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Topiramate is used alone or with other medications to treat certain types of seizures including primary generalized tonic-clonic seizures (formerly known as a grand mal seizure; seizure that involves the entire body) and partial onset seizures (seizures that involve only one part of the brain). Topiramate is also used with other medications to control seizures in people who have Lennox-Gastaut syndrome (a disorder that causes seizures and developmental delays). Topiramate is also used to prevent migraine headaches but not to relieve the pain of migraine headaches when they occur. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.
According to the Topamax package insert, weight loss is one of the drug’s most common side effects. However, weight gain is also a side effect of Topamax. Weight loss in patients taking Topamax appears to be dose-dependent — that is, higher doses of Topamax cause more weight loss.
Psychiatrists have used topiramate to treat bipolar disorder, although the available evidence does not support its use in any phase of bipolar disorder treatment. A more recent review, published in 2010, suggested a benefit of topiramate in the treatment of symptoms of borderline personality disorder, however the authors note that this was based only on one randomized controlled trial and requires replication. Also the authors noted that the long-term effects have not been studied.
Topiramate has been used as a treatment for alcoholism. The VA/DoD 2015 guideline on substance use disorders lists topiramate as a “strong for” in its recommendations for alcohol use disorder.
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