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How Effective Is Topamax For Migraines

How Long Does It Take To Flush Topamax Out Of Your System

Topamax and Migraines

Topamax has a half-life of about 21 hours. The half-life of a drug is the time it takes for the amount of the drug in your body to fall by half. It takes about five half-lives for a drug to be almost completely removed from your body. So for Topamax, most of the drug will be flushed out of your system within about 5 days after you stop taking it.

Benefits Of Taking Topamax

It may take a while for you to feel the full benefit of Topamax for migrainesDr. Friedman says lots of people see improvement in the first month, but it can continue improving for the first year. She also says that past clinical trials have shown 50% of people feeling 50% better on topiramate, with some reporting an even higher response rate.

But side effects are topiramates biggest downside some people simply cant tolerate them.

Its a love it or hate it drug, says Dr. Friedman, and sometimes people are afraid to take it because they hear about the side effects. But not everyone gets them, so its important to be open-minded about it.

Topamax And Birth Control

Topamax can harm a fetus if taken during pregnancy. For more information about taking Topamax during pregnancy, see the Topamax and pregnancy section above.

If youre sexually active and could become pregnant, talk with your doctor about your birth control needs while using Topamax.

Note: Sex and gender exist on spectrums. Use of the terms male and female below refers to sex assigned at birth.

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Dosage For Treating Seizures

Topamax is used to treat epilepsy in certain situations.*

The recommended dosage depends on whether youre taking Topamax alone or with other medications for your seizures.

The dosage of Topamax is gradually increased over the first few weeks of treatment. This allows your body to get used to the medication and helps reduce the frequency and severity of side effects.

* For details on the uses of Topamax, see the Topamax uses section above.

Topamax dosage when used alone

Topamax can be used on its own to treat partial-onset seizures and generalized tonic-clonic seizures.

The usual recommended dosage for treating these types of seizures is 200 mg twice per day. The drug should be taken once in the morning and once in the evening for a total of 400 mg per day. This is the dosage for both adults and children ages 10 years and older.

Your doctor will gradually increase your dose to this level as follows:

  • Week 1: 25 mg twice per day
  • Week 2: 50 mg twice per day
  • Week 3: 75 mg twice per day
  • Week 4: 100 mg twice per day
  • Week 5: 150 mg twice per day
  • Week 6: 200 mg twice per day

Topamax dosage when used with other seizure medications

Topamax can be used with other seizure medications to treat partial-onset seizures, generalized tonic-clonic seizures, and seizures linked to Lennox-Gastaut syndrome . LGS is a rare form of childhood epilepsy that causes several different types of seizures.

Topamax For Weight Loss

Topamax for Migraines: Side Effects, Safety, and More

Topamax isnt approved for weight loss. However, the drug may reduce your appetite, which may lead you to lose weight.

In clinical studies, weight loss occurred in 6% to 17% of people who took Topamax. This depended on the dosage and condition treated. By comparison, weight loss occurred in 1% to 3% of people who took a placebo .

One review of studies looked at the average weight loss in people who took Topamax. It also looked at how long it took them to lose weight when they took the drug. People who took Topamax for at least 4 months lost an average of 11.8 pounds more than those who took a placebo for the same time period.

Topamax isnt usually prescribed solely for weight loss. But your doctor might recommend Topamax for preventing seizures or migraine if you would also benefit from weight loss. For example, if youre at an increased risk for health problems because of excess weight, Topamax might help you. The drug might also be useful if youre taking other seizure or migraine treatments that can cause weight gain.

There isnt a particular dosage or best time of day to take Topamax for weight loss. You should take it as prescribed by your doctor for seizures or migraine.

If youre interested in taking Topamax for weight loss, its important to discuss the possible risks and benefits of this treatment with your doctor.

The Topamax dosage your doctor prescribes will depend on several factors. These include:

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Botox Tops Topiramate For Chronic Migraine Prevention

Damian McNamara

SAN FRANCISCO OnabotulinumtoxinA treatment is more effective, is better tolerated, and has greater functional improvement in the prevention of chronic migraine compared with the anticonvulsant topiramate, new research suggests.

