Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Birth control: Topiramate has been shown to affect birth control pills that contain low doses of estrogen. If you are a woman taking birth control pills you should receive a preparation containing not less than 30 µg of estrogen and report any changes in bleeding patterns to your doctor.
Drowsiness/reduced alertness: Topiramate can cause difficulty with concentration, speech or language problems, and drowsiness or fatigue. If you are taking this medication you should not drive or operate machinery until you have had a chance to see if it affects your mental or physical performance.
Heat regulation: For some people, especially children, topiramate may cause decreased sweating and increased body temperature. Let your doctor know if you or a child taking this medication experiences these symptoms. Proper hydration during exposure to warm temperatures, as well as before and during exercise, is recommended.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney stones: Approximately 1.5% of people taking topiramate develop kidney stones. Men seem to be at greater risk for this. Be sure to drink plenty of fluids while taking this medication in order to reduce the risk of kidney stone formation. If you experience pain in the kidney or flank areas, contact your doctor to have this investigated.
Laboratory tests: Topiramate may decrease sodium bicarbonate levels and lead to metabolic acidosis. If you experience shallow, rapid breathing, unusual tiredness and loss of appetite, contact your doctor. Sodium bicarbonate levels should be monitored by your doctor with blood tests, while you are taking topiramate.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.
Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.
Stopping treatment: Topiramate should be stopped gradually to decrease the risk of seizures. If it is necessary to stop taking topiramate, discuss with your doctor the best way to reduce your dose gradually. Do not stop taking this medication without talking to your doctor.
Vision changes: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you are taking topiramate you should immediately report blurred vision or painful and red eyes to a doctor. If left untreated, these symptoms can lead to permanent vision loss.
Pregnancy: Topiramate may cause harm to the developing baby if it is taken by a woman while she is pregnant. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and taking topiramate, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: Topiramate can be used in children aged 2 and older for seizures. The safety and effectiveness of using this medication have not been established for children under the age of 2. The safety and effectiveness of using this medication to prevent migraine headaches has not been established for children less than 18 years of age.