Topamax Side Effects

by on June 26, 2012


Commonly prescribed to prevent seizures in both children and adults, Topamax (Topiramate) has the potential to treat a variety of conditions but also poses the risk of a number of possible side effects. Many individuals experience slowed reactions, impaired thinking, and blurred vision while taking this medication so don’t drive or participate in activities that require alertness until you know which Topamax side effects may affect you.

Common Topamax Side Effects

Many people experience mild side effects when they take Topamax. Usually, the symptoms will subside but some individuals seek alternative treatment methods because the side effects of topiramate outweigh the benefits the medication can provide. Contact your doctor if any of these symptoms are bothersome or persist for several days:

  • Numbness or tingling in the extremities
  • Mild dizziness
  • Delayed reactions
  • Inability to focus
  • Irritability
  • Aggressive behavior
  • Headache
  • Word finding difficulties
  • Short term memory loss
  • Confusion
  • Fatigue
  • Nausea
  • Loss of appetite
  • Weight loss
  • Constipation
  • Diarrhea
  • Heartburn
  • Loss of coordination
  • Uncontrollable eye movements
  • Changes in mood or depression
  • Unexplained tremors or shaking
  • Excessive thirst
  • Irregular or missed menstrual cycles
  • Heavy menstrual bleeding
  • Painful or difficult urination
  • Hair loss
  • Changes in skin tone
  • Sleep difficulties
  • Pain in the muscles, back, or bones
  • Dry mouth
  • Swelling in the tongue, hands, arms, feet, ankles, or legs

Other common Topamax side effects include kidney stones and anhidrosis, which is the inability to sweat normally and can lead to overheating. Young children who take Topamax should avoid long periods of physical activity during warm weather and all topiramate users should drink plenty of water.

Serious Topamax Side Effects

A small portion of patients will experience more serious side effects of Topamax during their treatment. If you have any of the symptoms below, call your doctor immediately:

  • Blurred or double vision
  • Pain in the eyes
  • Severe nausea or vomiting
  • More frequent or intense seizures
  • Irregular, fast, or pounding heartbeat
  • Abnormally slow heart rate
  • Excessive fatigue
  • Abdominal pain or cramps
  • Unresponsiveness
  • Chest pain
  • Breathing difficulties or shallow breathing
  • Sharp or severe pain in the back or side
  • Fever
  • Chills
  • Prolonged loss of appetite
  • Cloudy or smelly urine
  • Blood in the urine
  • Constant or frequent urge to urinate

Topamax can also affect bone health in some patients, increasing the risk of broken bones in adult users and causing rickets, or curved bones, in children.


A FDA pregnancy category D drug, Topamax is not recommended during pregnancy. Studies have shown that the use of Topamax during pregnancy increases the chances of babies developing cleft lip or cleft palate in the womb. In some cases, this risk may be worth the seizure control that Topamax can offer. If you are pregnant or plan to become pregnant and suffer from seizures, discuss the safest treatment options with your doctor. Also remember that Topamax can decrease the effectiveness of hormonal contraceptives. If you become pregnant while taking this medication, contact your physician immediately.

Mental Health

A small percentage of Topamax users experience serious changes in their mental wellbeing. If you experience any unusual thoughts or behaviors, extreme mood changes, anxiety, panic attacks, violent behavior, or abnormal excitement, contact your doctor to discuss your symptoms. If the side effects are not too severe, the treatment benefits of Topamax may still be worth the risk.

About 0.2% of Topamax users develop suicidal thoughts or actions. In some reports, these serious side effects surfaced after just a week of treatment. Seek professional help immediately if you think about, plan, or try to harm yourself.


Because of the high risk of developing kidney stones while taking Topamax, it is extremely important to drink six to eight glasses of water each day. Ketogenic diet plans that are often recommended to control epileptic seizures can further increase the chance of kidney stones. High fat, low carb diets like these and the Atkins diet are not the best choice for Topamax users. Discuss a sensible diet plan with your doctor before starting the medication. Keep an eye on your weight during your treatment and report any changes to your physician.

Other Medications

Some medications can alter the effectiveness or intensify the side effects of Topamax. Be sure that your doctor is aware of all other medicines - prescription or over the counter - vitamins, and dietary supplements that you take regularly. It is especially important to discuss the risks of taking the drugs below while taking Topamax:

  • Other seizure medications, such as Dilantin, Tegretol, Depakote, etc.
  • Lithium
  • Bronchodilators, including Atrovent and Spiriva
  • Metformin for diabetes treatment
  • Medications to treat bladder or urinary disorders like Enablex, Vesicare, etc.
  • Enzyme inducers such as carbamazepine
  • Glaucoma medications like Diamox or and Neptazane
  • Evening primrose
  • Hormonal contraceptives, including pills, patches, implants such as Yaz, Yasmin and Seasonique.

Drowsiness and other side effects that may alter the mental state or alertness of the user can be worsened when Topamax is taken in combination with certain drugs. Discuss the use of the following substances with your doctor before taking topiramate:

  • Cold and allergy medications, particularly antihistamines
  • Sedatives and sleeping pills
  • Narcotic pain relievers and muscle relaxers
  • Antidepressants and medications for mental disorders and anxiety
  • Alcoholic beverages

Topamax is not the right medication for everyone, but can be an effective treatment for many people who suffer from severe migraines, life threatening seizures, or mental disorders like bipolar. Discuss the risks of topiramate side effects with your doctor, as well as other treatment options, to decide on the best medications for your condition and lifestyle.