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This medication, Topiramate, comes with several important safety warnings and precautions that you should be aware of. It is crucial to understand these potential risks and consult with your healthcare provider should you have any concerns.

• Vision Problems: Topiramate may lead to eye issues such as nearsightedness and increased eye pressure, with symptoms including redness, blurry vision, and eye pain. These can emerge suddenly, usually within a month of starting the medication. Should these symptoms appear, contact your healthcare provider immediately to prevent further vision deterioration. They will guide you on safely discontinuing the medication by gradually reducing the dosage to minimize the risk of seizures. Typically, these vision issues resolve once the medication is stopped.

• High Body Temperature and Trouble Sweating: This medication can impair sweating, resulting in overheating and elevated body temperature, particularly in children, adolescents, or during hot weather. The risk is heightened if other medications, such as anticholinergics, are also being used. It is important to monitor body temperature during physical activity or hot weather and take measures to stay cool, such as staying indoors with air conditioning, resting in the shade, using misting fans, and drinking water. If symptoms like nausea, muscle cramps, or headaches occur, which may indicate heat stroke or exhaustion, seek emergency medical assistance immediately.

• Higher Level of Acid in Blood (Metabolic Acidosis): Topiramate can occasionally increase blood acidity, leading to complications like kidney stones or bone fractures, and in children, it may affect bone growth. Symptoms include loss of appetite, fatigue, and irregular heartbeat. Those with kidney or severe breathing issues, diarrhea, on a keto diet, or experiencing status epilepticus are at increased risk.

• Suicidal Thoughts or Behavior: There is an increased risk of suicidal thoughts or behavior, which may occur as early as one week into treatment. It's important to monitor for worsening depression or unusual mood changes, especially during the initial treatment months or when adjusting the dose. Report any concerning behavior to your healthcare provider immediately. The risk is higher for individuals with a history of depression or those taking other seizure or mood-affecting medications.

• Cognitive and Mood Effects: The medication may affect concentration, memory, speech, coordination, and mood, potentially causing increased drowsiness or depression. Avoid driving or operating machinery until you know the medication's effects. Alcohol use can exacerbate these side effects. Starting at high doses or rapidly increasing doses can increase these risks.

• Higher Ammonia Levels: High ammonia levels can occur, particularly if taken with valproic acid or divalproex (Depakote), leading to fatigue, concentration issues, or vomiting. Severe cases may cause brain damage. Immediate medical attention is necessary if such symptoms are observed. The risk increases for those with metabolic disorders or on higher doses of topiramate.

• Serious Birth Defects: Topiramate can cause significant birth defects if used during pregnancy. It is crucial to use birth control if you do not plan to become pregnant. The medication should only be used in pregnancy if the benefits outweigh the risks. Pregnant individuals on topiramate are encouraged to join the North American Antiepileptic Drug (NAAED) Pregnancy Registry for monitoring and support.

• Skin Reactions: Rash and severe skin reactions are possible. Notify your healthcare provider of such reactions to safely discontinue the medication and discuss alternative treatments. Seek immediate medical help for symptoms like rash, blisters, skin peeling, mouth sores, or high fever.

• Withdrawal Seizures: Do not stop taking topiramate abruptly, as it may trigger seizures. Your healthcare provider will assist in gradually reducing the dose to prevent this.

• Drug Interactions: Be aware that topiramate can interact with numerous medications. Always inform your healthcare provider about all the medications you are taking.

Adhering to these guidelines ensures the safe use of topiramate and minimizes potential risks.

Common side effects:

• Tiredness
• Drowsiness
• Dizziness
• Nervousness
• Tingling in the hands or feet
• Loss of appetite
• Changes in taste
• Weight loss
• Difficulty sleeping
• Cough
• Sore throat
• Fever
• Coordination issues
• Lack of energy

Less common but important to monitor:

• Drooling
• Nausea
• Difficulty speaking
• Numbness
• Muscle stiffness
• Spinning sensation
• Constipation
• Abdominal pain
• Heartburn
• Tremors
• Diarrhea

Serious side effects:

• Suicidal thoughts or behaviors
• Severe vision problems
• Significant bleeding
• Severe skin reactions
• Extreme changes in body temperature
• Dangerously high blood acid levels
• Very high levels of ammonia in the blood
• Fatigue associated with high ammonia levels
• Poor mental alertness associated with high ammonia levels
• Vomiting associated with high ammonia levels

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

• Orlistat
• Hormonal birth control (pills, patches, or rings)

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

• Alcohol
• Marijuana (cannabis)
• Antihistamines (such as Cetirizine, diphenhydramine)
• Drugs for sleep or anxiety (such as Alprazolam, Diazepam, Zolpidem)
• Muscle relaxants
• Opioid pain relievers (such as codeine)
• Alfentanil
• Alprazolam
• Codeine
• Zolpidem
• Carbamazepine
• Fosphenytoin
• Valproic Acid