically wait to be addressed at an upcoming appointment.The best way to partner with your medical team is to, number one, get a medical team.Always consult a qualified healthcare provider before initiating Topamax for weight management.Obesity poses significant cardiovascular health risks, such as increased risk of hypertension and cardiovascular disease, and can cause or exacerbate arterial hypertension; it is an important cause of treatment-resistant arterial hypertension 2,3.Even more significantly, Eliasson et al. demonstrated a 6.6% weight loss with 9 months topiramate treatment in obese subjects with type 2 diabetes.Topiramate (Topamax) can cause ammonia to build up in your body. Take phentermine and topiramate at around the same time every day. If you have certain medical disorders or other variables that affect your health, this medicine may not be the best treatment for you. • Oligohidrosis and hyperthermia have been documented in topiramate post-marketing studies; antimuscarinic medications (such as trospium) can exacerbate these conditions. In fact, difficulties with concentration are reported in the region of 1% during the maintenance period at different target doses (50 mg, 100 mg and 200 mg), against prevalence rates of 3%, 6% and 9% during the titration phase. The authors reported a significant cognitive deterioration in about 70% of patients at 3 months, persisting in about 20% at 12 months. In fact, 17 out of 19 patients reported adverse events, with behavioral disturbances occurring in 15.8%. By contrast, data in children with learning difficulties, especially severe ones, suggest poor cognitive and sometimes behavioral tolerability. On a neuropsychological test battery, arithmetic is the only variable with a significant worsening after 28 weeks of treatment. Its central purported mechanisms for weight loss include increasing gamma-aminobutyric acid (GABA) and decreasing glutamate and dopamine secretion, subsequently decreasing appetite, food cravings, and binge eating; and through carbonic anhydrase inhibition, which can alter taste of carbonated beverages (12). FDA-approved for the treatment of seizures in youth 2–16 years of age, and for the prevention of migraine headaches in 12–17 year-old adolescents, in 1999 and 2014, respectively; however, has not been FDA or European Medicines Agency (EMA) approved for the treatment of obesity in either children or adults. Of these, topiramate has perhaps been the most commonly prescribed in pediatric weight management clinics (3). These results should be considered preliminary given the observational nature of this study, and prospective studies are needed to further characterize clinical effectiveness and identify and confirm potential predictors of response. There is limited information regarding Off-Label Guideline-Supported Use of Topiramate in pediatric patients. There is limited information regarding Off-Label Guideline-Supported Use of Topiramate in adult patients. WikiDoc does not promote the administration of any medication or device that is not consistent with its labeling. The educational content on WikiDoc drug pages is based upon the FDA package insert, National Library of Medicine content and practice guidelines / consensus statements. If needed, they can give you treatment for metabolic acidosis. Call your care team right away if you have signs of metabolic acidosis while taking topiramate (Topamax). This helps make sure the acid levels in your blood aren't too high. Specifically, reduction in HbA1c in this study was comparable with the current study. We recommend more studies with narrower inclusion criteria and larger sample size with different conditions with a long duration of follow-up in Iran and other middle to low income counties. Other adverse effects were included pruritus, insomnia and dizziness (less than 2 cases). How does Topamax work for weight loss? Concurrent weight loss programs with nonpharmacological treatment were introduced to all patients. TPM created clinically relevant body weight and blood pressure reduction effects while maintaining relatively mild adverse effects. The results confirmed that topiramate caused significant weight loss and was sustainable for one year with treatment. Ben-Menachem et al. inspected the predictors of weight loss in patients taking topiramate in combination with an anticonvulsant . Even if someone else has the same disease as you, do not share topiramate with them. If you feel that you need to stop taking topiramate, your doctor will provide you with instructions on how to do so. Even if you have never experienced a seizure, abruptly stopping topiramate can cause one. Topiramate should only be taken as directed by a healthcare