Topamax can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Topamax. These lists do not include all possible side effects.
For more information about the possible side effects of Topamax, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.
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Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Topamax, you can do so through MedWatch.
Mild side effects
Mild side effects* of Topamax can include:
- feeling of pins and needles or tingling
- sleepiness
- fatigue
- loss of appetite
- weight loss**
- speech problems, such as slurred speech
- slow reactions†
- trouble remembering or concentrating†
- dizziness†
- change in the way things taste
- nausea
- abdominal pain
- insomnia
- fever
- hair loss‡
These side effects may go away within a few days or a couple of weeks. However, if they become more severe or don’t go away, talk with your doctor or pharmacist.
* This is a partial list of mild side effects from Topamax. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Topamax’s prescribing information. ** For more information on this side effect, see the “Topamax for weight loss” section below. † This side effect could affect your ability to safely drive or use machines. You shouldn’t drive or use dangerous machines until you know how Topamax affects you. ‡ For more information about this side effect, see “Side effect details” below.
Serious side effects
Serious side effects from Topamax aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.
Serious side effects and their symptoms can include:
- Hyperthermia (high body temperature) and reduced sweating. Symptoms can include:
- fever
- not sweating in hot weather
- flushing
- Metabolic acidosis (high level of acid in your blood). Symptoms can include:
- rapid breathing
- fatigue
- loss of appetite
- confusion
- fast or irregular heart rate or rhythm
- Hyperammonemia (high level of ammonia in your blood), which may not cause symptoms in some people. Symptoms can include:
- feeling tired
- feeling less alert than usual
- vomiting
- rapid breathing
- Serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Symptoms can include:
- severe, widespread skin rash
- skin peeling
- skin blistering
- Personality or mood changes, including depression and suicidal thoughts or actions.*
- Kidney stones.*
- Allergic reaction.*
- Eye side effects, such as changes in your vision, glaucoma, or vision loss.*
* For more information about this side effect, see “Side effect details” below.
Side effects in children
Topamax is approved for treating certain types of seizures in children ages 2 years and older. It’s also approved for preventing migraine headaches in children ages 12 years and older. (To learn more about the uses of Topamax, see the “Topamax uses” section below.)
Side effects of Topamax in children are similar to those in adults. These side effects are described above and in “Side effect details” below.
One clinical trial looked at children ages 6 years and older who took Topamax alone for epilepsy. The most common side effects were:
- fever
- weight loss
- respiratory infections, such as colds
In other clinical trials, children ages 2 to 15 years took Topamax with other medications for epilepsy. The most common side effects in these studies were:
- fatigue
- sleepiness
- loss of appetite
In clinical trials involving children ages 12 years and older who took Topamax for migraine, the most common side effects were:
- feeling of pins and needles or tingling
- loss of appetite
- abdominal pain
- respiratory infections, such as colds
Children who take Topamax are less likely than adults to have speech problems, slow reactions, and trouble concentrating.
Serious side effect in children
One possibly serious side effect is more common in children than in adults. Children taking Topamax are more likely than adults to have fever and reduced sweating. These problems can lead to hyperthermia (high body temperature), which may need treatment in a hospital.
It’s important to monitor your child in hot weather. If they sweat less than usual or develop a high temperature, call your doctor for advice. A high temperature for children ages 2 years and older is one that’s above 99.5°F (37.5°C) when taken orally.
Additionally, children taking Topamax may have reduced bone mineral density (BMD). This is a measure of bone strength. Decreased BMD could indicate weakened bones.
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Children taking Topamax may also have reduced growth, affecting their weight and height. Doctors will monitor growth in children who take Topamax.
Side effect details
You may wonder how often certain side effects occur with this drug or whether certain side effects pertain to it. Here’s some detail on certain side effects this drug may or may not cause.
Allergic reaction
As with most drugs, some people can have an allergic reaction after taking Topamax. However, it isn’t known how often this side effect may have occurred in clinical trials.
Symptoms of a mild allergic reaction can include:
- skin rash
- itchiness
- flushing
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:
- swelling under your skin, typically in your eyelids, lips, hands, or feet
- swelling of your tongue, mouth, or throat
- trouble breathing
Call your doctor right away if you have an allergic reaction to Topamax, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.
Hair loss
Some people may have hair loss or hair thinning while taking Topamax.
In one clinical trial, hair loss was reported in 3% to 4% of people ages 16 years and older who took Topamax alone for epilepsy. It’s not known how often this side effect may have occurred in people who took a placebo. Hair loss wasn’t reported in people who took Topamax for migraine.
If you’re concerned about hair loss with Topamax, talk with your doctor. They may be able to suggest ways to help manage this side effect or suggest other treatment options.
