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What Is The Maximum Dose Of Topamax For Migraines

Suicidal Thoughts Or Behavior

Topiramate (Topamax): What is Topiramate? Uses, Dosage and Side Effects of Topiramate
  • Risk factors: History of depression

Topiramate can raise the risk of suicidal thoughts or behavior. Watch for worsening depression or any unusual changes in mood or behavior, especially during the first few months of treatment or when the dose changes. Be aware of changes in behavior that could lead to suicidal thoughts or depression, and report anything concerning to your provider right away.

Topamax Dosage For Adults

Topamax is approved to treat and prevent seizures and to prevent migraines in adults. It can also be used for other health conditions like sleep-related eating disorders and nightmares associated with PTSD. Topamax dosing will depend on the type and severity of the condition being treated. The following table lists dosages for Topamax when used by itself .

Topamax & Weight Loss

Regardless of how the drug works, it is known that it is often used as an off-label pill to lose weight. Although not everyone will lose weight from taking Topamax, many people lose a significant amount throughout their treatment. It is also important to mention that although it isnt approved as a standalone drug for weight loss, it is included in the formulation known as Qsymia which is approved specifically for weight loss.

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Topiramate For Migraine Prevention

Migraine and epilepsy share many biologic features, and so not surprisingly certain of the newer antiepileptic drugs have proven to be effective for the prevention of migraine attacks as well as seizures. One of these drugs is topiramate , and its successful performance in carefully conducted national studies has led to topiramate receiving the Federal Drug Administration indication for use in migraine prevention.

Precisely how topiramate prevents migraine is unclear, but, generally speaking, it appears to reduce the genetically derived brain hyperexcitability that provokes migraine attacks in susceptible individuals.

Usual dosing instructions for topiramate are as follows:

TABLE: Week Morning Bedtime 1 0 25 2 25 25 3 25 50 4 50 50 1 tablet = 25 mg.

Fifty milligrams twice daily was the dose proven to be the most effective and best tolerated in the clinical research trials conducted. In the individual patient, however, a lower or higher dose may be more appropriate.

Reviewed for accuracy by the American Migraine Foundations subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. to read about our editorial board members.

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Once A Day Vs Bid Dosing

100 Mg Topiramate For Migraine Weight Loss

Physicians often have their patients use topiramate once a day at night because the drug has a seventeen to twenty one hour half life. That method of treatment is often effective even when much higher doses are used. The problem, however, is that HS dosing results in a significant variation in the blood level throughout the day . With BID dosing, however, the blood level remains within a twenty percent range throughout the day. We have observed that our patients nearly always tolerate BID dosing and often do better in terms of their headache conditions.23

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Topamax For Weight Loss: How It Works Dosage & Individual Variation

Topamax is an anticonvulsant medication that is primarily used for the treatment of epilepsy, but has also been approved for migraine prevention and as an adjunct to phentermine for weight loss. It is also commonly used as an off-label medication to treat bipolar disorder as well as borderline personality disorder, but there is no conclusive evidence to support its efficacy in these conditions.

Despite the drug being effective in reducing the prevalence of seizures, its mechanism of action that produces therapeutic effects is unknown. Some speculate that it alters voltage-gated sodium channels as well as various calcium channels within the brain. Others believe that it may affect GABA receptors, AMPA receptors, and carbonic anhydrase isoenzymes.

How To Take Topamax

You should take Topamax exactly as directed by your doctor.

If youre prescribed Topamax tablets, be sure to swallow them whole. Do not crush or chew them. Doing so can affect how your body absorbs the drug and prevent you from getting your dose as prescribed. If you have trouble swallowing pills, talk with your doctor or check out this article. Your doctor may prescribe Topamax sprinkle capsules instead of tablets.

Topamax sprinkle capsules can be swallowed whole or opened. If its easier for you, the sprinkles can be added to a teaspoon of soft food, such as applesauce. Be sure to consume this immediately. You should not chew the sprinkles.

Also, you shouldnt prepare doses with food ahead of time. This can affect how the drug is absorbed by the body and prevent you from getting your dose as prescribed. After taking the sprinkles, you should drink a beverage, such as water, to make sure that you swallow all of them.

Its important that you dont take more Topamax than your doctor recommends. If you take more Topamax than your doctor prescribes, you may develop serious side effects.

