Take this medicine every day exactly as ordered by your doctor in order to improve your condition as much as possible. Do not take more or less of it, and do not take it more or less often than your doctor ordered.

Topiramate may be taken with or without food, on a full or an empty stomach. Swallow the tablets whole, without breaking, crushing, or chewing them. The bitter taste may be more noticeable if the tablets are held in the mouth or chewed. The capsules may be swallowed whole, or the contents of the capsule may be opened and the contents sprinkled on a small amount (teaspoonful) of soft food (such as applesauce, custard, ice cream, oatmeal, pudding, or yogurt) and swallowed immediately without chewing

Dosing

The dose of topiramate will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of topiramate. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking topiramate.

• For oral dosage form (tablets or capsules):
  • As an anticonvulsant:
    • Adults At first, 50 milligrams (mg) a day for the first week. Your doctor may increase your dose gradually every week if needed and tolerated, but the usual dose is not greater than 400 mg a day.
    • Children (age 2 to 16 years) At first, 25 milligrams (mg) nightly for the first week. Your doctor may increase your dose gradually every 1 or 2 weeks to be taken in two divided doses.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the medicine from freezing. Do not refrigerate.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking topiramate must be weighed against the good it will do. This is a decision you and your doctor will make. For topiramate, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to topiramate. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Topiramate has not been studied in pregnant women. However, studies in pregnant animals have shown that topiramate may cause birth defects in the offspring, as well as adverse effects in the mother, when given in doses many times higher than the human dose. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding It is not known whether topiramate passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.

Children Although there is no specific information comparing the use of topiramate in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults.

Older adults In studies done to date that have included adults older than 60 years of age, topiramate has not been shown to cause different side effects or problems in older people than it does in younger adults.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking topiramate, it is especially important that your health care professional know if you are taking any of the following:

• Acetazolamide (e.g., Diamox) or
• Dichlorphenamide (e.g., Daranide) Taking these medicines with topiramate may increase the chance of getting kidney stones
• Carbamazepine (e.g., Tegretol) Blood levels of topiramate may be decreased. Your doctor may need to adjust the dosage of either or both medicines
• Oral contraceptives (birth control pills) containing estrogen Topiramate may decrease the effects of these medicines; contraceptive failure may result; additional birth control measures may be needed to decrease the risk of pregnancy
• Phenytoin (e.g., Dilantin) Blood levels of topiramate may be decreased. Your doctor may need to adjust the dosage of either or both medicines
• Valproic acid (e.g., Depakene, Depakote) Blood levels of topiramate and/or valproic acid may be decreased. Your doctor may need to adjust the dosage of either or both medicines

• History of kidney stones Risk of having kidney stones again may be increased

• Kidney problems or
• Liver problems Higher blood levels of topiramate may result and increase the chance of side effects