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with or without a history of seizures or epilepsy, antiepileptic drugs, including TOPAMAX®, should be gradually withdrawn to minimize the potential for seizures or increased seizure frequency [see Clinical Studies (14)].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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Questions submitted to our Ask the Clinician column are answered by Dr. David Watson and Teri Robert.
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