Getting a Prescription
Make an appointment with your doctor. Topamax is only available by prescription, so your doctor must agree to give it to you. When you make the appointment, tell your doctor that you would like to discuss losing weight.
Describe your history of obesity and/or eating disorders. Topamax is generally prescribed off-label to treat obesity, especially for people with eating disorders like binge eating and bulimia nervosa. That said, Topamax is not used as a first-line treatment. Tell your doctor about your history of weight loss. Let them know what other treatments you have tried as well as what has and has not worked for you in the past. Because the side effects can be very serious, you should not take Topamax if you are only looking to shed a few pounds or if you are not seriously struggling with weight loss. There are other, safer options for weight loss. Talk to your doctor for more information. Off-label means that Topamax has not been officially approved as a weight loss drug, but some doctors may still prescribe it to treat the condition.
Inform your doctor about any other conditions you have. Topamax can worsen some medical conditions. Furthermore, you should not start taking Topamax if you are currently pregnant, as it could cause birth defects. To make sure that Topamax is safe, tell your doctor if you currently have or have a history of: Eye problems such as glaucoma Diabetes Metabolic acidosis (high levels of acid in the blood) Liver disease Kidney Osteoporosis or other bone conditions Depression, anxiety, or other mood disorders
Tell your doctor what other medications you are taking. Topamax can decrease the effectiveness of birth control. It may also cause harmful side effects if used in combination with a wide range of medications, including lithium, Xanax, Ambien, and Zyrtec. Let your doctor know about all medications (including over-the-counter medications) you are taking.
Let your doctor determine if Topamax is right for you. Since Topamax is not labeled to be used for weight loss, your doctor may not agree to prescribe you the medication. In this case, listen to your doctor’s advice. If they prescribe you a different medication, take it according to their instructions. Your doctor may prescribe you a pill called Qsymia instead. This contains topiramate, which is the same active ingredient as in Topamax. Unlike Topamax, Qsymia is labeled to be used for weight loss. Your doctor may give you a combination of phentermine and Topamax. Follow your doctor’s instructions to take both of these pills together. Do not shop around for a doctor who will prescribe you Topamax. There are many other treatments for weight loss and eating disorders, such as cognitive behavioral therapy, selective serotonin reuptake inhibitor (SSRI) antidepressants, and low-calorie diets.
Taking Topamax
Read the label to learn how often to take Topamax. The label of the medication will tell you how many pills to take and how many times a day you should take them. In general, you will take one pill twice a day. Topamax (and the generic versions) can be taken with or without food. Taking more than the recommended dose will not help you lose weight, but it can increase your chances of dangerous side effects.
Swallow the pill. If you have trouble swallowing the pill, take a sip of water with it. Do not chew the capsule. If you were given Topamax Sprinkle Capsule, you can open the pill with a fingernail and sprinkle the contents onto a spoonful of applesauce.
Take your medicine as soon as possible if you miss a dose. If you will take the next dose very soon, however, skip the missed dose. It is not a good idea to double up your dose of medication. For example, you might take a dose in the morning at 8 am and a dose at night at 8 pm. If you missed your morning dose and it is noon, go ahead and take the missed dose. If you missed the morning dose and it is 6 pm, skip the missed dose and just take your evening dose.
Eat a healthy, balanced diet to boost weight loss. Topamax may reduce your food cravings, but you will still have more success losing weight if you eat a nutritious diet while on it. Choose a diet that contains fruits, vegetables, lean meats, and whole grains. Avoid processed foods that are high in sugar and saturated or trans fats. To lose weight, you need to burn more calories than you consume. It is considered safe to lose 1 pound (0.45 kg) a week. To do this, you will need to cut 500 calories a day from your diet. Talk to your doctor or a registered dietitian to form a low-calorie diet plan that can help you lose weight. If you have been diagnosed with an eating disorder, talk to your therapist as well to determine if a diet is right for you at this time.
Exercise daily to burn more calories. Just like with diet, exercising while taking Topamax can increase your chances of losing weight. Talk to your doctor to see what type of exercises are safe for you. If you are just starting out, you can do gentle, low-impact exercises like walking, swimming, or using an elliptical. Do at least 20-30 minutes of exercise a day. You can hire a personal trainer at a local gym to a help you exercise. The trainer can help you get on an exercise regimen that will help you lose weight.
Store your medication in a dry, dark place. Topamax should be stored at room temperature. A medicine cabinet or drawer is a good place to keep your Topamax. Just make sure that children and pets cannot get to it.
Reducing the Risk of Side Effects
Visit your doctor for regular blood tests. Topamax can increase the acid in your blood, causing a condition called metabolic acidosis. To make sure that you don’t develop this, your doctor may request that you get blood tests every few weeks. The doctor will draw your blood and test it to make sure that you don’t develop this issue. Symptoms of metabolic acidosis include fatigue, loss of appetite, increased or decreased heart rate, and difficulty thinking. If you do not treat metabolic acidosis, you may develop bone or kidney issues.
Drink 6-8 glasses of water a day to prevent kidney problems. Topamax and other medications containing topiramate can increase your risk of kidney stones. To reduce this risk, drink plenty of water every day. Symptoms of a kidney stone include pain in the lower sides of your abdomen, pink or red urine, nausea, frequent urination, and a persistent need to urinate. Talk to your doctor immediately if you have these issues.
Stop drinking alcohol. Drinking alcohol while on Topamax can cause dizziness, sleepiness, and other potentially dangerous symptoms. While you are on Topamax, you should not drink any alcohol, just to be safe.
Tell your doctor if you experience any side effects. Topamax can cause a wide range of symptoms. Common side effects include dizziness, fever, diarrhea, a burning sensation in the mouth, and loss of muscle coordination. You may also move and think more slowly. More serious side effects include: Blurry vision Decreased or lack of sweating Panic attacks or increased anxiety Concentration or memory problems Muscle tremors Body temperature under 95 °F (35 °C)
Call for help if you experience suicidal thoughts. Topamax can cause people to have thoughts of suicide, even if they were not depressed before. If you feel depressed or if you start to think about suicide, tell your doctor. If you are experiencing a crisis, call a suicide hotline, such as: 988 Suicide and Crisis Lifeline (US): 988 (you can also text this number) Crisis Services Canada: 1-833-456-4566 Samaritans (UK and Ireland): 116 123 Lifeline (Australia): 13 11 14
Talk to your doctor before you stop taking Topamax. You may experience serious side effects if you suddenly stop taking Topamax. If you would like to stop, talk to your doctor about tapering off the medication. They will give you lower and lower doses until you have weaned off of it completely.
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