Kidney stones
Topamax can raise the risk of developing kidney stones. In clinical trials, kidney stones were reported in an average of 1.5% of adults who took Topamax for epilepsy, depending on the dose.
Topamax was compared with a placebo in some studies. It’s not known how many people experienced kidney stones. However, people treated with Topamax had 2 to 4 times more kidney stones than people in the general population.
It’s not known how many people who took Topamax for migraine may have had kidney stones during clinical trials.
Kidney stones were also reported in children taking Topamax for epilepsy or migraine, though it’s not known how often this occurred.
Symptoms of kidney stones
Symptoms of kidney stones can include:
- pain in your back or abdomen
- burning feeling or pain when urinating
- blood in your urine, which may turn your urine pink, red, or brown
- nausea or vomiting
- fever
If you have any of these symptoms while taking Topamax, call your doctor right away. You may need treatment to help your body get rid of any kidney stones.
During Topamax treatment
It’s important to drink plenty of fluids while you take Topamax. This can reduce your risk for developing kidney stones.
While taking Topamax, you’ll also have tests to check the level of acid in your blood. Kidney stones can be a sign that you have metabolic acidosis (a high level of acid in your blood).
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If you have metabolic acidosis, your doctor may lower your Topamax dose. If this doesn’t help, you may need to switch to a different treatment.
Eye side effects
Topamax may cause eye side effects. These may include vision changes, such as decreased or blurry vision, and secondary closed-angle glaucoma (sudden raised pressure in your eye). Glaucoma can lead to permanent blindness if not treated.
In clinical trials of people ages 16 years and older, they were given either Topamax or a placebo. This was in addition to one or two other epilepsy drugs. Abnormal vision, such as blurry vision, occurred in:
- 13% of people in the Topamax group
- 2% of people in the placebo group
In clinical trials of adults with migraine, they were given 50 milligrams (mg) or 100 mg of Topamax, or a placebo. Blurry vision occurred in:
- 4% of adults who used 50 mg of Topamax
- 2% of adults who used 100 mg of Topamax
- 2% of adults who used a placebo
It’s not known how often glaucoma occurs with Topamax. Eye side effects typically occur within the first month of Topamax treatment.
Symptoms of eye side effects
Symptoms of eye side effects can include:
- sudden decrease in vision
- blurry vision
- eye pain
- eye redness
- dilated pupils
If you have symptoms of eye side effects while taking Topamax, talk with your doctor. They may refer you to an eye specialist, who can check the pressure in your eyes. If you have glaucoma, you may need treatment for it. However, eye side effects usually get better after you stop taking Topamax.
If you have eye side effects, your doctor will typically recommend that you stop taking Topamax and switch to a different treatment. Ideally, Topamax should be stopped gradually. Your doctor will explain how to do this. To read more about stopping Topamax treatment, see the “Topamax withdrawal and dependence” section below.
Personality or mood changes
Topamax can sometimes cause personality changes that affect the way people behave, react, feel, or interact with others. For example, the drug may cause agitation, aggression, or other behavior problems. Topamax may also cause mood changes, such as anxiety, mood swings, and depression. In addition, the medication may raise your risk for suicidal thoughts or behaviors.
All antiepileptic drugs (medications used to treat seizures due to epilepsy) are known to slightly raise the risk of suicidal thoughts and behaviors. (Antiepileptic drugs are also called anticonvulsants.) These drugs can increase the risk regardless of what condition they’re treating.
Clinical trials looked at people taking an antiepileptic drug for any condition. The people had about twice the risk of suicidal thoughts or behaviors than people taking a placebo. In these studies, suicidal behavior or thoughts occurred in:
- 0.43% of people taking an antiepileptic
- 0.24% of people taking a placebo
Symptoms of depression
It’s important for you, your friends, and your family to watch for symptoms of depression while you take Topamax. These symptoms can include:
- having thoughts about suicide or harming yourself
- feeling sad or hopeless
- having trouble sleeping
- losing interest in usual activities
- feeling agitated or restless
- feeling anxious or having panic attacks
- being irritable, aggressive, or violent
- having other changes in your mood or behavior
If you have any symptoms of new or worsening depression while taking Topamax, talk with your doctor right away. They can suggest ways to ease this condition. They may also recommend that you switch to a different medication.
If you need to stop taking Topamax, your doctor will explain how to taper off the drug gradually. To read more about stopping Topamax treatment, see the “Topamax withdrawal and dependence” section below.
Weight gain (not a side effect)
Topamax isn’t known to cause weight gain. This side effect wasn’t reported in clinical trials with Topamax. However, weight gain has been reported with some anticonvulsant drugs that are in the same class as Topamax.
Topamax can cause weight loss. To read more about this, see the “Topamax for weight loss” section below.
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