professional. You’ll typically start with a low dose that increases slowly over several weeks to allow your body to adjust. There are many ways to save on topiramate, which is available as a generic medication. Never double up on your dose to make up for a missed one, as this may cause side effects. This is to make sure that too much topiramate isn’t building up in your body. Your body gets rid of topiramate mainly through your kidneys. Efficacy–safety stopping rule According to research, some patients start losing weight during the second week of using the medication and keep dropping weight as they continue to take it. After that, the dosage is increased to 7.5 mg/46 mg (phentermine/topiramate) orally once a day. The beginning dosage for Qsymia is 3.75 mg/23 mg (phentermine/topiramate) taken orally once daily for 14 days. That said, one observational study among adults with obesity prescribed semaglutide showed results that were relatively comparable to those seen in a randomized controlled trial comparing semaglutide with placebo (both as lifestyle modification adjuncts) (63, 64). In a separate longer term dose-ranging placebo-controlled trial, those receiving 92 mg topiramate plus lifestyle modification therapy experienced a mean 2.6 kg/m2 BMI reduction after approximately 1 year (18). That said, access to many of these medications, particularly glucagon-like peptide-1 receptor agonists (GLP1-RAs; e.g., liraglutide, semaglutide), continues to remain challenging and cost-prohibitive, and there are currently no approved options for youth 12 weeks), and will likely continue to be used as such for the foreseeable future, with topiramate perhaps being the most common (3). The mean dose was largely stable over time (see Supplementary Table S1), ranging from 34.2 ± 20.8 mg at the 1.5-month time point (269 patients with data available) to 39.7 ± 19.0 mg (at the 12-month time point 59 patients with data available. Forty-two percent and 44% of patients had baseline AST and ALT tests available, of which 10% and 18% had abnormalities (elevations) in these, respectively. These side effects can vary from person to person and tend to get better over time. Just like with any medication, Topamax can cause side effects. This risk is higher if you take it alongside other anti-seizure medications. Trichomegaly can be congenital or acquired secondary to medications or chronic illnesses. This study notes four patients who experienced scleritis while on TPM . All research studies mentioning the association of scleritis with TPM refer to a 2004 study conducted by Fraunfelder FW et al. Other studies have also shown overall BMI reduction or stabilization, and that baseline characteristics including higher BMI and younger age may predict response (20–24). This is partly due to historically lower utilization resulting from overall low availability of weight management providers, the relative newness of U.S. Topiramate is primarily used to treat seizures and alcohol use disorder, although it is also prescribed to prevent migraines and manage weight.1,2 Many medicines have been designed to treat migraines. Migraine treatment is aimed at stopping symptoms and preventing future attacks. Our caring team of Mayo Clinic experts can help you with your migraine-related health concerns. The diagnosis is based on your medical history, symptoms, and a physical and neurological exam. Never hesitate to ask your medical team any questions or concerns that you have. Unlike some other medications, Topamax’s weight-loss effect seems to continue past the 6-month mark.The maximum dose for weight loss can reach up to 200 mg per day, depending on the healthcare provider’s assessment.Common side effects include dizziness, drowsiness, cognitive issues (like memory problems), weight loss, and tingling in the hands or feet.But it hasn't yet proved that probiotics and prebiotics improve health and are safe for everyone.There is limited information regarding Monitoring of Topiramate in the drug label.It will also be relevant to perform direct comparisons of the benefits and adverse effects of topiramate with those of other drugs that have been shown to be effective in reducing both binge eating and body weight in controlled trials, such as sibutramine, zonisamide, and atomoxetine.Dizziness and impaired coordination are side effects of topiramate.As with any drug, there are hazards involved with Topamax.You might have a serious condition called metabolic acidosis (too much acid in the blood). Weight Loss Results with Topiramate Alone Increased activation of the pathway can also explain the overall weight reduction observed. Caricilli et al. concluded that fasted obese mice treated with TPM for 8 days