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Topamax (Topiramate)

by Teri Robert, MyMigraineConnection Lead Expert

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Topiramate is a neuronal stabilizing agent (aka anticonvulsant medication) that has proven effective as a Migraine preventive for some patients. It is one of only a few medications to have been approved by the FDA for Migraine prevention. As with other drugs in this category, patients should start at a low dosage and slowly taper up to therapeutic levels. The daily dose should be taken in two divides doses approximately 12 hours apart. If discontinuing this medication, it is essential to slowly taper off rather than discontinuing abruptly.

 

Type of medication: Rx, preventive, neuronal stabilizing agent (anticonvulsant )

 

Special Notes:

  • At the Migraine Trust's 14th biennial International Research Symposium, noted Migraine specialist Dr. Stephen Silberstein noted:
    • The best results were achieved at a dosage of 100 or 200 milligrams of topiramate per day, a lower dosage than that used to treat epilepsy.
    • The most commonly experience side effects were nausea and tingling of the extremities.
    • "What was amazing in this trial was the effect on weight. The patients who got topiramate lost, on average, 3.8 percent of their body weight."
  • In an interview with Teri Robert, Dr. Silberstein elaborated:
    • "The key to success with Topamax is a very slow titration up to the therapeutic dose. Patients should begin taking only 15 mg, once a day, and taper up slowly from there, being sure to take it in a split dose."
    • "The effective dosages are lower than you might think. Many patients achieve good results at only 50 mg per day."

 

Precautions:

·         Seek immediate medical attention if you experience blurred vision, changes in vision, or pain in or around the eyes during treatment with topiramate. These may be early signs of a serious side effect.

·         Do not stop taking topiramate without first talking to your doctor, even if your symptoms have improved. It is important to continue taking topiramate to prevent seizures from recurring.

·         Carry or wear a medical identification tag to let others know that you are taking topiramate in the case of an emergency.

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