This is a question that we recently encountered online. Since it’s a common question, we felt it appropriate to answer it here as well.
I’ve been taking Topamax for migraine prevention. Started at 25 mg per day and tapered up by adding 25 mg per week until I got to 100 mg twice a day. I started having symptoms of kidney stones. The results aren’t back yet, but my doctor told me to cut the Topamax dosage to 50 mg twice a day, then to nothing. Is this safe? April.
The prescribing information for topiramate (Topamax) says:
“In patients with or without a history of seizures or epilepsy, antiepileptic drugs, including TOPAMAX®, should be gradually withdrawn to minimize the potential for seizures or increased seizure frequency [see Clinical Studies (14)]. In situations where rapid withdrawal of TOPAMAX® is medically required, appropriate monitoring is recommended.”
This is a wise precaution, and under “normal” circumstances, we would expect to taper down the dosage by 25 mg per week until the patient gets down to the last 25 mg, then stop. When starting topiramate, we’d expect to taper up by 25 mg per day as well.
That said, there are sometimes sound medical reasons for discontinuing topiramate more quickly. In patients with no history of seizures, quickly discontinuing topiramate under your doctor’s supervision is usually safe. Of course, we can’t say that it’s safe specifically for you, or any individual. That answer would need to come from each person’s own physician.
Thank you for your question,
Dave Watson and Teri Robert!
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© David Watson and Teri Robert, 2017.
Dr. David Watson is a UCNS certified migraine and headache specialist and the director of the West Virginia University Headache Center. Dr. Watson takes a special interest in migraines, cluster headaches, and tension-type headaches. He strives to stay up-to-date on current research and treatments and regularly attends continuing medical education conferences. “Dr. Dave” is also very active in the migraine community, taking part in and leading advocacy efforts to benefit the entire community. He is the founder and chairman of the board of Runnin’ for Research, a nonprofit organization that helps interested patients and doctors set up races in their areas to raise research funding for headache disorders. He’s also a regular participant in the Alliance for Headache Disorders Advocacy’s “Headache on the Hill” event and is co-secretary of the American Headache and Migraine Association. You can follow Dr. Watson on Twitter.
Teri Robert is a leading patient educator and advocate in the area of migraine and other headache disorders, and has been writing for the HealthCentral migraine site since 2007. She is a co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association. She received the National Headache Foundation’s Patient Partners Award for “ongoing patient education, support, and advocacy,” in 2004 and a Distinguished Service Award from the American Headache Society in 2013. You can find links to Teri’s work on her web site and blog and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.
Do you have questions about Migraine? Reader questions are answered by UCNS certified Migraine and headache specialist Dr. David Watson, and award-winning patient educator and advocate Teri Robert. Questions may be submitted via our submission form. Accepted questions will be answered by publishing the answers in our Ask the Clinician column. For an overview of how we can help and questions we can and can’t answer, please see Seeking Migraine and Headache Diagnoses and Medical Advice.