Topiramate

Topiramate is the active ingredient in the brand-name medication Topamax^®, an anticonvulsant medication used to treat seizures and prevent migraines by stabilizing electrical activity in the brain and reducing abnormal brain cell firing. 

The drug is FDA-approved to treat epilepsy, including partial onset and generalized tonic-clonic seizures, and for migraine prevention in adults and adolescents ages 12 and older. 

Common side effects include dizziness, paresthesia, fatigue, weight loss, and trouble concentrating, and it carries a warning for increased risk of metabolic acidosis (a condition where too much acid builds up in the body) and kidney stones.

Topamax (topiramate) is indicated for:

• Epilepsy: initial monotherapy for the treatment of partial-onset or primary generalized tonic-clonic seizures in patients 2 years of age and older; adjunctive therapy for the treatment of partial-onset seizures, primary generalized tonic-clonic seizures, or seizures associated with Lennox-Gastaut syndrome in patients 2 years of age and older

• Preventive treatment of migraine in patients 12 years of age and older

Anticonvulsant

Epilepsy: Most common (≥10% more frequent than placebo or low-dose Topamax) adverse reactions in adult and pediatric patients were:

• Tingling

• Anorexia

• Weight loss

• Speech disorders/Related speech problems

• Fatigue

• Dizziness

• Sleepiness

• Nervousness

• Slowing down of physical and mental activities

• Abnormal vision

• Fever

Migraine: Most common (≥5% more frequent than placebo) adverse reactions in adult and pediatric patients were:

• Tingling

• Anorexia

• Weight loss

• Difficulty with memory

• Taste perversion

• Diarrhea

• Loss of sensation

• Nausea

• Abdominal pain

• Upper respiratory tract infection

The cost of topiramate varies depending on factors such as your insurance plan, which pharmacy you use, the dosage, and quantity. Without insurance, generic topiramate may cost around $70 and $165 for a month’s supply, although there are coupons and savings programs that may help you pay for the drug. Brand-name Topamax may cost between $475 and $540 for a month’s supply. Insurance plans may cover all or some of the cost of these medications.

Hers offers access to personalized Weight Loss Medication Kits. Kits may contain one of several combinations of medications that help support weight loss, such as a compounded version of topiramate**. These medication kits start at $69 per month with a monthly subscription plan paid in full. The cost includes a provider consultation, ongoing provider support, and access to the Hers app. 

**Compounded medications are not approved or evaluated for safety, effectiveness, or quality by the FDA.

• Drug interactions: contraceptives, lithium

• Acute myopia and secondary angle closure glaucoma

• Visual field defects

• Oligohidrosis and hyperthermia

• Metabolic acidosis

• Suicidal behavior and ideation

• Cognitive/Neuropsychiatric adverse reactions

• Fetal toxicity

• Withdrawal of AEDs

• Decrease in bone mineral density

• Negative effects on growth (height and weight)

• Serious skin reactions

• Hyperammonemia/Encephalopathy

• Kidney stones

• Hypothermia has been reported with and without hyperammonemia during topiramate treatment with concomitant valproic acid use

*This information is from the label for brand name Topamax^®. See the Full Prescribing Information for more complete information. Topiramate, the active ingredient in Topamax, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient topiramate.