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How To Take Topamax For Migraines

How To Use Topamax

Topiramate / Topamax – The Migraine Guy

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking topiramate and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually twice daily. To prevent kidney stones from forming, drink plenty of liquids while taking this medication unless your doctor instructs you otherwise.

If you are using the tablet form of this medication, swallow the tablets whole since breaking them may leave a bitter taste.

If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

Dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight. Your doctor will gradually increase your dose to reduce your risk of side effects. For some conditions, you may start treatment with topiramate once daily at bedtime and slowly increase your dose to twice a day. It may take several weeks or months to reach the best dose for you and to get the full benefit from this medication.

Tell your doctor if your condition persists or if it worsens.

Is Topamax Used For Weight Loss If So Whats The Dosage For This Purpose

It depends. Topamax isnt approved for weight loss. Theres no maximum dose of Topamax for weight loss since the drug isnt approved for this use.

However, topiramate may be prescribed off-label for weight loss. Topiramate is the active drug in Topamax. Several studies have shown topiramate to cause weight loss in certain people. It may reduce appetite, which can lead to weight loss.

Also, a drug called Qsymia is approved for long-term weight management in adults. Qsymia contains the active drugs topiramate and phentermine. You can read more about Qysmia in this article.

Its important to take Topamax as prescribed by your doctor. And if you have questions about your weight while taking Topamax, your doctor can help. They can also answer any questions you have about off-label uses of Topamax and other drugs used for weight management.

What Can I Take Instead Of Topamax For Migraines

Other medication options are available for preventing migraines for those who cannot take Topamax. Some of these include valproate, which is another type of anti-seizure medication. Other options include medications that lower blood pressure and certain antidepressant medications. Discuss all options with your physician.

Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.

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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.

When To Consider Migraine

Migraine, Weight loss, Topamax: What Is The Connection ...

Most people who experience migraine report one or more severe headaches per month, and more than 1 in 10 report one severe headache per week.8 Consider migraine-prevention therapy in the following situations:6,9

  • recurring migraines that produce disability lasting 3 or more days
  • contraindication to, or ineffectiveness of, acute treatments
  • use of acute treatments more than twice a week
  • presence of uncommon migraine conditions, including hemiplegic migraine, migraine with prolonged aura, or migrainous infarction.

Patient preference and the cost of treatments for both acute migraine management and migraine prevention will influence treatment choice.6,9

When considering migraine-prevention therapy be aware of the possibility of medication-overuse headache , a disorder characterised by frequent migraine-like headaches during regular acute medication overuse .10 Treatment of MOH involves careful withdrawal of the overused agent. In patients with underlying migraine, initiate migraine-prevention therapy in parallel with MOH management.11,12 Consider referring a patient with MOH to a specialist.

Unless contraindicated, beta blockers remain first-line migraine-prevention drugs13

There is little evidence for the superior efficacy of one migraine-prevention drug over another

Topiramate 100 mg/day has efficacy in migraine prevention

The goals of migraine-prevention therapy are to:

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Can Topiramate Cause Problems

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with topiramate. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common topiramate side-effects What can I do if I experience this?
Feeling sick
If this continues, let your doctor know
Nose and throat problems, tingling feelings, loss of weightIf any become troublesome, speak with your doctor for advice

Important: topiramate has been associated with a number of serious unwanted effects. Although these occur less commonly than the side-effects listed above, you must let your doctor know straightaway if you notice either of the following:

  • Problems with your eyesight.
  • Mood changes, distressing or depressed thoughts, or feelings about suicide.

If you experience other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

What Is The Dosage For Topiramate

  • Most commonly, topiramate immediate-release tablets and sprinkles are started in low doses, 25 or 50 mg per day, and then increased slowly by 25 to 50 mg per week until an effective daily dose is reached for treatment of seizures.
  • For children 10 years or older and adults, the dose may be increased by 100 mg in weeks 5 and 6 when topiramate is used alone.
  • This slow approach to treatment reduces side effects. The recommended final adult dose is 200-400 mg administered as two divided doses daily.
  • In children, the starting dose is up to 25 mg , taken nightly for the first week.
  • The dose is then increased at 1 or 2-week intervals by 1 to 3 mg/kg/day administered in two divided doses.
  • The target dose is 5 to 9 mg/kg per day in two divided doses.
  • Migraine is treated 25 mg nightly for the first week then increased by 25 mg weekly up to a maximum dose of 100 mg administered in two divided doses.
  • Patients should maintain an adequate fluid intake to minimize the risk of kidney stones.
  • The recommended dose for extended-release capsules is 200-400 mg once daily.
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    What Are The Brand Names For Topiramate

