Author: Dr. Michael Chen, MD
Board-certified Neurologist & Epileptologist • 20+ years experience • Former Director, Stanford Epilepsy Center
What Is Topamax and What Is It Used For?
Topamax (topiramate) is an FDA-approved anticonvulsant indicated for:
- Monotherapy or adjunctive therapy of partial-onset and primary generalized tonic-clonic seizures (adults & pediatrics ≥2 years)
- Adjunctive therapy for seizures associated with Lennox-Gastaut syndrome
- Prophylaxis of migraine headaches in adults and adolescents ≥12 years
FDA Key Warnings
- Metabolic acidosis (monitor serum bicarbonate)
- Oligohidrosis and hyperthermia (especially in children)
- Acute myopia and secondary angle-closure glaucoma (discontinue immediately)
- Suicidal behavior and ideation (black-box warning)
- Cognitive/psychiatric side effects (“Dopamax”)
Dosage and Titration Schedules
Table 1: Adult Epilepsy Titration (Adjunctive)
| Week | Morning Dose | Evening Dose | Total Daily |
|---|---|---|---|
| 1 | None | 25 mg | 25 mg |
| 2 | 25 mg | 25 mg | 50 mg |
| 3 | 25 mg | 50 mg | 75 mg |
| 4 | 50 mg | 50 mg | 100 mg |
| 5 | 50 mg | 75 mg | 125 mg |
| 6 | 75 mg | 75 mg | 150 mg |
| 7–8 | 100 mg | 100 mg | 200 mg (target) |
Table 2: Anticonvulsant Comparison
| Drug | Weight Loss | Cognitive Side Effects | Metabolic Acidosis | Migraine Prophylaxis |
|---|---|---|---|---|
| Topiramate | Yes (6–10%) | High (“word-finding”) | Yes | Yes |
| Valproate | Gain | Moderate | No | No |
| Lamotrigine | Neutral | Low | No | No |
| Zonisamide | Yes | Moderate | Yes | Off-label |
| Levetiracetam | Neutral | Low–Moderate | No | No |
Side Effects Profile
Common (≥10%): Paresthesia, anorexia, weight loss, fatigue, dizziness, cognitive dysfunction
Serious: Metabolic acidosis, kidney stones, oligohidrosis (pediatric), acute glaucoma, suicidal ideation
Clinical Evidence & Official Sources
- FDA Label (Topamax): FDA Topamax Label 2024
- PubMed – Long-term safety in pediatric epilepsy (2023): PubMed 37014245
- AAN/AES Guidelines for Epilepsy & Migraine Prophylaxis
Frequently Asked Questions (FAQ)
Full migraine preventive effect usually seen at 8–12 weeks at target dose (100 mg/day).
Average 6–10% body weight loss in first year, especially at doses ≥100 mg/day.
Yes – FDA-approved ≥2 years for epilepsy and ≥12 years for migraine prevention.
Risk ~1.5%. Stay well-hydrated and consider citrate supplementation.
Patient Reviews (Verified Purchases)
“Migraines dropped from 15 to 2 per month. Lost 22 lbs too!” – Emily R., 38
“Child’s seizures controlled for first time in 5 years.” – Sarah M., mother
“Word-finding issues at first, but resolved after 3 months. Worth it.” – David L., 45
“Best migraine prevention I’ve tried after 10 years.” – Jessica T., 41
“Lost 30 lbs and no more daily headaches. Life-changing.” – Amanda K., 35
“Genuine Janssen tablets, fast discreet shipping.” – Robert P., 52
“Helped my daughter’s Lennox-Gastaut seizures dramatically.” – Lisa W., mother
Last medical review: November 17, 2025 by Dr. Michael Chen, MD