There are several options for printing:

• Click "Print this page" on the left hand side to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.
• Download a handy BILL (Brief Information Leaflet), a one-page brief summary of the main questions and answers from here. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

^{Updated 5.12}

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Topiramate is usually used for:

• Epilepsy (several different types e.g. partial seizures and GTC seizures)
• Migraine (to stop attacks happening)

It has also sometimes been used to help:

• Bipolar mood disorder
• Eating disorders
• Alcohol dependence

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Topiramate can have quite a few side effects. These can be worse when you start. You can make this much easier by starting at a low dose to start with.

Topiramate should be started slowly to reduce side effects.

For epilepsy, the starting dose should be 25mg a day at night for a week. It can then be increased by 25-50mg a day every 1-2 weeks. The usual top dose is 100-200mg a day (50-100mg twice a day, e.g. morning and evening), although up to 500mg to 1000mg a day have been used.

For migraine the maximum dose is 100mg a day.

Unless the person has a kidney problem, the doses are the same in the elderly. The dose in children is based on age and weight.

^{Updated 10.11}

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:  

• Alcohol dependence - main options, main medicines and handy chart
• Alcohol withdrawal - main options, main medicines and handy chart
• Bipolar mood disorder - main options, main medicines and handy chart
• Eating disorders - main options, main medicines
• Epilepsy - main options, main medicines

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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Topiramate has lots of effects in the brain but we are not sure exactly how it works. Topiramate can boost the effect of GABA (the brain's main calming chemical messenger), but it does this in a different way to other similar drugs. It is also a carbonic-anhydrase inhibitor, which sounds good but probably doesn't mean anything.

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Take topiramate as directed on the medicine label. Try to take it at regular times each day. Taking it at mealtimes may make it easier for you to remember as there is no problem about taking topiramate at any time.  

If the instructions say to take it ONCE a day this is usually best at bedtime as they may make you drowsy at first. If the label says twice a day, this is best as morning and night.

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Topiramate can be taken before, after or with food.

Tablets should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat. The tablets should not be broken or chewed.

The sprinkle or hard capsules can be swallowed whole. Or, you can open them carefully and sprinkle the beads inside on to a small amount of food e.g. a teaspoon of soft food such as apple sauce, custard, yoghurt, porridge or a pudding. This can then be swallowed. Have something to drink afterwards to make sure all the food and medicine gets to the stomach. The beads should not be chewed.

^{Updated 10.11}

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This will depend on why you are taking topiramate. For advice on the various conditions, please click the links below:

• Epilepsy
• Bipolar mood disorder
• Eating disorders
• Alcohol dependence

^{Updated 10.11}

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This will depend on what you are taking it for. Click the links below for the answers for each condition: 

• Epilepsy
• Alcohol dependence
• Bipolar mood disorder
• Eating disorders

^{Updated 10.11}

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For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"
• there should be a "reward" (e.g. a good feeling) from taking the drug
• should produce tolerance ie you need more drug to get the same effect
• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Topiramate has none of these and so is not addictive. Any discontinuation effects are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is nearly time for your next dose then take the next dose as normal. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by the bed, in a car etc.

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If you are taking topiramate for epilepsy and you stop it suddenly, your fits can start again. So, it is unwise to stop taking topiramate suddenly, even if you feel better. If you have been taking it for fits or seizures, you should drop the dose by 50-100mg a day every 2 weeks, or even slower if possible. If you are taking other medicines this may have to be even slower. If you are not taking topiramate for epilepsy, or you have a major side effect, you might be able to stop it a bit quicker. You should discuss this fully with your doctor.

^{Updated 10.11}

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The table below will show you some of the main side effects you might get from topiramate. Unfortunately there are lots, so please see the (PIL) for the full list. However, if you start topiramate slowly and increase the dose slowly you may not get too many. If you do get side effects after you have increased your dose, it sometimes helps to go back to your last dose for a few days, then increase it again.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

^{Updated 12.11}

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Topiramate is likely to make you sleepy, especially when you start taking it. It may be possible to change your doses and when you take them to help with this.