In a 36-week head-to-head, prospective, open-label study, investigators found a greater proportion of patients in the onabotulinumtoxinA group achieved the primary outcome of a 50% or greater reduction in headache days from baseline compared with those in topiramate group .

“The reason we did this trial is if we look at what happens in the community vs published data, there is a bit of a disconnect. In clinical practice, topiramate tends to be a first-line preventive treatment,” said study investigator Andrew Blumenfeld, MD, director of the Headache Center of Southern California in Carlsbad.

The findings were presented here at the American Headache Society Annual Meeting 2018.

Prophylactic Treatment Of Episodic Migraine With Topiramate

The primary efficacy measure in all trials was the change of mean monthly migraine frequency from baseline through the entire DB period. Significance was tested between the treatment groups and placebo. Frequency was measured with headache diaries using the concept of migraine period, defined as any occurrence of migraine headache that started, ended or recurred within 24 hours. Pain lasting longer than 24 hours after its initial onset constituted a new, distinct migraine period. The secondary outcome variables were largely similar in all studies as well including time of topiramate action onset, proportion of subjects responding to treatment , mean change in monthly migraine days as well as change in number of days per month requiring rescue medication compared to baseline. Some trials also reported the change in duration and severity of migraine attacks. Due to the similarity in study design and chosen endpoints, a pooled analysis with all patients from the three trials randomized to topiramate 100 mg/day was performed by Bussone et al in 2005.

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What Are The Most Common Side Effects Of Topamax For Migraines

Though Topamax can be successful in reducing the frequency and severity of migraines, that success often comes at a pricemany people struggle to tolerate the common side effects of the drug, which Dr. Friedman says may include:

  • a tingling, pins-and-needles sensation in the extremities or face
  • loss of appetite leading to weight loss
  • sleepiness/drowsiness
  • nausea
  • brain fog

Dr. Park adds that these side effects can be experienced across the range of dosages for topiramate depending on the individual patient.

I have some patients who get to 100 milligrams twice daily and unfortunately some patients who do not tolerate even 25 milligrams daily, he says.

Is It Safe For Me Take Topamax For Migraines

Topiramate / Topamax – The Migraine Guy

Interactions of Topamax :

  • At doses higher than 200 mg, Topamax can reduce the effectiveness of your birth control pill
  • Topamax can increase the risk of birth defects, particularly cleft and should not be taken during pregnancy. If you find out you are pregnant while on Topamax, contact your physician’s office immediately.
  • It may increase your risk of kidney stones
  • Carbamazepine or Phenytoin may increase the elimination of Topamax from your body making it less effective
  • If you combine Topamax with valproic acid this could raise your blood ammonia levels causing hypothermia

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Whats Topamaxs Drug Classification

Topamax belongs to a class of drugs called anticonvulsants. Anticonvulsants are also called antiepileptic drugs.

Anticonvulsants are mainly used to treat epilepsy . But many drugs in this class, including Topamax, are also effective for other conditions that dont involve seizures. These include migraine and nerve pain.

Reason For Pbs Listing

The Pharmaceutical Benefits Advisory Committee recommended listing on the basis of acceptable cost-effectiveness compared with placebo for migraine prevention in patients unable to take a beta blocker and/or pizotifen.1 The PBAC noted that there was insufficient evidence that topiramate was effective in prior treatment failure and limited the listing to patients with contraindications or poor tolerance to longer-established migraine-prevention drugs.2

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Whats The Dosage Of Topamax For Children

The Topamax dosage for children depends on the condition being treated, your childs age, and their body weight.

Topamax dosage for preventing migraine headaches

Topamax is used to prevent migraine headaches in children ages 12 years and older. The dosage is the same as it is for adults. See the Dosage for preventing migraine headaches section above for details.

Topamax dosage for treating seizures

For treating seizures, the dosage for children depends on whether Topamax is used alone or with other drugs. See below for details.

Topamax dosage when used alone in children ages 2 years to 9 years

Topamax can be used on its own to treat partial onset seizures and generalized tonic-clonic seizures in children ages 2 years and older.

For children ages 2 years to 9 years, the Topamax dosage is based on weight.