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What If I Miss A Dose Of Topamax

According to Mayo Clinic, if you miss a dose of Topamax, take the missed dose immediately unless you are closer in time to your next available dose. Never double doses. Further, if your next available dose is is within six hours, wait until that dose and skip the missed dose. If you miss more than one dose, contact your prescribing physician.

Higher Level Of Acid In Blood

Topiramate (Topamax) – Uses, Dosing, Side Effects
  • Risk factors: Kidney disease | Severe breathing disorders | Diarrhea | Keto diet | Status epilepticus

In some rare cases, topiramate can raise the level of acid in your blood . If not treated in time, it can cause kidney stones, or weaken your bones and make them more likely to fracture . In children, it may affect their growth. Other symptoms of metabolic acidosis include loss of appetite, fatigue, and irregular heartbeat. Your provider might do regular blood tests to make sure the level of acid in your blood is not high.

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Pharmacist Tips For Topiramate

For the first few weeks while you adjust to the effects of topiramate , avoid activities that require you to be alert, like driving, since topiramate can cause sleepiness, dizziness, and confusion.

Children should be watched closely while on topiramate , since it can raise their body temperature and lower their ability to sweat, especially in hot weather. Keep your child out of direct sunlight and heat, and have them drink plenty of water when it’s hot outside.

If you have trouble swallowing pills, you can open up the capsule of topiramate and sprinkle the contents inside on a small amount of soft food. The mixture should be swallowed right away and not chewed. The only capsule that you cannot do this to is Trokendi XR. Trokendi XR capsule must be swallowed whole, not chewed or crushed.

Don’t stop taking topiramate suddenly, because this can worsen your seizures. Your provider will lower your dose slowly over time to prevent this from happening.

Avoid drinking alcohol while taking topiramate , because it can worsen some of the side effects such as sleepiness and dizziness.

Topiramate can raise your risk for bleeding. Let your provider know if you’re taking over-the-counter medications such as ibuprofen or aspirin or if you’re on blood thinners such as warfarin , because these medications can interact with topiramate and put you at a higher risk for bleeding.

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Is Topamax Used To Treat Bipolar Disorder Or Depression

Topamax doesnt have Food and Drug Administration approval for treating bipolar disorder or depression. But your doctor may prescribe Topamax off-label if other treatment options havent worked for your condition.

havent found Topamax to be highly effective when used alone or with other medications to treat bipolar disorder compared with a placebo .

There are limited studies on Topamaxs effectiveness for treating depression. One study found that taking Topamax with a selective serotonin reuptake inhibitor such as fluoxetine or citalopram improved symptoms in people with major depressive disorder compared with a placebo. But more studies are needed to confirm the effectiveness of Topamax for depression.

If youre interested in taking Topamax to treat bipolar disorder or depression, talk with your doctor.

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What Should I Ask My Doctor

The sections above describe the typical dosages provided by the drug manufacturer. If your doctor recommends Topamax for you, they will prescribe the dosage thats right for you.

Remember, you shouldnt change your dosage of Topamax without your doctors recommendation. Only take Topamax exactly as prescribed. Talk with your doctor if you have questions or concerns about your current dosage.

Here are some examples of questions you may want to ask your doctor:

  • How often will my dosage for Topamax be adjusted if its not working for me?
  • Will my dosage be reduced if I have serious side effects?
  • Does my dosage of Topamax need to change if Im taking other medications with it?

If you take Topamax for migraine, sign up for Healthlines online newsletter for tips on managing your condition.

Topamax For Alcohol Dependence


Topamax is sometimes prescribed off-label for alcohol dependence because it can reduce alcohol cravings. The starting dose is 25 mg, taken once per day. The dose can be increased by 25 mg per day every week until a dose of 150 mg per day is reached.

  • Standard adult dosage for alcohol dependence: 100-150 mgtaken once per day

  • Maximum adult dosage for alcohol dependence: 150 mgtaken once per day

RELATED: What happens when you mix Topamax and alcohol?

