Topamax (Topiramate)

Topamax (Topiramate HCL) is used as monotherapy or adjunctive therapy for partial onset seizures and primary generalized tonic-clonic seizures; adjunctive treatment of seizures associated with Lennox-Gastaut syndrome; prophylaxis of migraine headache.

Some doctors prescribe Topamax as a mood stabilizer for people with bipolar disorder (manic depression).

• Absorption: Topiramate absorption is rapid, not affected by food. T max is 2 hr. Steady state is reached in about 4 days.
• Elimination half-life: 21 hr.
• Metabolism: Hepatic via P450 enzymes.
• Excretion: Topiramate is primarily eliminated unchanged in urine (about 70% of a dose).

• weight loss and appetite suppression potential 4
• can reverse weight gain induced by psychotropic medications 5
• probably works for all seizure types
• relatively low drug interaction potential
• one of the few FDA-approved prescriptions for migraine prevention

• risk of developing kidney stones (about 1.5%) 1
• risk of acute myopia and angle-closure glaucoma 1
• emotional and cognitive side effects 1
• decrease efficacy of oral contraceptives 1
• more cognitive side effects than with other newer anticonvulsants

• chronic daily headache 2
• cluster headache 9
• neuropathic pain 12
• bipolar disorder 6
• obesity and weight loss 4, 14
• alcohol dependence 7
• opiate withdrawal 13
• bulimia nervosa 8
• smoking cessation 10
• binge eating disorder 11

Topamax for Chronic daily headache
The study have shown that Topamax may decrease of the headache days per week, significantly decrease the headache severity, reduce the headache hours per day and weekly analgesic consumption. These effects continued for an average follow-up of 8+/-4 months. The average effective dose was 100 mg/day. Slowly increasing the drug at moderate increments resulted in high tolerability of topiramate 2.

Topamax is also safe, well tolerated, and highly effective at low doses in the treatment of chronic daily headaches in children 3.

Topamax for Weight loss
The evidence of a strong weight-reducing potential of Topamax is indisputable and clinically significant. Weight loss appears to be one of the most common side effects with Topamax therapy. For some people, this may be a good thing. However, for many people weight loss may be a highly undesirable effect (for example, for growing children).

Topamax is not FDA approved as a weight loss drug, but many clinical studies have demonstrated it's weight loss potential.

In long-term clinical study at 60 weeks, patients in the placebo group lost 1.7% of their baseline body weight, while patients in the Topamax 96, 192, and 256 mg/day treatment groups lost 7.0, 9.1, and 9.7%, respectively. Weight loss >/=5% of baseline weight was achieved by 18% of subjects in the placebo arm vs 54, 61, and 67% of patients receiving topiramate 96, 192, and 256 mg/day, respectively. Weight loss >/=10% was achieved by 6 vs 29, 40, and 44%, respectively. Weight loss was accompanied by significant improvements in blood pressure and glucose and insulin. The most common adverse events more frequently observed in topiramate-treated patients occurred mostly during the titration phase and were related to the central or peripheral nervous system and included paresthesia, difficulty with concentration/attention, depression, difficulty with memory, language problems, nervousness, and psychomotor slowing. 14

Anticonvulsant activity may be due to a combination of potential mechanisms: Blocks neuronal voltage-dependent sodium channels, enhances GABA(A) activity, antagonizes AMPA/kainate glutamate receptors, and weakly inhibits carbonic anhydrase.

If you are going to buy Topamax or Topiramate without having a prescription, it may be a good idea to read users reviews at first.

• Topamax and weight loss: on MedHelp.org
• Topamax & Weight Loss: on HealthCentral.com
• Topamax for weight loss? on Healthboards.com

• 1. U.S. Food and Drug Administration Topamax Prescription Information
• 2. Mosek A, Dano M. Topiramate in the treatment of refractory chronic daily headache. An open trial. J Headache Pain. 2005 Apr;6(2):77-80. PubMed
• 3. Borzy JC, Koch TK, Schimschock JR. Effectiveness of topiramate in the treatment of pediatric chronic daily headache. Pediatr Neurol. 2005 Nov;33(5):314-6. PubMed
• 4. Chengappa KN, Chalasani L, Brar JS, Parepally H, Houck P, Levine J. Changes in body weight and body mass index among psychiatric patients receiving lithium, valproate, or topiramate: an open-label, nonrandomized chart review. Clin Ther. 2002 Oct;24(10):1576-84.
• 5. Van Gaal L, Rissanen A, Wilding J, Vercruysse F, Perry B, Fitchet M. Efficacy and safety of topiramate in obese subjects. Int J Obes. 2003;27:(suppl1):S14.
• 6. Vieta E, Torrent C, Garcia-Ribas G, Gilabert A, Garcia-Pare's G, Rodriguez A, Cadevall J, Garci'a-Castrillo'n J, Lusilla P, Arrufat F. Use of topiramate in treatment-resistant bipolar spectrum disorders. J Clin Psychopharmacol. 2002 Aug;22(4):431-5. PubMed
• 7. Johnson BA, Ait-Daoud N, Akhtar FZ, Ma JZ Arch Gen Psychiatry. 2004 Sep;61(9):905-12. PubMed
• 8. Hedges DW, Reimherr FW, Hoopes SP, Rosenthal NR, Kamin M, Karim R, Capece JA. Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, part 2: improvement in psychiatric measures. J Clin Psychiatry. 2003 Dec;64(12):1449-54. PubMed
• 9. Lainez MJ, Pascual J, Pascual AM, Santonja JM, Ponz A, Salvador A. Topiramate in the prophylactic treatment of cluster headache. Headache. 2003 Jul-Aug;43(7):784-9 PubMed
• 10. Khazaal Y, Cornuz J, Bilancioni R, Zullino DF. Topiramate for smoking cessation. Psychiatry Clin Neurosci. 2006 Jun;60(3):384-8.
• 11. McElroy SL, Shapira NA, Arnold LM, Keck PE, Rosenthal NR, Wu SC, Capece JA, Fazzio L, Hudson JI. Topiramate in the long-term treatment of binge-eating disorder associated with obesity. J Clin Psychiatry. 2004 Nov;65(11):1463-9. PubMed
• 12. Chong MS, Libretto SE. The rationale and use of topiramate for treating neuropathic pain. Clin J Pain. 2003 Jan-Feb;19(1):59-68. PubMed
• 13. Zullino DF, Krenz S, Zimmerman G, Miozzari A, Rajeswaran R, Kolly S, Khazaal Y. Subst Abus. 2005 Dec;25(4):27-33. PubMed
• 14. Wilding J, Van Gaal L, Rissanen A, Vercruysse F, Fitchet M; OBES-002 Study Group. A randomized double-blind placebo-controlled study of the long-term efficacy and safety of Topamax in the treatment of obese subjects. Int J Obes Relat Metab Disord. 2004 Nov;28(11):1399-410.

Last modified: April, 2010