The starting dosage is 25 mg taken in the evening for 1 week. If your child tolerates this dosage, the Topamax dosage is increased to 25 mg taken twice per day for 1 week. After this, the dosage is gradually increased by 25 mg to 50 mg over several weeks until the maximum dosage for their weight is reached. The dose is increased gradually to lower the risk of side effects with the drug.

The table below shows the recommended dosage of Topamax based on your childs weight in kilograms .*

250 mg to 400 mg

* One kg equals about 2.2 pounds.

Topamax dosage when used alone in children ages 10 years and older

Topamax dosage for children when used with other seizure drugs

How Topamax May Prevent Migraines

How effective is Topiramate for Headache?

According to the website of the manufacturer, Topamax is hypothesized to function by keeping excitable nerve cells in the brain calm. It does this via modulation of charged particle inflow and outflow. In other words, when a person takes Topamax and the topiramate chemical crosses the blood-brain-barrier , it essentially relaxes or downregulates overexcitability of neurons, thereby preventing the series of neurologic events that triggers a migraine attack.

More specifically, Topamax functions as an inhibitor of voltage-gated sodium channels , high-voltage calcium channels, and kainate receptors. It also appears to enhance activity of GABA, the predominant inhibitory neurotransmitter in the brain. It remains unclear as to whether one mechanism contributes more substantially to its efficacy as a migraine prophylactic compared to others, or if all hypothesized mechanisms act synergistically to prevent migraines.

Voltage-gated sodium channels inhibition: Many inhibitors of voltage-gated sodium channels are effective in prophylaxis of migraines. Whether this particular mechanism plays a significant role in the migraine prophylactic effect associated with Topamax is unclear. It is well-understood that dysfunction of voltage-gated sodium channels can facilitate neuronal excitability .

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          Indications For Taking Topamax

          Topamax has both approved and off-label uses. In the United States, the drug is officially approved by the Food and Drug Administration for:

          • Migraine prevention in adults and adolescents 12 and older
          • Partial-onset seizure treatment in adults and children two and older
          • Primary generalized tonic-clonic seizure treatment in adults and children two and older

          Topamax can also be in combination with other drugs to treat partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome .

          Among its off-label uses, Topamax is sometimes prescribed to treat:

          • Alcohol dependency
          • Weight loss

          What Happens With Epilepsy And Migraine

          Epilepsy and migraine are both neurological conditions. With epilepsy, you have seizures. With migraine, you have headaches, among other symptoms. But the conditions are considered to be linked, and many people have epilepsy and migraine together.

          The causes of epilepsy and migraine arent fully understood. But with both conditions, it seems that nerve cells in your brain are oversensitive to certain triggers, such as flickering lights or hormones.

          The trigger causes electrical signals to build up in the nerve cells in your brain. This causes them to fire inappropriate signals to other nerve cells. These nerve cells then pass on signals to other parts of your body. The increased electrical signaling can lead to a seizure in people with epilepsy. In people with migraine, it can lead to auras and headaches.

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          Which Prophylaxis Medication In Which Patient

          Medications are chosen for prophylaxis in any particular case based on their adverse event profile, meaning that their potential side effects make the decision. Efficacy of these medications is less significant as a criterion since the principal choices all have similar documented efficacy . Considering these usual choices of preventer medications, there are considerable issues to ponder. First and foremost, the typical patient will be a younger woman, somewhere between 20 and 50. These patients often have low blood pressure, concerns about body weight, desire to exercise, potential for pregnancy, and a disinclination toward sedating or depressing medications.

          Whenever possible, it would be reasonable to select a migraine prophylaxis medication that would not interfere with these concerns. It would also be reasonable, whenever possible, to find a treatment that meets other needs such as hypertension or neuropathy. Basically meaning getting two-for-one.

          Evaluating our traditional medication choices, it is immediately apparent why the evolution has been toward topiramate in the neurological community.