    Topiramate is a generic drug sold under several different brand names in the US and Canada:

    • Feeling weak, drowsy, or tired
    • Upper respiratory infections
    • Speech and memory difficulties

    This is not an exhaustive list of all potential side effects of Topiramate. For more information, consult your doctor or healthcare provider. Patients should talk to their doctor about what to expect with treatment Topiramate. If you notice any new or worsening side effects when taking Topiramate, contact your doctor or healthcare provider immediately.

    Topiramate In Pediatric Migraine

    Topiramate – My Experience – Cervicogenic Headaches/Migraines

    Migraine occurs in 10.6% of children and adolescents between the ages of 5 and 15 years and 28% of adolescents between the ages of 15 and 19 years. Currently, no drugs have been approved by the Food and Drug Administration for migraine prophylaxis in pediatric patients. Three randomized, controlled trials have been conducted, however, including a total of 212 children and adolescents between 6 and 17 years. Topiramate at 100 mg/day, but not 50 mg/day, significantly reduced the monthly migraine day rate from baseline versus placebo during the 12-week double-blind treatment phase. Effective dosages reported throughout these trials ranged from 2 to 3 mg/kg/day and are much lower than the dosages usually required for the adjunctive treatment of epilepsy in young children. Safety and tolerability was comparable to reports from adult study populations. Most common side effects in children were weight loss , anorexia , abdominal pain , difficulties in concentration, somnolence/sedation , and paresthesia . Side effects tended to decline over time and dropout rates due to side effects were very low in the different trials . Assessment of PedMIDAS results showed a significant decrease in absent school days and an improvement in the quality of life in these children.

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    How Is Topamax Related To Weight Loss

    Although studies have suggested that Topamax may result in weight loss, the exact reason for this is unknown. Possible reasons include the following:

    • Suppresses appetite: Studies have shown people who take this medication may experience appetite suppression or reduction as a side effect.
    • Controls addiction: Clinical trials have shown that topiramate targets addiction centers of the brain by changing neural pathways that work within these centers and reducing the overexcitation of nerves there. As a result, stress-induced bingeing behavior may be reduced.
    • Alters hormone levels: Topiramate consumption reduces the amount of leptin, which is a hormone related to the stress hormone cortisol. Leptin regulates appetite, and when it is low, it can cause you to feel less hungry.
    • Disorientation: Topamax can cause dizziness and disorientation as a side effect, which may lead to people refusing or forgetting to eat.
    • Ketosis: Topamax causes fluctuations in blood glucose and insulin levels, which may induce ketosis. Ketosis is a state in which the body uses fat as fuel, resulting in significant weight loss.
    • Boosts metabolism: Topamax may help speed up metabolism, which can contribute to weight loss.
    • Reduces saliva production: Topamax reduces saliva production, which can affect taste. Loss of taste can in turn lower appetite and cause you to eat less.

    How Effective Is Topamax

    The short answer its considered to be an effective option for migraine prevention.

    Both US and European authorities have given Topamax or topiramate what they term Grade A. Grade A is the highest rating a treatment can receive. The grade is a reflection of the quality of research evidence and the efficacy of its results according to the clinical evidence.

    When several clinical research studies are collectively reviewed to analyze and evaluate research it is called a systematic review. Often meta-analysis is used to summarise the results of these studies.

    Fortunately this work has been conducted on topiramate for the prevention of migraine attacks in adults. A nonprofit called The Cochrane Collaboration reviewed 17 studies and found that patients did reduce their frequency of migraine headaches per month versus placebo. They also found that patients were around twice as likely to reduce the number of attacks by 50% or more with topiramate than with placebo.

    The scientific conclusion for this systematic review was that topiramate at a 100mg/day dosage can be effective and reasonably well-tolerated in adult patients.

    Get A List Of Proven Migraine Preventative Treatments. Free for a limited time.

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    Topamax Withdrawal And Dependence

    There havent been studies on whether Topamax can cause drug dependence.

