Topamax® (topiramate) is a medication originally developed for seizure control. It has been prescribed off-label for several years now for prevention of cluster headaches and Migraine attacks, with considerable success for many patients.
As is often the case with medications being prescribed for off-label use, the dosage and the tapering up the full dosage as varied greatly from one doctor to the next. Now, with some clinical trials of Topamax® for Migraine prevention complete, information from those clinical trials is available and can be quite helpful.
Dr. Stephen Silberstein, a headache and Migraine specialist, has been working in those clinical trials. He was kind enough to share information from those trials so we can be more educated patients.
Here are his recommendations for safely tapering up to a therapeutic dosage level:
- Week 1: 15 mg - -25 mg at bedtime
- Week 2: 25 mg, twice a day
- Week 3: 25 mg day dose, 50 mg bedtime dose
- Week 4: 50 mg, twice a day
- Weeks 5 - 7: maintain 50 mg, twice a day. If that isn't working progress through weeks 8 - 11 if necessary
- Week 8: 50 mg day dose, 75 mg bedtime dose
- Week 9: 75 mg, twice a day
- Week 10: 75 mg day dose, 100 mg bedtime dose
- Week 11: 100 mg twice a day
- Weeks 12 - 18. Maintain 100 mg twice a day.
- If 100 mg twice a day doesn't give the desired results, he recommends tapering down and off Topamax rather than going to a higher dosage because the clinical trials are showing that there is no benefit to going higher.
Dr. Silberstein also offered some other helpful pieces of information:
- This medication needs to be taken in a split dose. That means the total daily dosage should be taken in two doses, 12 hours apart.
- If you experience the rather common side effect of tingling in your hands and/or feet, ask your doctor about a potassium supplement. This will often stop that side effect.
- Don't expect a miracle weight loss with Topamax®. If you experience weight loss, it is a side-effect. In the clinical trials, patients lost an average of 3.8% of their starting body weight. This is usually a temporary side effect, and the amount of weight lost is proportional to starting body weight.
- Unless there is an urgent need to discontinue Topamax® quickly, it should not be abruptly discontinued. Doing so increases the risk of seizures even in people who have not experienced seizures before. Discontinuing Topamax® should be accomplished by reversing the taper used to get to your current dosage.
Remember don't make any changes to how you take your medication(s) without consulting your doctor first. If your doctor's instructions for taking Topamax® differ from Dr. Silberstein's advice, discuss this information with him or her. If you're thinking about Topamax for cluster or Migraine prevention, this is good information to share with your doctor. This is information that has been published in some of the specialized medical journals, but has yet to be widely disseminated. Your doctor may appreciate your sharing it as Dr. Silberstein is very well known and respected in the field.
For many people, Topamax® is a great preventive medication. It is, however, a very powerful medication. Please take care to take it correctly and safely. If you experience any side effects, especially visual side effects, report these to your physician as soon as possible.