Topiramate

Topiramate, marketed as Topamax among other names, is an oral medication primarily prescribed for the treatment of epilepsy and the prophylaxis of migraines. For epilepsy, this includes treatment for generalized or focal seizures. It has also been used off-label for alcohol dependence and essential tremor. Common side effects include tingling, feeling tired, loss of appetite, abdominal pain, weight loss, and cognitive dysfunction, such as trouble concentrating. Serious side effects may include suicidal ideation, increased ammonia levels resulting in encephalopathy, and kidney stones. Topiramate can cause birth defects, including cleft lip and palate. Risks and benefits should be carefully discussed with the full treatment team. Topiramate is considered "probably compatible" with lactation and is not contraindicated for breastfeeding, though monitoring of the infant for diarrhea or poor weight gain may be considered. Its mechanism of action is unclear. Topiramate was first synthesized in a search for an oral hypoglycemic agent; however, it received its initial approval as an anticonvulsant in 1996. It is available as a generic medication. In 2023, it was the 71st most commonly prescribed medication in the United States, with more than 9 million prescriptions.