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The following information outlines critical safety and warning details associated with the use of topiramate. Patients and healthcare providers should carefully consider these points to ensure safe usage and management of any potential risks.

• Vision Problems: Topiramate may cause sudden eye issues, such as redness, blurry vision, and eye pain, typically occurring about a month after beginning the medication. If you notice any changes in your vision, contact your healthcare provider immediately. They may gradually reduce your dosage to minimize the risk of seizures and halt further vision deterioration. These symptoms generally resolve once the medication is discontinued.

• High Body Temperature and Sweating Difficulty: Some individuals, particularly adolescents and children, may find it challenging to sweat while on topiramate, increasing the risk of overheating. This risk is heightened in hot weather or when taking anticholinergic medications. To reduce the risk of heat-related illnesses, stay cool indoors with air-conditioning, rest in shaded areas, use misting fans, and stay hydrated. Seek immediate medical attention if symptoms of heat stroke, such as nausea, muscle cramps, or headache, occur.

• Metabolic Acidosis: Topiramate can lead to an increase in blood acid levels, potentially resulting in kidney stones, fractures, or stunted growth in children. Symptoms include loss of appetite, fatigue, and irregular heartbeat. Those with kidney issues, severe breathing problems, diarrhea, or on a ketogenic diet should be cautious.

• Suicidal Thoughts or Behavior: There is a risk of increased suicidal thoughts or behaviors, which may manifest within the first week of treatment. Monitor for worsening depression or unusual mood changes, especially if there is a history of depression or concurrent use of mood-altering medications. Report any concerning behaviors to a healthcare provider immediately.

• Cognitive and Mood Changes: Topiramate may impair concentration, memory, speech, coordination, and mood, potentially causing increased sleepiness. Avoid driving or operating machinery until you know how topiramate affects you. Alcohol can exacerbate these side effects, so it is advisable not to consume it while on this medication.

• Ammonia Levels: When taken with valproic acid or divalproex, topiramate may increase ammonia levels in the blood, causing fatigue, difficulty concentrating, or vomiting. High ammonia levels can lead to brain damage, so seek medical help if these symptoms arise, particularly if there's a history of metabolic disorders.

• Pregnancy Risks: Topiramate can cause significant birth defects or affect fetal growth. Women of childbearing potential should use effective contraception while taking this medication. Pregnant individuals are advised to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry for monitoring.

• Skin Reactions: Severe skin reactions, including rashes, blisters, and skin pain, may occur. Inform your healthcare provider immediately to discuss alternative treatments and prevent further complications.

• Withdrawal Seizures: Do not abruptly discontinue topiramate, as it can lead to the recurrence or worsening of seizures. A healthcare provider should guide the gradual reduction of dosage.

• Drug Interactions: Topiramate can interact with various medications, so it is crucial to discuss all current medications with a healthcare provider to avoid adverse interactions.

Common side effects:

• tiredness
• drowsiness
• dizziness
• tingling sensation in the hands or feet
• nervousness
• loss of appetite
• changes in taste
• weight loss
• trouble sleeping
• upper respiratory symptoms like cough or sore throat
• slight fever

Less common but important to monitor:

• nausea
• difficulty speaking
• numbness
• muscle stiffness
• tremors
• constipation
• belly pain
• indigestion
• spinning sensation
• drooling
• feeling of fatigue

Serious side effects:

• suicidal thoughts or behaviors
• significant vision problems
• severe bleeding
• serious skin reactions
• extreme changes in body temperature
• high blood acid levels
• high ammonia levels in the blood
• fatigue
• confusion
• irregular heartbeat
• severe eye issue that could lead to permanent blindness
• sudden vision changes
• eye pain

Interactions with high risk of serious adverse effects and should be avoided:

• Orlistat
• Hormonal contraceptives such as pills, patches, or rings

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Alcohol
• Marijuana (cannabis)
• Antihistamines (e.g., cetirizine, diphenhydramine)
• Drugs for sleep or anxiety (e.g., Alprazolam, Diazepam, [Zolpidem](https://savehealth.com/zolpidem))
• Muscle relaxants
• Opioid pain relievers (e.g., codeine)
• Alfentanil
• Benzhydrocodone
• Bromazepam
• Buprenorphine
• Butorphanol
• Calcifediol
• Calcium Oxybate
• Cannabidiol
• Carbinoxamine
• Citalopram
• Clobazam
• Dihydrocodeine
• Doxylamine
• Esketamine
• Flibanserin
• Gabapentin
• Gabapentin Enacarbil
• Hydrocodone
• Hydromorphone
• Ketamine
• Lemborexant
• Levorphanol
• Lofexidine
• Loxapine
• Magnesium Oxybate
• Meperidine
• Methadone
• Metoclopramide
• Midazolam
• Morphine
• Morphine Sulfate Liposome
• Nalbuphine
• Oxycodone
• Oxymorphone
• Pentazocine
• Periciazine
• Piperaquine
• Potassium Oxybate
• Pregabalin
• Remifentanil
• Remimazolam
• Scopolamine
• Sodium Oxybate
• Sufentanil
• Tapentadol
• Tramadol
• Trazodone
• Ulipristal
• Zolpidem

Interactions with low risk that usually do not require a change in therapy:

• Carbamazepine
• Fosphenytoin
• Ginkgo
• Hydrochlorothiazide
• Phenobarbital
• Phenytoin
• Pioglitazone
• Posaconazole
• Valproic Acid