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How To Take Topiramate

  • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about topiramate and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take topiramate exactly as your doctor tells you to. It is usual to start topiramate treatment on a low dose , and then for the dose to be increased gradually. A usual maintenance dose is 50-100 mg daily, taken either as a single dose or divided into two doses over the day.
  • Swallow topiramate tablets with a drink of water. Do not chew the tablets as they have a bitter taste. If you have been prescribed capsules, you can swallow the capsules in the normal way with a drink of water or, if you prefer, you can open up the capsule and sprinkle the contents on to a spoonful of some soft food . Do not chew the contents of the capsules.
  • It is important that you drink plenty of water while you are taking topiramate. This is because there is a slight risk that kidney stones can develop and drinking plenty of water reduces this risk.
  • Try to get into a habit of taking topiramate at the same time each day. You can take topiramate before or after food.
  • If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.

Dosing For The Preventive Treatment Of Migraine

The recommended total daily dose of TOPAMAX® as treatment for patients 12 years of age and older for the preventive treatment of migraine is 100 mg/day administered in two divided doses . The recommended titration rate for TOPAMAX® for the preventive treatment of migraine is as follows:

Table 3: Preventive Treatment of Migraine Titration Schedule for Patients 12 Years of Age and Older

Morning Dose

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Important Questions For Your Doctor Before Taking Topiramate

Topiramate tablets are taken by mouth with water or other liquids. Before starting Topiramate talk with your doctor if you:

  • Have a history of hypersensitivity to topiramate
  • Have a history of alcohol use
  • Have acute myopia and secondary angle closure glaucoma
  • Have a history of depression or thoughts of suicide
  • Have a history of kidney or liver impairment
  • Have weak, brittle or soft bones
  • Have lung or breathing problems
  • Are planning on having surgery
  • Are on a high fat diet/low carbohydrate diet
  • Are pregnant or planning to get pregnant. Topiramate can cause fetal harm when administered to a pregnant woman.

Individuals with the above conditions should be monitored closely while taking Topiramate.

A physician, individual medical circumstances, and clinical outcome will guide the dose and titration rate. Longer intervals between dose adjustments can be used.

Do not suddenly stop taking Topiramate without talking to your doctor, as serious complications can arise.

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

Topiramate / Topamax – The Migraine Guy

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.

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Dosage And Tapering Topamax For Migraine Prevention

by Patient Advocate

How to best taper up to therapeutic dosage

Topamax is a medication originally developed for seizure control. It is also FDA approved for Migraine prevention.

Dr. Stephen Silberstein, director of the Jefferson Headache Center and Professor of Neurology at Thomas Jefferson University, conducted some of the clinical trials of Topamax for migraine prevention and prescribes it for some of his patients. He emphasizes that proper dosage and titration is essential for successful use of Topamax.

Here are his recommendations for safely tapering up to a therapeutic dosage level:

  • Week 1: 25 mg at bedtime

  • Week 2: 25 mg, twice a day

  • Week 3: 25 mg day dose, 50 mg bedtime dose

  • Week 4: 50 mg, twice a day

  • Weeks 5 – 7: maintain 50 mg, twice a day. If that isn’t effective in reducing the frequency and severity of Migraine, progress through weeks 8 – 11 if necessary.

  • Week 8: 50 mg day dose, 75 mg bedtime dose

  • Week 9: 75 mg, twice a day

  • Week 10: 75 mg day dose, 100 mg bedtime dose

  • Week 11: 100 mg twice a day

  • Weeks 12 – 18. Maintain 100 mg twice a day.

  • If 100 mg twice a day doesn’t give the desired results, he recommends tapering down and off Topamax rather than going to a higher dosage because the clinical trials showed no benefit to going higher.

Dr. Silberstein also offered some other helpful pieces of information:

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.

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What Interacts With Topamax

Dont take Topamax at the same time as certain medications because of the potential for drug interactions. Drug interactions can worsen the common side effects of Topamax or cause new side effects entirely. Its best to talk with your doctor before taking Topamax if you take any of the following:

  • Metformin

  • Antiepileptic drugs like phenytoin and carbamazepine.

  • Valproate

  • Carbonic anhydrase inhibitors like zonisamide and acetazolamide.

  • Amitriptyline

Effect On Quality Of Life

Topamax Weight Loss

Improvement in HRQOL has been recently reported in an analysis of data pooled from the three MGR trials . The Migraine-Specific Questionnaire was used to assess the effect of 100 mg/day TPM on HRQOL. This tool evaluates quality of life in three domains: role restriction , role prevention , and emotional function . All these domains improved significantly more in TPM-treated patients than in those on placebo.

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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.


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