showed increased mRNA levels of anorexigenic agents, such as POMC, TRH, and CRH, in the hypothalamus . Multiple physiological mechanisms are described for topiramate, which enhances its ability to treat a wide array of seizure types . TPM was FDA-approved in 1996 as a monotherapy and adjunctive therapy for epilepsy and migraine treatment . For almost two decades, between the mid-1970s, when carbamazepine and valproic acid were introduced, and 1993, when felbamate was approved, no new seizure drugs were developed for clinical use. These activities may become riskier due to some topiramate side effects, such as psychomotor slowness, disorientation, difficulty concentrating, and dizziness. The optimal dosage of Topamax for overall weight loss will vary from person to person. Your healthcare practitioner may prescribe topiramate for additional conditions. Topiramate can assist people with type 2 diabetes in better controlling their blood sugar levels, or glycemic control, in addition to helping them lose weight. Sixty-three percent of medical professionals polled in 2012 said they had prescribed Topamax to help people lose weight. Recently Kocamaz M and Karadag O reported the case of a 24-year-old woman who developed a sudden drop of vision in both eyes and diplopia on the second day of examination. The researchers suggested that TPM is similar to other medicines that can cause palinopsia and may inhibit neural activity. Most recently, Yun SH et al. presented a case series of nine patients who experienced palinopsia while taking TPM. One of these is topiramate, an anti-epileptic medication that is frequently marketed under the Topamax brand. The brand name Qsymia (phentermine/topiramate) is used to sell this combination. (Off-label drug use is the practice of prescribing an FDA-approved medication for a reason other than the one for which it is licensed.) We included both kinds of studies in the belief that the effects of topiramate both under ideal conditions (efficacy studies such as RCTs) and routine clinical situations (effectiveness trials such as those reporting on the effects of topiramate as an add-on to other psychopharmacologic treatments) can contribute to treatment of this disorder. Given its potential role in stabilizing mood and reducing impulse control problems and weight, topiramate has been proposed as a treatment for obese patients with binge eating disorder (BED). We conclude that, among youth with obesity prescribed topiramate plus lifestyle modification in a pediatric weight management clinical setting, mean percent change in %BMIp95 and BMI were both significantly reduced at 1.5, 3, 6, and 12 months after initiation, with %BMIp95 reductions from baseline of 2.2, 3.9, 6.6, and 9.3 percentage points at these time points. We found that around 20%–40% of missing data at each time point was due to either not having a BMI available within the analysis window, or due to being censored after additional weight-altering medications (including non-weight management related) were started or adjusted, which was more common at the 6- and 12-month time points. Use effective birth control while taking topiramate if you are capable of getting pregnant. Use a precise measurement tool to determine your dosage if you are taking topiramate oral liquid. If it is recommended that a topiramate capsule become accessible and scattered on light food, do not chew the meal and swallow it right away. Moreover, older subjects may be particularly sensitive to the cognitive effects of AEDs and a clearly dose dependency is not always evident Ramsay et al. 2008. A 12-week, open-label study explored cognitive outcomes of 53 children treated with topiramate as monotherapy or add-on therapy, reporting no significant changes in measures of memory Brandl et al. 2010. The incidence of treatment-emergent adverse events seems to be clearly dose dependent with concentration/attention difficulties occurring only in a limited number of subjects. The authors observed detrimental effects of topiramate in attention, short-term memory and verbal fluency. Before you start taking Topamax, talk to your doctor about your medical history. • Topiramate may raise phenytoin levels in the blood. • Because topiramate inhibits carbonic anhydrase, it raises the risk of kidney stones when combined with other carbonic anhydrase inhibitors (e.g. acetazolamide). TOPAMAX® (topiramate) is believed to help "calm" the process that leads to migraines. Migraines may not be completely eliminated, but TOPAMAX® (topiramate) can help stop them before they start, so you can get fewer of them to think about. TOPAMAX® (topiramate) can help stop migraines before they start so you can get fewer of them to think about.