Topiramate (Topamax)

Topiramate, sold under the brand name Topamax among others, is a carbonic anhydrase inhibitor medication used to treat epilepsy and prevent migraines.

It has also been used in alcohol dependence.

It works by facilitating GABA-A receptors.

It reduces dopamine levels in the mesocortical limbic system, and decreases alcohol induced reinforcement, and the propensity to drink.

It may reduce the rate of heavy, drinking, compared with placebo, but does not improve rates of abstinence.

It is considered a second line medication to reduce heavy drinking.




For epilepsy this includes treatment for generalized or focal seizures.

Has been used  weight management in combination with phentermine.

It is taken by mouth.

Use in pregnancy may result in harm to the baby and use during breastfeeding is not recommended.

Bioavailability 80%

Protein binding 13–17%; 15–41%


Liver (20–30%)

Elimination half-life 21 hours

Excretion Urine (70–80%)

5% or more of patients experience confusion, dizziness, ataxia, impaired concentration, paresthesias, somnolence and emotional lability.

Common side effects include tingling, loss of appetite, feeling tired, abdominal pain, weight loss,[8] and decreased cognitive function such as trouble concentrating.

Serious side effects may include suicide, increased ammonia levels resulting in encephalopathy, and kidney stones.

An effective antiepileptic agent.

In children, it is indicated for the treatment of Lennox-Gastaut syndrome, a disorder that causes seizures and developmental delay. 

Effective preventative for migraine.

It was most frequently prescribed for the prevention of migraines as it decreases the frequency of attacks.

Reduces appetite and helps with weight loss.

Maybe beneficial in cocaine dependence.

Efficacious in the treatment of alcohol dependence.

Topiramate is used to treat medication overuse headache.

Other uses include treatment of obesity, binge eating disorder, and off-setting weight gain induced by taking antipsychotic medications.

It is used in the combination of phentermine/topiramate for weight loss.

Associated with cognitive impairment, sedation, renal acidosis and kidneys stones from carbonic anhydrase inhibition.

Increased risk of fetal cleft palate defects.

Topiramate may impair heat regulation, especially in children.


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