Topiramate is a seizure medicine, also called an anticonvulsant. Topiramate is used to treat certain types of seizures in adults and children who are at least 2 years old. Trokendi XR is for use in adults and children who are at least 6 years old.

Some brands of topiramate are also used to prevent migraine headaches in adults and teenagers who are at least 12 years old. These medicines will only prevent migraine headaches or reduce the number of attacks, but will not treat a headache that has already begun.

Topiramate may also be used for purposes not listed in this medication guide.

Topiramate may cause vision problems that can be permanent if not treated quickly. Call your doctor right away if you have a sudden decrease in vision.

Topiramate can increase body temperature and decrease sweating, which may lead to life-threatening dehydration. Tell your doctor if you have decreased sweating, high fever, and hot dry skin.

Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

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.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with topiramate and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs) or the manufacturer's website to obtain the Medication Guide.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Topiramate can be taken with or without food.

Swallow the tablet whole and do not crush, chew, or break it. The Trokendi XR extended-release capsule must be swallowed whole. Do not break or open.

Measure liquid medicine with the supplied measuring device (not a kitchen spoon).

If you cannot swallow a Qudexy XR or Topamax Sprinkle Capsule whole, open it and sprinkle the medicine into a spoonful of applesauce or other soft food. Swallow the mixture right away without chewing. Do not save it for later use.

Carefully follow the swallowing instructions for your medicine.

Topiramate doses are sometimes based on weight in children. Your child's dose needs may change if the child gains or loses weight.

Drink plenty of liquids while you are taking topiramate, to prevent kidney stones or an electrolyte imbalance.

You will need frequent medical tests. If you need surgery, tell the surgeon ahead of time that you are using topiramate. Any medical care provider who treats you should know that you take seizure medication.

Do not stop using topiramate suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose.

Call your doctor if your seizures get worse or you have them more often while taking topiramate.

Store at cool room temperature away from moisture, light, and high heat. Throw away any unused liquid medicine 60 days after opening the bottle.

You should not use topiramate if you are allergic to it. Do not take Trokendi XR within 6 hours before or 6 hours after drinking alcohol.

Tell your doctor if you are sick with diarrhea, or if you have ever had:

• glaucoma or other eye problems;

• metabolic acidosis (high levels of acid in your blood);

• kidney disease, kidney stones, or dialysis;

• lung disease, breathing problems;

• mood problems, depression, or suicidal thoughts or actions;

• liver disease;

• a growth disorder; or

• soft or brittle bones (osteoporosis, osteomalacia).

Topiramate can increase the level of acid in your blood (metabolic acidosis). This can weaken your bones, cause kidney stones, or cause growth problems in children or harm to an unborn baby. You may need blood tests to make sure you do not have metabolic acidosis, especially if you are pregnant.

Some people have thoughts about suicide while taking an anticonvulsant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Taking topiramate during pregnancy may increase the risk of cleft lip and/or cleft palate, a birth defect that can develop early in pregnancy even before you know you are pregnant. However, having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant.

If you take topiramate during pregnancy: The benefit of preventing seizures may outweigh any risks posed by topiramate. There may be other medications that are safer to use. Do not start or stop taking topiramate without your doctor's advice.

If you are not pregnant or planning to become pregnant, use effective birth control to prevent pregnancy while taking topiramate.

Topiramate can make birth control pills less effective. Ask your doctor about other birth control options such as an injection, implant, skin patch, vaginal ring, condom, diaphragm, cervical cap, or contraceptive sponge.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of topiramate on the baby.

It may not be safe to breastfeed a baby while you are using this medicine. Ask your doctor about any risks.

Take the medicine as soon as you can. Do not take two doses at one time. Skip a missed Topamax dose if your next dose is due in less than 6 hours. Call your doctor if you have missed more than one dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of topiramate can be fatal.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Tablets, extended-release capsules and solution should be stored at room temperature and away from excess heat and moisture (not in the bathroom). Sprinkle capsules should be stored at or below 77°F (25°C) and not in the bathroom. Never store mixtures of topiramate sprinkles and soft food. These should be used right away or discarded. Dispose of any unused solution 60 days after first opening the bottle.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Talk to your doctor before changing your diet or beginning any type of weight loss program. Do not follow a ketogenic diet (a high-fat, low-carbohydrate diet used to control seizures) or any other high-fat, low-carbohydrate diet while you are taking this medication.

Do not drink alcohol. Dangerous side effects or increased seizures may occur.

Avoid becoming overheated or dehydrated in hot weather. Topiramate can increase body temperature and decrease sweating, leading to life-threatening dehydration (especially in children).

Avoid the use of a ketogenic or "ketosis" diet (high in fat, low in carbohydrates) while you are taking topiramate.

Topiramate may cause blurred vision and may impair your reactions. Avoid driving or hazardous activity until you know how topiramate will affect you.

Also avoid activities that could be dangerous if you have an unexpected seizure, such as swimming or climbing in high places.

Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Tell your doctor right away if you have new or sudden changes in mood or behavior, including new or worse depression or anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, more active or talkative, or have thoughts about suicide or hurting yourself.

Topiramate may cause serious side effects. Call your doctor at once if you have:

• a skin rash, no matter how mild;

• dizziness or loss of coordination;

• vision problems, blurred vision, eye pain or redness, sudden vision loss (can be permanent if not treated quickly);

• confusion, problems with thinking or memory, trouble concentrating, problems with speech;

• dehydration symptoms--decreased sweating, high fever, hot and dry skin;

• signs of a kidney stone--severe pain in your side or lower back, painful or difficult urination;

• signs of too much acid in your blood--irregular heartbeats, feeling tired, loss of appetite, trouble thinking, feeling short of breath; or

• signs of too much ammonia in your blood--vomiting, unexplained weakness, feeling like you might pass out.

Common side effects of topiramate may include:

• dizziness, drowsiness, tiredness, slow reactions;

• problems with speech or memory, abnormal vision;

• numbness or tingling in your arms and legs, decreased sensation (especially in the skin);

• changes in your sense of taste, feeling nervous;

• nausea, diarrhea, stomach pain, loss of appetite;

• fever, weight loss; or

• cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Using topiramate with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or depression.

Tell your doctor about all your other medicines, especially:

• zonisamide;

• birth control pills;

• divalproex, valproic acid; or

• other glaucoma medications, including eye drops.

This list is not complete. Other drugs may affect topiramate, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to topiramate.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.