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> Topamax (topiramate) Overview


Topamax Article Index | Brand and Generic Availability

Brand & Generic Names; Drug Class

US brand name: Topamax
Generic name: topiramate
Drug Class: AntiepilepticDrugs/Anticonvulsants
Learn More about Topamax’s Generic & Worldwide Availability

Topamax’s Approved & Off-Label Uses (Indications)

US FDA Approved Treatment(s)

Epilepsy - by itself or with other meds, for adults & children. Migraines. Qsymia is topiramate combined with phentermine, and is approved to treat obesity.

Popular Off-Label Uses

Bipolar disorder (works best as an add-on). Eating disorders - especially sleep eating. Alcoholism. PTSD. Used by itself for weight loss - especially for weight gain caused by other crazy meds.

Learn More about Topamax’s Approved & Off-label Uses

How Long Until Topamax Starts Working (Onset of Action)

For migraines: anywhere from one day (don’t get your hopes up, but it happens) to a month.

For epilepsy: it’s complicated.

Likelihood of Working

For migraines: Really good, which is probably why OrthoMcNeil P-Diddy Janssen are all about Topamax for migraines these days.
For epilepsy: pretty good. Learn how Topamax Compares with Other Drugs

How to Take Topamax

For migraines: the initial dose is 25mg a day, increased by 25mg a day each week as needed until you reach 100mg a day, usually divided into two doses.

For epilepsy: the initial dose is 25mg a day, increased by 25mg a day each week until you reach 100mg a day, usually divided into two doses. If you’re still having seizures, the recommended increase is 50mg a day each week until you achieve seizure control or the recommended maximum of 400mg a day.


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How to Stop Taking Topamax (Discontinue, Withdrawal)

OrthoMcNeil MS-Passport now agrees with us. Per the PI sheet, unless you need to stop taking Topamax due to a severe adverse reaction, you should reduce your dosage by 25–50mg a day every week. Learn More about Taking and Discontinuing Topamax



Topamax’s Pros and Cons

Pros

Currently the only modern AED approved by the FDA that you can take by itself to treat both generalized, flopping around tonic-clonic seizures as well as partial seizures. You’re more likely to lose weight than gain weight. Can (but doesn’t always) work for migraines at 25mg a day with barely any side effects after a few weeks. Can (but doesn’t always) work for seizures at 100mg a day.

Cons

The promise of losing weight is oversold and often leads to disappointment. Topamax can make you dumber than a box of rocks.

Interesting Stuff your Doctor Probably didn’t Tell You about Topamax

Topamax may encourage you to stop smoking, in that you may just not like to smoke after you start and withdrawal symptoms won’t be as bad. Topamax can mess with lithium levels in seemingly random ways, and taking it along with Depakote or any other valproate can cause hypothermia (excessively low body temperature) and/or hyperammonemia (elevated ammonia in your blood), so taking Topamax to lose medication-induced weight gain can get tricky.

Best Known for

Turning you into the stereotype of a supermodel: thin and stupid.
In-Depth Pros & Cons

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Topamax’s Side Effects (Adverse Reactions)

Typical Side Effects

Sleepiness, fatigue, and/or lethargy. A pins & needles effect/tingling in the extremities that usually goes away after a week or two - but you want this one if you’re taking Topamax for migraines. Sodas and other carbonated beverages will taste like ass. Memory loss, aphasia (weird words coming out in place of what you meant to say or write), word find problems (not being able to recall the names of people, things or concepts), and a general cognitive impairment that has earned this drug the nicknames “Stupamax” and “Dopamax.”

Uncommon Side Effects

Dry and/or itchy eyes along with assorted vision problems. You may find yourself not able to drink coffee any more, so be prepared to quit the bean. Food in general, and not just carbonated beverages, may not taste quite the same. Frequent, intense déjà vu or jamais vu. If you were experiencing one prior to taking Topamax be prepared to experience the other.

Freaky Rare Side Effects

Tongue paralysis, neverending cough, staghorn calculus (I’d like to know how you do calculus using antlers), and palinopsia and the Alice in Wonderland syndrome. So Topamax explains Sarah Palin?
Learn More about Topamax’s Side Effects.
TMI at times


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What You Really Need to be Careful About

Glaucoma, not sweating, kidney stones.

Topamax’s Black Box and Other Warnings, Pregnancy Category, etc.

Pharmacology

topiramate’s Half-Life & How Long Until It Clears Your System

Plasma half-life: Half-life: 21 hours. Clearance: four to five days.

topiramate’s Pharmacokinetics Information Overload

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on topiramate’s pharmacokinetics page.

How topiramate Works

the current best guess at any rate
Topamax is a fairly broad-spectrum anticonvulsant. It prevents migraines and various types of seizures by blocking voltage-dependent sodium and calcium channels, inhibiting glutamate and carbonic anhydrase, and promoting the reception of GABA and/or increasing the amount of GABA, depending on the location in your brain and the study you read. Topamax may also affect voltage-sensitive sodium channels.

Learn More than You Probably Ever Wanted to Know about How topiramate Works
AKA mechanism/method of action, pharmacodynamics


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Ratings, Reviews, Comments, PI Sheet, and More

Topamax Comments

Whichever nickname you use, Dopamax, Stupamax, or a supermodel drug, when it works Topamax is a freaking Godsend. I’m more than happy to put up with the frequent renal calculus (doctorese for the sediment in my piss that is more “kidney sand” and “kidney pebbles” than kidney stones), the hosed memory, the increased problems in getting the right words out of my mouth, and random periods of coffee = panic attacks so I don’t have to worry about having some kind of seizure activity a couple times a week or go through the hell that is ultradian rapid cycling.

With one of the simplest titration schedules and approval to be used as monotherapy (by itself) to treat generalized, flopping on the ground & pissing your pants seizures, Topamax will often be prescribed before Depakote or Stavzor - the newest flavor of valproic acid - even if the side effects for lower dosages of valproates often suck less than the side effects of Topamax at dosages required to treat some of those forms of epilepsy. Topamax side effects might suck more, but it is easier to take, so it’s a hard call as to which really sucks less.

Topamax (topiramate) has long been
Extended Comments
As if I didn’t go on long enough already.

Topamax Ratings & Reviews, and Consumer Comments & Experiences

Rate Topamax

Give your overall impression of Topamax on a scale of 0 to 5. Detailed ratings and reviews are available on the Topamax Ratings & Reviews Page.

Get all critical about Topamax

3 stars Rating 2.9 out of 5 from 130 criticisms.
Vote Distribution: 32 – 3 – 17 – 13 – 27 – 38


Rate this article

If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Topamax (topiramate) Overview

4 stars Rates 3.9 out of 5 from 68 value judgments.
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Discussion board

Consumer experiences with and questions about Topamax on Crazymeds Topamax discussion board. Sign up for a free account to post your own.

More Allegedly Useful Links. Mostly official sites, PI sheet-equivalents4 from countries other than the US, and reviews from other consumer review sites.


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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.



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References

  1. Topamax’s Full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.

Topamax Article Index | Brand and Generic Availability

1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.

2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

4 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.


If you have any questions not answered here, please see the Crazymeds Topamax discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


Last modified on Sunday, 01 June, 2014 at 13:46:15 by JerodPoorePage Author Date created Tuesday, 11 January 2011 at 13:43:23
“Topamax (topiramate): a Synopsis for the Educated Consumer.” by Jerod Poore is copyright © 2011 Jerod Poore Published online 2011/01/11
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Topamax, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




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All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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