    However, once Topamax controls your condition, you will need to keep taking it to continue to prevent seizures or migraine. If you stop taking Topamax, your seizures or migraine headaches may happen more often. They could also become more severe. Sometimes people without epilepsy have had seizures after suddenly stopping Topamax.

    You shouldnt stop taking Topamax without first talking to your doctor. If you and your doctor decide to stop treatment, you may need to stop taking Topamax gradually. This can help reduce your risk for seizures. Your doctor will explain how to do this.

    Could Topamax Work For You

    Approved for prevention of both migraine and epilepsy ...

    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.

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    Adverse Events With Topiramate

    There are a number of adverse events associated with topiramate use. The majority of these are transient when they occur and not sufficient to require discontinuation of the drug.15

    Parasthesias or tingling can occur in 60% or more of cases. In our practice, virtually every patient on topiramate reports this side effect if asked. It is often described as transient and involving the limbs or face. It may be the sensation of a frozen limb coming back to life. Sometimes it can be so severe that patients describe it as numbness. There has been a single brief report in Headache recommending adding potassium in these patients to relieve the parasthesiaseither in the form of foods or supplements. Weve had some success with this approach in our clinic.

    Diarrhea can be an issue and require treatment. Wed had several patients who had to stop the medication because of this side effect. We have used diarrhea medications such as loperimide and other bowel calming drugs in these patients in an attempt to pass through this adverse event.

    Abnormality in taste is common, particularly with carbonated beverages. A few of the 500 patients on the drug have had more significant issues with this. One of our frequent migraine people, who was also a chef, discontinued the drug because she complained of being unable to taste her own culinary creations.

    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.

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    Will Topamax Make Me Feel High

    It depends on how you define feeling high. Typically, feeling high describes feelings of pleasure or extreme happiness. Topamax doesnt have this type of effect.

    Topamax is more likely to make you feel sleepy, low in energy, or a bit dazed and confused. You may also have trouble with concentration, memory, or speech while taking it. But some people may also describe these very different effects as feeling high.

    What Happens With Epilepsy And Migraine

    Topamax and Migraines

    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.

    Read Also: Migraine Seizure Medication

    How Does It Work

    The short answer is were not sure actually.

    Topiramate was originally developed for epilepsy. Those with epilepsy started noticing an improvement in their migraine condition in several case studies and from there a trial was conducted to test migraine patients specifically. It was not designed with migraine in mind but it is arguably an effective treatment for the prevention of migraine.

    Epilepsy and migraine share a number of biological and clinical features in common. Perhaps not surprising to find that anticonvulsant medications may have a therapeutic benefit for both indications.

    Scientific studies suggest topiramate reduces brain hyperexcitability, which is thought to provoke migraine attacks in those susceptible.

    The ways in which a drug works is often referred to in clinical papers as its mechanism of action. Topiramates mechanism of action may involve:

  • Blocking voltage-dependent sodium channels
  • Antagonizing the AMPA/kainite subtype of the glutamate receptor
  • Inhibiting the carbonic anhydrase enzyme
  • What does all that mean in English?

    It essentially describes how Topamax blocks certain neurotransmitters or pathways in the brain as well as changing or altering how they behave.

    Consideration Of Topiramate For The Migraine Patient

    The recent popularity of Topiramate arose out of the inadequacy of many of our previous choices. The efficacy concerns with the older medications were overshadowed by the adverse event profiles of the drugs. Young to mid-life womenthe primary patient population in the headache worldprotested about the risk of birth defects, fatigue, exercise intolerance, weight gain, and many other issues. Topiramate appeared to answer many of these concerns, even though it produced its own unique set of side effects. Most of the side effects could be tolerated and were often transient. Topiramate adverse events included parasthesias, memory loss, GI distress, kidney stones, and many other less common issues. A drop-out rate of 10-25% was in line with most of the other preventer drugs used in headache.13

    Considering the position of the primary care doctor in the community and recent changes in the practice of medicine, their attitude can be readily understood. There are always advances and new therapy considerations for hundreds of disease states, any of which might be residing in the reception area waiting to be seen. The doctor has to make a choice how far she or he will take every difficult or special case and which new therapy might be considered. Further, time and complexity is of primary concern in primary care, where the average office visit is seven to ten minutes.

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