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What is the most important information I should know about Topamax?

• Seek immediate medical attention if you experience blurred vision, changes in vision, or pain in or around the eyes during treatment with Topamax. These may be early signs of a serious side effect.
• Do not stop taking Topamax without first talking to your doctor, even if your symptoms have improved. It is important to continue taking Topamax to prevent seizures from recurring.
• Carry or wear a medical identification tag to let others know that you are taking Topamax in the case of an emergency.
• Use caution when driving, operating machinery, or performing other hazardous activities. Topamax may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
• Alcohol should be avoided while taking Topamax. Alcohol may cause increased sedation or drowsiness. It may also increase the risk of having a seizure.
• Unless otherwise directed by your doctor, drink several extra glasses of fluid each day during treatment with Topamax to minimize the risk of side effects such as kidney stone formation and metabolic acidosis (a decrease in a certain electrolyte in the body). Additional fluid may be necessary during hot weather, vigorous exercise, and illness (e.g., fever, vomiting, diarrhea).
• Decreased sweating and high body temperature have been associated with the use of Topamax. These side effects may be dangerous. Avoid becoming overheated in hot weather and during vigorous exercise, monitor sweating, and drink plenty of fluid to maintain hydration. If sweating is decreased or body temperature is elevated, contact your doctor.

What is Topamax?

• The exact way that Topamax works is unknown. However, it is believed that Topamax alters the chemical impulses in the brain that cause seizures.
• Topamax is used with other medications to control seizures. Topamax is also used to prevent migraine headaches.
• Topamax may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking Topamax?

• Before taking Topamax, tell your doctor if you
  • have kidney disease or a history of kidney stones;
  • have liver disease;
  • have lung or respiratory disease such as asthma, emphysema, or bronchitis; or
  • need to have surgery.
• You may not be able to take Topamax, or you may require a dosage adjustment or special monitoring during treatment
• Topamax is in the FDA pregnancy category C. This means that it is not known whether Topamax will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or if you could become pregnant during treatment.
• It is not known whether Topamax passes into breast milk. Do not take Topamax without first talking to your doctor if you are breast-feeding a baby.

How should I take Topamax?

• Take Topamax exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
• Take each dose of Topamax with a full glass of water.
• The tablets should be swallowed whole. Due to their bitter taste, the tablets should not be broken.
• The capsules may be swallowed whole or opened to facilitate swallowing. If the capsules are opened, the entire contents of the capsule should be sprinkled onto a small amount (teaspoon) of soft food (e.g., applesauce, custard, ice cream, oatmeal, pudding, yogurt). This drug/ food mixture should be swallowed immediately, without chewing. The mixture should not be stored for future use. If the mixture is combined in a small container, add some water to the container after the dose has been taken, and drink the water to ensure the whole dose has been taken.
• Topamax can be taken with or without food.
• It is important to take Topamax regularly to get the most benefit.
• Carry or wear a medical identification tag to let others know that you are taking this medicine in the case of an emergency.
• Do not stop taking Topamax without first talking to your doctor, even if your symptoms have improved. It is important to continue taking Topamax to prevent seizures from recurring.
• Unless otherwise directed by your doctor, drink several extra glasses of fluid each day during treatment with Topamax to minimize the risk of side effects such as kidney stone formation and metabolic acidosis (a decrease in a certain electrolyte in the body). Additional fluid may be necessary during hot weather, vigorous exercise, and illness (e.g., fever, vomiting, diarrhea).
• Your doctor may want you to have blood tests or other medical evaluations during treatment with Topamax to monitor progress and side effects.
• Store Topamax at room temperature away from moisture and heat.

What happens if I miss a dose?

• Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

• Seek emergency medical treatment if an overdose is suspected.
• Symptoms of a Topamax overdose are not known but may include severe drowsiness, poor coordination, tremor, confusion, difficulty speaking, and nausea.

What should I avoid while taking Topamax?

• Use caution when driving, operating machinery, or performing other hazardous activities. Topamax may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
• Alcohol should be avoided while taking Topamax. Alcohol may cause increased sedation or drowsiness. It may also increase the risk of having a seizure.
• Unless otherwise directed by your doctor, drink several extra glasses of fluid each day during treatment with Topamax to minimize the risk of side effects such as kidney stone formation and metabolic acidosis (a decrease in a certain electrolyte in the body). Additional fluid may be necessary during hot weather, vigorous exercise, and illness (e.g., fever, vomiting, diarrhea).
• Ketogenic diets (high protein, very low carbohydrate diets that may induce ketosis) may increase the risk of kidney stone formation and should be avoided during treatment with Topamax.
• Decreased sweating and high body temperature have been associated with the use of Topamax. These side effects may be dangerous. Avoid becoming overheated in hot weather and during vigorous exercise, monitor sweating, and drink plenty of fluid to maintain hydration. If sweating is decreased or body temperature is elevated, contact your doctor.
• Tell your doctor and dentist that you are taking Topamax before having any type of surgery.

What are the possible side effects of Topamax?

• Seek immediate medical attention if you experience blurred vision, changes in vision, or pain in or around the eyes during treatment with Topamax. These may be early signs of a serious side effect.
• If you experience any of the following serious side effects, stop taking Topamax and seek emergency medical attention or contact your doctor immediately:
  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
  • worsening of seizures;
  • metabolic acidosis (a high acidity of the blood that may be detected by blood tests). Symptoms of metabolic acidosis include increased rate of breathing, decreased appetite, and irregular heartbeats;
  • decreased sweating;
  • fever or increased body temperature; or
  • side or low back pain, or painful or difficult urination (may indicate kidney stones).
• Other, less serious side effects may be more likely to occur. Continue to take Topamax and talk to your doctor if you experience
  • dizziness, poor coordination, sluggishness, or drowsiness;
  • irregular back-and-forth movements of the eyes;
  • nausea, decreased appetite, or weight loss;
  • tremor, numbness, or tingling;
  • confusion, difficulty concentrating or decreased memory;
  • speech or language difficulties; or
  • changes in behavior, depression, nervousness, or agitation.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Topamax?

• Before taking Topamax, tell your doctor if you are taking any of the following medicines:
  • another seizure medication such as valproic acid (Depakote, Depakene), carbamazepine (Tegretol, Carbatrol, Epitol), phenytoin (Dilantin), and others;
  • a carbonic anhydrase inhibitor such as acetazolamide (Diamox), methazolamide (Neptazane), or dichlorphenamide (Daranide);
  • metformin (Glucophage, Fortamet); or
  • digoxin (Lanoxin, Lanoxicaps).
• You may not be able to take Topamax, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the drugs listed above.
• Topamax may decrease the effectiveness of certain birth control pills. Talk to your doctor about other birth control options to prevent unintended pregnancy.
• Topamax may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, pain relievers, sedative (sleep aids), anxiety medicines, and muscle relaxants. Dangerous sedation, dizziness, or drowsiness may occur if Topamax is taken with any of these medications.
• Drugs other than those listed here may also interact with Topamax. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

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