Drug Interactions

Topiramate (Topamax®) Interactions

Topiramate Drug Interactions:

Topiramate has minimal hepatic drug interactions. Inhibits carbonic anhydrase, CYP2C19 (weak). Induces CYP3A4 (weak).

  • Acetazolamide, dichlorphenamide: increased risk of nephrolithiasis and hyperthermia.
  • Carbamazepine: may reduce topiramate levels by 40%.
  • Hydrochlorothiazide: increased topiramate levels.
  • Oral contraceptives (estrogens): blood levels of estrogens are decreased when coadministered with topiramate, this may lead to a loss of efficacy.
  • Phenytoin: May decrease topiramate levels by as much as 48%; topiramate may increase phenytoin concentration by 25%
  • Valproic acid: increased risk of hyperammonemia.

Can you take Topiramate and Alprazolam (Xanax®)?

There are no reported drug interactions between topiramate and alprazolam 1. No special precautions appear to be necessary during concomitant use.

Can you take Topiramate and Amitriptyline?

Generally, concomitant use of topiramate and amitriptyline is safe. Amitriptyline and topiramate combination may be beneficial for patients with migraine and comorbid depression 9 and help to reduce the dosage of amitriptyline.

Can you take Topiramate and Aripiprazole (Abilify®)?

There are no drug interactions between topiramate and aripiprazole 1. Taking topiramate and aripiprazole together is safe. Their concomitant is use not associated with increased side effects 11.

Can you take Topiramate and Diazepam (Valium®)?

There are no reported drug interactions between topiramate and diazepam 1. There is evidence that topiramate may potentiates the antiseizure activity diazepam 4.

Can you take Topiramate and Excedrin® (Acetaminophen/Aspirin/Caffeine)?

Topiramate does not interfere with the active components in Excedrin® -- acetaminophen, aspirin, and caffeine 1.

Can you take Topiramate and Ibuprofen (Advil®)?

No drug interactions 1. Topiramate can be taken with Ibuprofen at the same time.

Can you take Topiramate and Lamotrigine (Lamictal®)?

There are no pharmacokinetic interactions between topiramate and lamotrigine 6. Lamotrigine has no effect on topiramate levels 5.

Can you take Topiramate and Nortriptyline (Pamelor®)?

Due to the lack of interaction between topiramate and nortriptyline the concurrent use of both drugs is safe 1. The combination topiramate with nortriptyline is useful for migraine prevention 12.

Can you take Topiramate and Rizatriptan (Maxalt®)?

No drug interactions 1. Topiramate prophylactic therapy does not affect the efficacy or safety of rizatriptan for acute migraine relief 7.

Can you take Topiramate and Propranolol?

Topiramate and propranolol don't interfere with each other 1 and can be used at the same time. Propranolol, a nonselective beta-blocker, is sometimes used in combination with topiramate to reduce migraine headache frequency 10.

Can you take Topiramate and Sertraline (Zoloft®)?

There are no drug interactions between topiramate and sertraline 1. Combination topiramate with sertraline is effective for binge-eating disorder 3.

Can you take Topiramate and Tramadol?

The combined use is considered safe. Topiramate label does not warn about concurrent use with tramadol 1. Experimental studies indicate that combination tramadol plus topiramate acts synergistically and may be very effective for the relief of neuropathic pain 2.

Topiramate during Pregnancy

Pregnancy Category D.

An increased risk of cleft lip and cleft palate (oral clefts) has been observed in infants born to women treated with topiramate (Topamax) during pregnancy.

Nursing Mothers
Based on limited data, topiramate was found in breast milk; low concentrations were detected in nursing infants.


  • 1. U.S. FDA Topamax (Topiramate) Information
  • 2. Codd EE, Martinez RP, Molino L, Rogers KE, Stone DJ, Tallarida RJ. Tramadol and several anticonvulsants synergize in attenuating nerve injury-induced allodynia. Pain. 2008 Feb;134(3):254-62. PubMed
  • 3. Brambilla F, Samek L, Company M, Lovo F, Cioni L, Mellado C. Multivariate therapeutic approach to binge-eating disorder: combined nutritional, psychological and pharmacological treatment. Int Clin Psychopharmacol. 2009 Nov;24(6):312-7. PubMed
  • 4. De Sarro G, Gratteri S, Bonacci F, Musumeci SA, Elia M, De Sarro A. Topiramate potentiates the antiseizure activity of some anticonvulsants in DBA/2 mice. Eur J Pharmacol. 2000 Jan 28;388(2):163-70. PubMed
  • 5. Berry DJ, Besag FM, Pool F, Natarajan J, Doose D. Lack of an effect of topiramate on lamotrigine serum concentrations. Epilepsia. 2002 Aug;43(8):818-23. PubMed
  • 6. Doose DR, Brodie MJ, Wilson EA, Chadwick D, Oxbury J, Berry DJ, Schwabe S, Bialer M. Topiramate and lamotrigine pharmacokinetics during repetitive monotherapy and combination therapy in epilepsy patients. Epilepsia. 2003 Jul;44(7):917-22. PubMed
  • 7. Seeburger JL, Cady RK, Winner P, et al. Rizatriptan for treatment of acute migraine in patients taking topiramate for migraine prophylaxis. Headache. 2012 Jan;52(1):57-67. PubMed
  • 8. Hollander E, Dell'Osso B. Topiramate plus paroxetine in treatment-resistant obsessive-compulsive disorder. Int Clin Psychopharmacol. 2006 May;21(3):189-91. PubMed
  • 9. Keskinbora K, Aydinli I. A double-blind randomized controlled trial of topiramate and amitriptyline either alone or in combination for the prevention of migraine. Clin Neurol Neurosurg. 2008 Dec;110(10):979-84. PubMed
  • 10. Silberstein SD, Dodick DW, Lindblad AS, Holroyd K, Harrington M, Mathew NT, Hirtz D; Chronic Migraine Treatment Trial Research Group. Randomized, placebo-controlled trial of propranolol added to topiramate in chronic migraine. Neurology. 2012 Mar 27;78(13):976-84 PubMed
  • 11. Kenna GA , Leggio L, Swift RM. A safety and tolerability laboratory study of the combination of aripiprazole and topiramate in volunteers who drink alcohol. Hum Psychopharmacol. 2009 Aug;24(6):465-72. PubMed
  • 12. Krymchantowski AV1, da Cunha Jevoux C, Bigal ME. Topiramate plus nortriptyline in the preventive treatment of migraine: a controlled study for nonresponders. J Headache Pain. 2012 Jan;13(1):53-9. PubMed

By HealthyStock Research Group, September 2009
Medical resources reviewed: August 2018

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