          Topamax To Treat Seizures

          Topiramate – My Experience – Cervicogenic Headaches/Migraines

          Topamax is FDA-approved to treat epilepsy in adults as well as children ages 2 years and older. Its used as initial monotherapy. This means its prescribed before any other medications are added. Topamax is used to treat:

          • Partial-onset seizures. For the purpose of treating partial-onset seizures, Topamax may be used alone or with other drugs to treat seizures. These are called antiepileptic drugs.
          • Generalized tonic-clonicseizures. For the purpose of treating generalized tonic-clonic seizures, Topamax may be used alone or with other antiepileptic drugs.
          • Seizures linked toLennox-Gastaut syndrome. For this purpose, Topamax is used with other antiepileptic drugs.

          Topamax is taken to help prevent seizures. It is a type of drug called an anticonvulsant. Topamax is also called an antiepileptic drug.

          Epilepsy is a condition that causes repeated seizures . The type of seizure you have depends on the part of your brain thats affected.

          Partial-onset seizures

          With partial-onset seizures, also called focal seizures, the excessive electrical activity starts in only one part of your brain. Partial seizures dont make you lose consciousness.

          Partial seizures are referred to as simple or complex. With simple partial seizures, you may have muscle twitching in one part of your body or a change in your senses. This could be a tingling feeling or a change in taste, smell, or vision. You may have trouble communicating but still be aware of your surroundings.

          Generalized tonic-clonic seizures

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          How Long Does It Take Topamax To Start Working

          It may take 2 to 3 months for you to see the full effect of Topamax on your migraine headaches. In research studies, some patients had fewer headaches after one month of treatment.

          Topamax for migraine prevention is usually started slowly at lower doses. Your doctor will slowly increase your dose over a 4 week period. The recommended daily dose of Topamax for migraine prevention is 50 mg twice a day .

          Learn more: Topamax dosage

          Topamax is available as oral tablets and as oral sprinkle capsules. Do not chew, break or crush the tablets as they have a bitter taste. The capsules can be swallowed whole or sprinkled on a small amount of soft food and consumed right away. Do not chew the food and medicine mixture.

          Topamax And Withdrawal And Dependence

          No studies have looked at whether Topamax can cause drug dependence, so its not known if this can occur.

          But you shouldnt suddenly stop taking Topamax. Suddenly stopping your treatment can lead to your seizures or migraine becoming more severe or occurring more often.

          If youre experiencing side effects from Topamax, talk with your doctor about your treatment options. And if you need to stop taking Topamax, your doctor may slowly decrease your dosage. This helps prevent serious side effects and worsening of your condition.

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          Could Topamax Work For You

          You dont have to be a chronic migraine sufferer to benefit from a preventive medication like Topamax. But Dr. Friedman says the patients who respond to the drug usually have a few other things in common.

          We think about migraine prevention therapies in people who have at least four headache days per month with severe disability from migraines, she says, meaning that your migraines prevent you from performing your usual daily tasks.

          Also included are people who have inadequate relief from acute therapies for migraine and those who have special kinds of migraine regardless of the frequency.

          However, topiramate is not suitable for everyone. Friedman says it cannot be taken during pregnancy, and that she would think twice about prescribing it to someone with a history of calcium-based kidney stones because some research indicates topiramate can increase the risk of developing them.

          How Long Should A Patient Take Topirimate

          Topiramate Weight Loss Reviews

          There should be no pre-established time for topiramate therapy any more than there is for any other migraine prophylaxis medication. Patients have to be individualized in this area as well. A women with a ten year history of frequent severe and disabling migraine is unlikely to be cured by a few months of topiramate. We tell our patients they are likely to be on topiramate for years before we attempt to taper off.

          The whole idea of prophylaxis therapy for migraine begins with the concepts of improving quality of life and reducing disability. And since a migraine condition is often progressive, prophylaxis therapy serves to stop that progression. In the headache specialty, weve all seen that on a regular basis. Patients arrive having increasing headaches and, with preventer therapy, begin to have a declining number of disabling headache. Does kindling take place with migraine? Do headaches beget headaches just as has been said for many decades in epilepsy? Are chronic severe headache a form of learned behavior and worsen by the process of pathway formation?

          We would say yes from the observations at our clinic with our 75,000 headache patients. Looking at the process this way, the prophylaxis therapy may be curative in certain patients.

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