Topamax (topiramate) originally had an indication for treatment of epilepsy but it was approved in the Fall of 2004 for preventive treatment of migraine also.  Two long acting versions of topiramate came out as Trokendia XR and Qudexy XR which both have indications for treating epilepsy and migraine.

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.

Topiramate—Preventive Treatment For Migraine Headache Symptoms?  The American Academy of Neurology current update for pharmacologic treatment for migraine prevention for adults states that “topiramate is established as effective and should be offered for migraine prevention (Level A).”

Available dose sizes of topiramate.

Topamax (topiramate) comes as a sprinkle cap 15 and 25 mg, and as a TAB 25, 50, 100, 200 mg.

Trokendia XR and Qudexy XR come as extended release ER Cap 50, 100, 200 mg.

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How to Dose.

The suggested maintenance daily dose for adults is 100 mg.  Topamax, Trokendia XR, and Qudexy XR should all be tapered up to 100 mg starting at 25 mg per week and adjusting the dose up by 25 mg/week till 100 mg is reached.

Topamax (topiramate) should be taken every 12 hours, while Trokendia XR and Qudexy XR may bd dosed 1/day.

For migraine prevention it is suggested that all patients stay on the 100 mg daily dose for 4-6 weeks to judge treatment affect on migraine before discontinuing the drug.

The maximal dose for migraine is 200 mg/day.

Some special migraineurs are really sensitive to Topiramate, but it may be effective a low dose such as 25 mg a day. At this low dose the side effects of slowing and somnolence are usually minimal or may disappear with prolonged use.

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Side effects.

The American FDA lists possible side effects of psychomotor slowing, somnolence, word finding difficulty, numbness, weight loss, insomnia, anxiety, decreased sweating and hyperthermia, secondary angle closure glaucoma, kidney stones-especially in men, possible birth defects, and metabolic acidosis. 

A large European study couldn’t confirm topiramate risk for causing kidney stones, but it is still on the PI (product information) note from the FDA.

My experience is that women especially prefer topiramate, if they can tolerate it, because of the chance of possible weight loss. 

The most common starter symptoms are paresthesiaes which means numbness and tingling of distal hands and feet.  This usually goes away after several months.

Topiramate can also cause a strange symptom that soda fountain drinks like Coke taste flat.

Word finding difficulty and trouble with memory have earned topiramate the lay name, “Dopamax.”  This can be very troublesome but is a dose related side effect.  Many times, just dropping the daily dose from 100 mg to 75 mg helps a lot.  However, there may be a decrease in migraine prevention effectiveness also when the dose is decreased.

Topamax (topiramate) which is given twice a day, like 50 mg at 7 A.M. and 50 mg at 7 P.M. in general has more of the above listed side effects than either Trokendia XR or Qudexy XR which are long acting drugs.

Topamax (topiramate) may go above and below the high and low limits of blood concentration as measured by drawing a blood level.  Trokendia XR and Qudexy XR doses stay in the middle of the high/low blood level concentration, thus causing fewer side effects.

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Effectiveness.

Topiramate in the various formulations can effective reduce migraine about 30-40%.

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Other uses of topiramate.

Current FDA indications are for epilepsy and for migraine.

It is one of the secondary drugs that may be used for treatment of benign essential or familial tremor.  It is also used for treatment of bipolar disorder.

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All the best.

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Britt Talley Daniel MD