Topiramate is a medication used to manage and treat epilepsy and migraine, and it is in the second-generation anti-epileptic drugs class of drugs. In addition, Topiramate has approval for chronic weight management for individuals with a body mass index over 30. Topiramate received FDA approval in 1996 for treating epilepsy as monotherapy or adjunctive therapy. This activity will highlight the indications, mechanism of action, and adverse event profile pertinent to interprofessional team members in managing patients with epilepsy, migraine, and related conditions. It also lists other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions, toxicity, and monitoring related to topiramate therapy.

How should this medicine be used?

Topiramate comes as a tablet, a sprinkle capsule (capsule that contains small beads of medication that can be sprinkled on food), an extended-release (long-acting) capsule and solution (liquid) to take by mouth. The tablets, sprinkle capsules, and solution are usually taken with or without food once or twice a day. The extended-release capsules are usually taken with or without food once a day. Take topiramate at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take topiramate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Be sure that the prescription your doctor gives you is clear and easy to read. Talk to your pharmacist to be sure that you are given topiramate. If you think you were given the wrong medication, talk to your pharmacist. Do not take any medication unless you are certain it is the medication that your doctor prescribed.

Topiramate tablets have a bitter taste so you should swallow them whole. It is especially important that you not take topiramate tablets that have been broken for any length of time because tablets that are broken may lose their effectiveness over time.

Swallow extended-release capsules (Trokendi XR brand only) whole; do not split, chew, or sprinkle on food.

The sprinkle and extended-release capsules (Qudexy XR brand only) may be swallowed whole or opened and poured over soft food. To take the sprinkle capsules or extended-release capsules (Qudexy XR brand only) mixed with food, you can carefully open the capsule and sprinkle the entire contents onto a spoonful of soft foods, such as applesauce. Swallow the mixture right after you mix it without chewing, and then drink fluids to make sure that you swallow all of the medication.

Use a marked (calibrated) measuring device to measure the topiramate solution dose to make sure the correct dose is being given. Do not use a household teaspoon or tablespoon. Ask your pharmacist for an measuring device if one is not included with your medication.

Your doctor will probably start you on a low dose of topiramate and gradually increase your dose, not more than once every week.

Topiramate may control your seizures or migraines but will not cure your condition. Continue to take topiramate even if you feel well. Do not stop taking topiramate without talking to your doctor, even if you experience side effects such as unusual changes in behavior or mood. If you suddenly stop taking topiramate, you may have severe seizures, even if you have not had seizures in the past. Your doctor will probably decrease your dose gradually.