Topamax Warnings and Precautions

There is a lot of important information to be aware of before starting a medication like Topamax. For example, Topamax can pose health risks to the fetus if taken during pregnancy. Other warnings and precautions include being aware of potentially dangerous drug interactions, using the drug with caution if you have liver disease, and knowing that the medicine passes through breast milk if you are nursing.

Topamax: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking Topamax® if you have:
  • Kidney disease, such as kidney failure (renal failure)
  • Liver disease, such as liver failure or cirrhosis
  • Kidney stones
  • Glaucoma
  • Severe respiratory conditions
  • Severe diarrhea
  • Any allergies, including allergies to food, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding
  • Following a ketogenic diet.
Make sure to tell your healthcare provider about all other medicines you may be taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Some Precautions and Warnings With Topamax

Some warnings and precautions to be aware of with Topamax include:
  • Topamax can cause a specific type of electrolyte imbalance called metabolic acidosis. This is fairly common with Topamax and can become a problem if it lasts too long or is severe. Signs of metabolic acidosis include rapid breathing, fatigue, loss of appetite, and an irregular heart rhythm (arrhythmia). Metabolic acidosis can increase your risk of kidney stones, rickets, and osteoporosis. Chronic metabolic acidosis in children can stunt their growth. Certain people have a higher risk of developing metabolic acidosis, such as those with kidney disease, diarrhea, surgery, severe respiratory conditions, or people following a ketogenic diet (see Epilepsy Diet). It is recommended that your healthcare provider check your bicarbonate level (which is a measure of metabolic acidosis) before starting Topamax and regularly thereafter, to make sure you are not developing this condition.
  • Topamax can cause glaucoma, a serious condition of the eye. Tell your healthcare provider immediately if you have sudden vision problems, especially if accompanied by eye pain.
  • Topamax can affect the body's ability to cool itself by sweating. Decreased sweating, especially in warm weather or accompanied by a fever, can be dangerous. Tell your healthcare provider if you notice decreased sweating.
  • As with all epilepsy medications, Topamax should be stopped gradually to reduce the risk of increased seizures.
  • Topamax can cause cognitive problems, such as confusion, problems with concentration or attention, memory loss, and speech problems (such as difficulty finding the right words).
  • Topamax can cause psychiatric problems, such as depression, anxiety, hallucinations, paranoia, and suicidal actions or thoughts.
  • Topamax can cause drowsiness and fatigue. Be sure you know exactly how Topamax affects you before you drive or operate heavy machinery.
  • Very rarely, sudden unexplained death has occurred in people taking Topamax for epilepsy. However, this does not seem to be significantly more common than in people who were not taking Topamax.
  • Combining Topamax with valproic acid (Depakene®) or divalproex sodium (Depakote®, Depakote ER®) may increase your risk of increased ammonia levels in your blood, which can cause brain problems. It is not known if Topamax alone can cause this problem. Be sure to tell your healthcare provider if you experience signs of this problem, such as unexplained lethargy, vomiting, and mental problems (such as confusion).
  • Topamax can cause kidney stones. This risk is increased for people taking carbonic anhydrase inhibitors (see Topamax Drug Interactions) or people following a ketogenic diet. It is important to drink plenty of fluids to help prevent kidney stones.
  • One of the most common Topamax side effects is paresthesia (unusual sensations, such as burning, tingling, or pricking).
  • Since Topamax is cleared from the body through the kidneys, people with kidney disease require lower Topamax doses.
  • Since the liver also helps to clear Topamax from the body, Topamax should be used cautiously in people with liver disease.
  • Topamax can interact with other medications (see Topamax Drug Interactions).
  • Topamax is a considered a pregnancy Category D medication. This means that Topamax may cause harm to an unborn baby if it is used during pregnancy. In particular, there is evidence that Topamax taken during early pregnancy may cause cleft lip and/or cleft palate (oral clefts) in babies.

In general, Topamax is not recommended for use during pregnancy, unless the benefits to the pregnant woman clearly outweigh any possible risks to the unborn child. Talk to your healthcare provider about the risks and benefits of using Topamax during pregnancy (see Topamax and Pregnancy for more information)

  • Topamax passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about using Topamax (see Topamax and Breastfeeding for more information).


  • Early evidence suggests that seizure medications, including Topamax, may increase the risk of suicidal thoughts or behaviors (see Seizure Medications and Suicide for more information)
Know the Signs - Concussion Safety

Information on Topamax

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