Topiramate Uses

Topiramate is used to treat primary generalized tonic-clonic seizures (previously called grand mal seizures) and partial onset seizures (also called partial seizures, focal seizures, or focal onset aware seizures). This medicine is also prescribed to people with Lennox-Gastaut syndrome, a condition associated with seizures and developmental delay. Additionally, topiramate is used for migraine prevention; however, it is not used to treat migraine headaches. 

There may be other uses of topiramate, such as for binge eating disorder, essential tremor, and alcohol dependence—your health system pharmacists or healthcare professionals can give you further drug information.

Topiramate Mechanism of Action

Topiramate works by decreasing abnormal activity in the brain by blocking voltage-sensitive sodium channels in brain cells and increasing the activity of an inhibitory neurotransmitter called GABA.

Topiramate Doses

Topiramate is available as tablets (25 mg, 50 mg, 100 mg, and 200 mg); sprinkle capsules (15 mg and 25 mg); extended-release (long-acting) capsules (brand name Qudexy XR) (25 mg, 50 mg, 100 mg, 150 mg, and 200 mg); and an oral solution (brand name Eprontia) (25 mg/mL). The typical doses are as follows:

Monotherapy (topiramate alone) for epilepsy in adults and children 10 years of age and older: 400 mg per day in two divided doses. The dose is increased gradually over a period of 6 weeks, starting with 25 mg twice daily in week 1, 50 mg twice daily in week 2, 75 mg twice daily in week 3, 100 mg twice daily in week 4, 150 mg twice daily in week 5, and 200 mg twice daily week 6 onwards.

Monotherapy (topiramate alone) for epilepsy in children 2 to 9 years of age: The topiramate dose is based on the child’s body weight.

Adjunctive therapy for partial onset seizures or Lennox-Gastaut Syndrome in adults (age 17 years and older): 200 to 400 mg daily in two divided doses.

Adjunctive therapy for primary generalized tonic-clonic seizures in adults (age 17 years and older): 400 mg daily in two divided doses. The medicine is started at 25 to 50 mg daily and increased by 25 to 50 mg daily at weekly intervals. 

Adjunctive therapy for partial onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome in children 2 to 16 years of age: 5 to 9 mg/kg/day. The starting dose is 25 mg daily or less (1 to 3 mg/kg/day) at night for week 1. The dose is then increased at 1-2 week intervals by 1 to 3 mg/kg/day (given in two divided doses) until clinical response (seizure control) is achieved. The maximum total daily dose of topiramate is 400 mg per day.

For migraine prevention in adults and children 12 years of age and older: 100 mg daily in two divided doses. The dose titration is as follows: 25 mg in the evening for week 1, 25 mg twice daily for week 2, 25 mg in the morning and 50 mg in the evening for week 3, and 50 mg twice daily for week 4 onwards.