The brand name of the anticonvulsant medication topiramate (tow-PEER-uh-mate). Also known as Epitomax in some European countires.

Topamax is FDA approved for various seizure disorders and as a preventative medicine for those with migraine headaches. Its off-label uses include bipolar disorder, alcoholism, and obesity. I must admit that my knowledge veers on the side of its migraine usage, as that is what I take it for. Its effectiveness for treating seizures (to be used in conjunction with another seizure medication) is high. It has also been quite successful in treating migraines, and has been popular due to the fact that it causes weight loss rather than weight gain, as do many other migraine preventatives. On the other hand, it has been much less effective in its off-label uses (which does not necessarily follow: migraine was an off-label use until the summer of 2004), and patients often will discontinue the medication because its side effects are too severe to be worth it for something like weight loss.

The most common dose is 200mg per day taken in either one dose or split between the morning and evening, though lower doses are sometimes effective (pills are available in 15mg and 25mg sprinkle capsules and 25mg, 100mg and 200mg tablets.) Research indicates that doses above 400mg daily are generally not more effective than lower doses, though it is approved for doses up to 600mg per day. Users must titrate on and off of this medication; the suggested rate is 25mg/week. Patients who go off of Topamax cold turkey may experience seizures, even if they have never had one before.

Side Effects
Common side effects include fatigue, paresthesias (tingling in the extremities), weight loss/anorexia (note: not anorexia nervosa), change in taste (carbonated beverages tasting bad seems to be a universal side effect), cognitive slowness (Topamax has a dumbening effect, earning it the nicknames Dopamax and the less creative Stupamax), and aphasia. Most of these side effects disappear, or at least become less severe once the right dose is found and the body adjusts to being on the medication.

Less common side effects, which should be reported promptly to your doctor include abdominal pain, mood swings, unsteadiness, breathing problems, fast, slow or irregular heartbeat, loss of consciousness, fever, and persistent sore throat.

Rare side effects include decreased sweating, creating a risk of hyperthermia, sudden glaucoma (at the first signs of vision problems or eye pain or itching, patients should seek medical attention), and tongue paralysis.

Drug Interactions
Tell your doctor if you are taking any drugs that cause decreased sweating (e.g. acetazolamide, anticholinergics, etc.) or drowsiness (e.g. sedatives, sleep aids, narcotic pain relievers, certain antihistamines, etc.). This drug may interfere with the effectiveness of birth control pills.

How It Works
Like other anticonvsulants, Topamax works by decreasing the amount of neurological activity in your brain; this excess activity is what causes seizures and migraine episodes. Unlike other medications, Topamax works primarily in the temporal lobes, making it ideal for some and worthless for others (if you have a neurological disorder and experience mood swings of intense rage, olfactory hallucinations, deja vu or jamais vu often, you probably have problems with your temporal lobe, though Topamax may work for you even if you don't experience these things.)

Here's a basic outline of what Topamax does to your brain (condensed from
  • Adjusts sodium voltage channels, which reduces neurological activity.
  • Makes you more receptive to the GABA present in your brain, which causes fatigue and mood stablization.
  • Causes kainate to work on glutamate receptors; gluatamate acts as an anticonvulsant, antidepressant and antipsychotic.
  • Inhibits some isoenzymes of carbonic anhydrase (not sure what this does other than give you kidney stones, please let me know if you know something about organic chemistry.)

References:, which contains more (though chiefly anecdotal) discussion on the use of Topamax for seizures, as well as kidney stones and how to avoid them.
The pamplet that comes with a prescription for Topamax, published by The Hearst Corporation.

I take this particular drug. This is round four on it, and here are my personal notes:

1) don't plan anything for the next week. If like me you are or were somewhat small when you first began taking this drug, plan to spend the first week or two laid up in bed, barely moving to hit the can and maybe a handful of nomnoms. My grandmother said she had to force me to drink broth and sugar-laiden coffee, but I don't remember it.
2) prepare to have a heavy period. If you're female, prepare for cramps of a lifetime. And a constant period i'm at eight months and holding. Ugh.
3) forgetfulness, or switching words around. can't think of that word you're looking for? Why are those two words or letters transposed, yet they look right? Welcome to the wacky universe of side effects.
4) your hair may or may not fall out. Ugh. That is unpleasant, to say the least.

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