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topiramate

Generic name: Topiramate

Available as: Topiramate: tablets 25mg, 50mg, 100mg, 200mg, capsules 15mg, 25mg, 50mg.
​Topamax: tablets 25mg, 50mg, 100mg, 200mg, sprinkle capsules 15mg, 25mg, 50mg.

Adults

Average total daily dose: Taken alone: 100mg daily (up to 18 years) or 100 – 200mg daily (over 18 years). Taken with other AEDs: 5 – 9mg/kg daily (up to 18 years) or 200 – 400mg daily (over 18 years). All divided into 2 doses.

Doses per day: 2

Treatment: Used for focal seizures with or without secondary generalisation and tonic clonic seizures, where other treatment has not worked. Topiramate has a licence for monotherapy but is not widely used as a first line drug

Most common possible side effects include the following. Report severe reactions, such as a skin rash, to your doctor.
Rash. Nausea, diarrhoea, vomiting, constipation, indigestion, abdominal pain, dry mouth, appetite changes, impaired attention, cognition and coordination, movement problems, tremor, drowsiness, dizziness, anxiety, confusion, mood changes, depression, irritability, and anaemia.

Children

Average total daily dose: Monotherapy (from 6 years): 50mg twice daily up to 250mg twice daily. Add-on therapy (from 2 years): 2.5 – 4.5mg/kg twice daily up to 200mg twice daily.

Doses per day: 2

Treatment: Monotherapy for generalised tonic clonic seizures or focal seizures with or without secondary generalisation. Add-on therapy for generalised tonic clonic seizures or focal seizures with or without secondary generalisation and for Lennox-Gastaut syndrome.

Most common possible side effects include the following. Report severe reactions, such as a skin rash, to your doctor.
Headache, drowsiness, dizziness, weight loss and pins and needles. Slowed thought and speech may occur. Some cases of eye problems have been reported within one month of starting treatment.

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Please note:

  • This information is a guide only, and lists the usual daily doses of anti-epileptic drugs (AEDs). The dose taken may be different to those listed above.

  • Treatment of neonatal seizures (from birth to 28 days of age) is not covered.

  • Most doses are listed as ‘mg/kg’: this means milligrams of AED per kg of the child’s weight.

  • Children starting AED treatment at the age of 12 may start on adult doses. Some AEDs are only used for children aged 12 and over (including eslicarbazepine acetate, lacosamide, perampanel, pregabalin, retigabine and tiagabine).

  • Some AED doses are listed as ‘twice daily’ (for example ‘5mg/kg twice daily’). This means that the dose listed is taken each time (and so the total daily dose will be double that listed).

  • Some AED doses are listed as ‘divided into 2 (or 3) doses’ (for example ‘25 - 30mg/kg daily divided into 2 doses’). This means that the total amount listed is divided into two to give the dose taken each time.

  • ‘Effective’ means the seizures it works for. ‘Monotherapy’ means the AED is taken on its own. ‘Add-on therapy’ means the AED is taken alongside other AEDs. ‘Tolerance’ means that a drug becomes less effective the longer you take it.

  • Information for this page comes from sources including the British National Formulary (BNF), the British National Formulary for children (BNFC) and the electronic medicines Compendium (eMC). The side effects listed here are some of the most common possible side effects and may be worded differently in the patient information leaflet for the AED. Doctors may refer to the BNF/BNFC for starting doses and how to increase doses. For more details, and a complete list of side effects, visit medicines.org.uk/emc(opens new window).

  • Every effort is made to ensure that all information is correct at time of publishing but information may change after publication. This information is not a substitute for advice from your doctor. Epilepsy Society is not responsible for any actions taken as a result of using this information.