Bipolar Disorder Treatment Medications Topamax (Topiramate) Uses and Side Effects By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on November 10, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by John C. Umhau, MD, MPH, CPE Medically reviewed by John C. Umhau, MD, MPH, CPE John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Learn about our Medical Review Board Print Peter Dazeley / Getty Images Table of Contents View All Table of Contents Indications Dosing Side Effects Considerations Drug Interactions Topamax (topiramate) is an anticonvulsant medication used in the treatment of epilepsy and migraine headaches. Topamax is also commonly used off-label to treat a wide range of mood disorders and eating disorders and to aid in substance abuse therapy. While Topamax's mechanism of action is unclear, we know that the drug blocks sodium channels in the body that deliver electrical impulses to excitable cells (such as nerve, muscle, and brain cells). By doing so, Topamax appears to enhance the activity of a chemical messenger (neurotransmitter) known as gamma-aminobutyric acid (GABA). 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 (FDA) for: Migraine prevention in adults and adolescents 12 and olderPartial-onset seizure treatment in adults and children two and olderPrimary 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 (a severe form of childhood epilepsy). Among its off-label uses, Topamax is sometimes prescribed to treat: Alcohol dependency Bipolar disorder Borderline personality disorder (BPD) Depression Post-traumatic stress disorder (PTSD) Tourette syndrome Weight loss (specifically to control binge-eating and purging) Topamax Dosing Topamax is available in capsule and tablet formulations. The tablet is offered in a 25-, 50-, 100-, and 200-milligram (mg) dose. The capsule is available in 15 mg and 25mg. The dosage can vary by the condition being treated and the person's age. When starting treatment, the dosage is typically tapered up to reduce the risk of side effects. It takes approximately five days for the medication to build up and reach a steady state in a person's system. It should also be tapered down if the decision is made to stop treatment. Stopping abruptly can cause a rebound of disease symptoms (such as seizures in people with epilepsy or abnormal moods in people with bipolar disorder). When prescribed for smaller children, the Topamax capsule can be broken open and its contents sprinkled over food. Common Side Effects of Topamax Topamax has a number of side effects that tend to be transient and resolve on their own as the body adapts to the treatment. Most are mild to moderate in severity. Common side effects include: Bruising or bleedingChanges in menstruationCognitive difficultiesConstipationDiarrheaDizzinessDouble visionDry mouthHeadacheHeartburnLoss of appetiteMood changesMuscle or bone painNauseaNervousnessParesthesiaSleepinessSlow reactionsStomach upsetTaste changesTingling or prickly skin sensationsTremorsWeaknessWeight loss Paresthesia is an abnormal sensation, often a tingling or prickling of the skin, that most commonly affects the arms and legs. While usually painless, it is one of the most common reasons why people discontinue the drug. Any persistent, severe, or worsening side effects should be reported to your doctor immediately. Considerations and Complications Less commonly, Topamax may cause serious complications that require you to either stop or avoid treatment. Among them: Glaucoma: In some individuals, Topamax can cause glaucoma. Symptoms usually appear within a month of starting treatment and may be recognized by the sudden blurring of vision, eye pain, redness, and abnormally dilated pupils.Kidney damage: This most often affects people over 65 who have an underlying kidney disorder. Kidney function tests should be routinely performed to monitor for any abnormalities. Kidney stones have also been known to develop in Topamax users, the risk of which may be reduced by drinking plenty of water.Metabolic acidosis: This is the potentially serious build-up of acid in the blood, most often seen in children 15 and under that can be caused by Topamax usage. Symptoms include nausea, vomiting, fast breathing, and lethargy. If left untreated, metabolic acidosis can lead to coma and death.Pregnancy: If taken during pregnancy, Topamax may cause issues for the fetus, including a cleft palate and small size for their gestational age. This medication can also be found in breastmilk. While Topamax is not absolutely contraindicated, you must weigh the benefits and consequences of treatment if you are pregnant, planning to get pregnant, or breastfeeding. Topamax Drug Interactions Certain drugs are known to interact with Topamax, either by reducing or increasing the availability of Topamax or the other co-administered drug. This is especially true when used with other anticonvulsants such as Tegretol (carbamazepine) and Lamictal (lamotrigine). Dose adjustments may be required to compensate for this effect. Other co-administered drugs that may require dose adjustments include the diuretic Microzide (hydrochlorothiazide) and the diabetes medications Actos (pioglitazone) and metformin. Among the drugs to be avoided are those classified as carbonic anhydrase inhibitors, which include: Diuretics: Such as Keveyis (dichlorphenamide)Epilepsy drugs: Such as Diamox (acetazolamide) and Zonegran (zonisamide)Glaucoma medications: Such as Azopt (brinzolamide), Neptazane (methazolamide), and Trusopt (dorzolamide) Estrogen-based contraceptives may also be compromised if taking Topamax, increasing the risk of pregnancy and breakthrough bleeding. Was this page helpful? Thanks for your feedback! Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Sign up for our newsletter and get it free. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Food and Drug Administration (FDA). Topamax (topiramate) tablets and Topamax (topiramate capsules) sprinkle capsules. Medline Plus. Topiramate. Fariba K, Saadabadi A. Topiramate. In: StatPearls. StatPearls Publishing; 2021. Additional Reading Estemalik, E. and Tepper, S. Preventive treatment in migraine and the new US guidelines.Neuropsychiatr Dis Treat. 2013;9:709-20. doi: 10.2147/NDT.S33769 Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.