What Meds

Psychiatric Medications

Brand Names: Topamax

Topamax is the brand name for topiramate, an anticonvulsant. It is usually used to control epileptic seizures either alone or with other medications. It is thought to act through various mechanisms, including blocking sodium channels in neurons and modulating various chemical receptors in the brain.

Why is this drug prescribed?
Topamax is FDA-approved for treatment of Lennox-Gastaut syndrome (seizure syndrome) in adults and in children over the age of 2. It is also approved for treatment of partial and generalized tonic-clonic seizures in adults and children over the age of 10 (when used alone) or over the age of 2 (when used in combination with other medications).  Furthermore, it is approved for prevention of migraine headaches in adults.

Although the drug has not been found effective in acute mania, it is often used as add-on treatment in patients with bipolar disorder, especially to help control weight gain (due to it’s appetite-suppression properties).

How much of this drug is typically used?
Tablets: 25 mg, 50 mg, 100 mg, 200 mg
Sprinkle capsules: 15 mg and 25 mg

Warnings and Precautions
Because Topamax causes an increased risk of kidney stones, it is especially important to drink plenty of fluids while taking this medication.

Topamax should not be discontinued abruptly or withdrawal symptoms, including an increased frequency of seizures, may appear. Dosage should be gradually tapered when it is discontinued.

Topamax may cause blurred or double vision, clumsiness or unsteadiness, dizziness, drowsiness, and difficulty thinking or concentrating. Patients taking this medication should not drive or do anything requiring mental alertness and concentration until the effects of this medication are known not to impair these abilities.

For Pregnant or Nursing Mothers: Topamax has not been studied in pregnant or lactating women, but high-dose animal studies suggest that Topamax may increase the chances of birth defects and complications during pregnancy. Topamax may pass into breast milk and is not recommended for use in breastfeeding mothers.

Topamax should Not be used for people with an allergic reaction to it.

Topamax may be used with caution in people with the following conditions:

Adverse Reactions
Topamax may cause the following reactions:


Interactions with Drugs and Other Substances
Drugs or substances that may interact with Topamax include:

Research Studies and Use in Child Psychiatry
Topiramate is sometimes used to treat bipolar disorder, although there are no positive placebo-controlled studies for this purpose.  One study in children and adolescednts with bipolar disorder found that topirmate was not more effective than placebo in treating manic or mixed states.

 Due to it’s appetite-reducing properties, it is often used in conjunction with other mood stabilizers/antipsychotics for children having significant weight gain from taking these medications.  Usually, doses under 100 mg/day are used for this purpose as then topiramate is less likely to cause cognitive deficits at this dose.


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