^{Updated 11.11}

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Topiramate is rare in that it often causes weight loss. Usually drugs cause people to gain weight, although topiramate can cause weight gain sometimes. In fact quite a few people take topiramate just for this side effect.

Click here for a few tips on helping you feel less hungry.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Topiramate has not been reported to have a major adverse effect on these three stages. However, if this does seem to happen, you should discuss this with your doctor, as a change in dose may help minimise any problem.

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Topiramate can cause kidney stones in a few people. This is more likely if you have other things that increase th e chances of getting kidney stones. We are not joking, but this includes high doses of vitamin C (ascorbic acid) and massive amounts of Worcester sauce. Topiramate doesn't seem to have any effect on caffeine, or vice versa.

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect may things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

You should be careful about drinking alcohol while taking topiramate as it will make you feel more sleepy. If this happens, you must take extra care if you are allowed to drive or operate machinery. You must seek advice on this. The manufacturers say that you should not drink alcohol with topiramate.

It is not safe to drive after drinking alcohol, with or without topiramate. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Topiramate causes drowsiness and can cause more if used with other medicines that cause sedation. 

• The effects of topiramate can sometimes be increased by stopping carbamazepine, stopping phenytoin, hydrochlorothiazine (a "water tablet")
• The effects of topiramate can sometimes be decreased by phenytoin, carbamazepine
• Topiramate can sometimes increase the effects of diazepam, imipramine, moclobemide, omeprazole and phenytoin (rare), metformin
• Topiramate can sometimes decrease the effects of digoxin (just a little), lithium (just a little), haloperidol
• Topiramate can make the Oral Contraceptive tablet ("The Pill") less effective. If you are taking the Pill, you should let your doctor know if you get any change in bleeding.
• Topiramate can cause kidney stones ("nephrolithiasis") and if it is taken with other drugs that can also cause kidney stones this can make them more likely. Other drugs can include allopurinol, megadose ascorbic acid, furosemide (a "water" tablet), phenolphthalein (a laxative) and steroids.

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just that you may need to follow your doctor's instructions very carefully. There are other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

^{Updated 1.12}

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with topiramate.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with topiramate.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with topiramate and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with topiramate and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with topiramate, but again this doesn't mean it's safe.

^{Updated 1.12}

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Topiramate can make the Oral Contraceptive tablet ("The Pill") less effective. If you are taking the Pill, you should let your doctor know if you get any change in bleeding.

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In the UK, Levonelle one step® is available and is usually known as 'the morning-after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking topiramate (or if you have taken it in the last 4 weeks), your liver will be working quicker and so the usual dose may not work. You should see your Doctor as soon as possible as you will need a higher dose. Levonelle one step® has 1.5mg of levonorgestrel, and you will need 3mg of levonorgestrel to be safe. You should also take the dose as soon as possible, so don't delay.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily topiramate doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

^{Updated 11.11}

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Topiramate was reclassified by the FDA (the American Regulators) in 2011 as "D" in 2011. This is because the risk of "oral clefts" seems to be higher with topiramate (about 1 in 70 babies) than with other anticonvulsants (1 in 200) and compared to no anticonvulsants (1 in 1400). There is also a risk that the baby might have a lower birth weight if you've taken topiramate.

Another problem is that when you become pregnant, topiramate can build up in the body, especially in the first 3 months. So you might get more side effects and might need a lower dose. You must get advice from a specialist if you want to be become pregnant or if you are pregnant and you are taking topiramate.

^{Updated 11.11}

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that topiramate gets into breast milk but we don't know how much yet. It is not recommended at the moment but you might want to get some personal expert advice on this.

^{Updated 11.11}

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Topiramate can cause drowsiness, dizziness, tiredness, blurred vision and sight problems. So, you should not drive when taking topiramate, or at least to start with. You must get advice about this.  

If you are taking any medicines, the rules about driving will depend on the country you're driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don't rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

^{Updated 11.11}

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You will not need blood tests to check on the amount of topiramate in your blood.

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