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Topiramate for epilepsy


Important information about all medicines

Clinical author's note: Michael Stewart 25/06/2024: the Medicines and Healthcare products Regulatory Agency (MHRA) has introduced new pregnancy safety measures for women and girls needing treatment with topiramate (Topamax®).

Due to an increased risk of birth defects you should not become pregnant whilst taking topiramate. A pregnancy test will be required before your doctor will start treatment with this medicine. Women and girls of childbearing potential must use effective contraception during treatment with topiramate. Some types of hormonal contraception are less effective when taking this medicine. Make sure you have discussed with your doctor which types of contraception are suitable.

If you are already taking topiramate for epilepsy and think you may be pregnant, do not stop taking your medication. Epileptic seizures can also harm an unborn baby. Make an appointment to see your doctor as soon as possible.

Speak with your doctor if you are planning to become pregnant or think you may be pregnant whilst taking this medicine.

Take topiramate regularly every day, and drink plenty of water.

If you become depressed or develop any problems with your eyesight, make an appointment to see your doctor straightaway.

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About topiramate

Type of medicine

An antiepileptic medicine

Used for

Epilepsy, prevention of migraine

Also called


Available as

Tablets and Sprinkle® capsules, oral liquid medicine

Topiramate is prescribed alone or alongside other medicines to treat epileptic disease and seizures. It can be taken both by adults and by children.

A seizure is a short episode of symptoms which is caused by a burst of abnormal electrical activity in the brain. Topiramate is thought to work mainly by reducing these abnormal electrical activities.

Before taking topiramate for epilepsy

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking topiramate it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breastfeeding.

  • If you have any problems with the way your liver works, or with the way your kidneys work.

  • If you have a rare inherited blood disorder called porphyria.

  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

  • If you have ever had an allergic reaction to a medicine.

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How to take topiramate

  • Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about topiramate and will provide you with a full list of the side-effects which you may experience from taking it.

  • Take topiramate exactly as your doctor tells you to. It is usual for adults to start topiramate treatment on a low dose (25 mg at night), and then for the dose to be increased gradually to a regular maintenance dose, which is taken twice daily. Doses for children are tailored to their age and weight.

  • Swallow topiramate tablets with a drink of water. Do not chew the tablets as they have a bitter taste. If you have been prescribed capsules, you can swallow the capsules in the normal way with a drink of water or, if you prefer, you can open up the capsule and sprinkle the contents on to a spoonful of some soft food (porridge, yoghurt or custard for example). Do not chew the contents of the capsules.

  • It is important that you drink plenty of water while you are taking topiramate. This is because there is a slight risk that kidney stones can develop and drinking plenty of water reduces this risk.

  • Try to get into a habit of taking topiramate at the same time(s) each day. You can take topiramate before or after food.

  • If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.

Getting the most from your treatment

  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. You may need to have eye tests and weight checks from time to time.

  • When you first start a new treatment for epilepsy there may be a change in the number or type of seizures you experience. Your doctor will advise you about this.

  • Several different manufacturers make topiramate tablets and capsules, and your treatment could be affected by switching between different formulations. Each time you collect a new supply from your pharmacy, check to see if the tablets/capsules are the same as you have had before. If they are different, discuss this with your pharmacist who will advise you.

  • You need to take topiramate every day. Stopping treatment suddenly can cause problems and your doctor may want you to reduce your dose over a few days if this becomes necessary.

  • You must avoid getting pregnant while you are taking topiramate. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner. If you are a woman and want to have a family, make sure you discuss this with your doctor. This is so that you can be given advice from a specialist before you become pregnant.

  • People with epilepsy must stop driving. Your doctor will advise you about when it may be possible for you to start driving again. This will usually be after a year free of seizures.

  • If you buy any medicines, always check with a pharmacist that they are suitable to take with your other medicines.

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Can topiramate cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with topiramate. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common

topiramate side-effects (these affect more than 1 in 10 people)

What can I do if I experience this?

Feeling sick (nausea)

Stick to simple foods - avoid rich or spicy meals

Feeling sleepy, dizzy or tired

If this happens, do not drive and do not use tools or machines


Drink plenty of water to replace lost fluids

Feeling depressed

If this continues, let your doctor know (see also below)

Nose and throat problems, tingling feelings, loss of weight

If any become troublesome, speak with your doctor for advice

Important: topiramate has been associated with a number of serious unwanted effects. Although these occur less commonly than the side-effects listed above, you must let your doctor know straightaway if you notice either of the following:

  • Problems with your eyesight.

  • Mood changes, distressing or depressed thoughts, or feelings about suicide.

If you experience other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

How to store topiramate

  • Keep all medicines out of the reach and sight of children.

  • Store in a cool, dry place, away from direct heat and light.

  • The oral liquid medicine keeps for one month after first opening. After this time make sure you use a new bottle. It is a good idea to write the date you opened the bottle on the label.

Important information about all medicines

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Report side effects to a medicine or vaccine

If you experience side effects, you can report them online through the Yellow Card website.

Further reading and references

Article history

The information on this page is written and peer reviewed by qualified clinicians.

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