How long does topiramate stay in your system?

In this article:

• How long does topiramate stay in your system?
• What affects the duration?
• Side effects & risks
• How long do the side effects last?
• Discontinuation
• Alternatives

In this article

• How long does topiramate stay in your system?
• What affects the duration?
• Side effects & risks
• How long do the side effects last?
• Discontinuation
• Alternatives

Topiramate, also sold under the brand names Topamax and Trokendi XR, is a prescription drug approved by the Food and Drug Administration (FDA) for the treatment of seizure disorders, such as epilepsy. It is also used to help manage migraine headaches, as a mood stabilizer in psychiatric patients, and for chronic weight management. It has a number of off-label uses, such as treating substance use disorders. While it requires a prescription, topiramate is not considered a controlled substance. 

Although topiramate is typically prescribed for long-term use, you may wish to stop taking topiramate due to side effects, pregnancy plans, or other reasons. Stopping topiramate requires a gradual taper under the supervision of a healthcare provider. Topiramate remains in your system for about five days after discontinuing use. 

How long does topiramate stay in your system?

Topiramate begins working in your body as soon as you take a dose. “Peak levels occur roughly one to three hours after taking the medication,” explains Austin Shuxiao, MD, an internist and founder of PeachIV. However, you might not notice symptoms starting to ease until you’ve been taking topiramate consistently for about four days. That’s approximately how long it takes the medication to reach a “steady state,” or when the concentration stays at a therapeutic level consistently. It may take up to 12 weeks to reach full effectiveness. 

“Topiramate’s half-life is about 21 hours in a healthy adult,” Dr. Shuxiao says. The half-life is the time it takes for half of the concentration of the medication to be eliminated from your body after taking your last dose. In a “steady state,” it takes about four or five days to fully clear the medication from your system. 

The dose doesn’t affect how fast it’s processed. However, your medical history, age, and weight can change the timeline. Topiramate can be detected in blood, hair, or urine laboratory testing during the time it is in your system. 

RELATED: Topamax dosage guide

Factors that influence how long topiramate stays in your system

There are certain characteristics that change how long topiramate remains in your body. “In short: the kidneys matter most; dosage should be adjusted if renal function is reduced,” says Ryan Sultan, MD, psychiatrist and research director at Integrative Psych. 

Kidney function

“Topiramate is cleared/excreted by the kidneys, so impaired kidney function will lengthen the half-life,” explains Dr. Shuxiao. “People with impaired kidney function should take about 50% of the normal dose” because if your kidneys don’t work as well as expected, it lasts longer. Indeed, one study found that patients with health conditions such as chronic kidney disease take a longer time to clear the medication from their systems, and recommended half the normal dose for this population. 

Age

“Elderly people will typically have decreased clearance of most drugs, including topiramate, and may need a lower dosage,” says Dr. Shuxiao. One study found that topiramate had a 13% longer half-life in a group of people aged 65-85 when compared to a group of younger patients. Older adults had a higher concentration of the drug in their blood with the same dose.

Older people aren’t the only age group that may experience a different half-life with topiramate. Dr. Sultan notes that children clear topiramate from their systems more quickly than adults. One study found that topiramate has a 50% higher clearance in kids ages 4-17 than in adults.

Weight

Both experts note that weight can play a minor role when it comes to how fast the body clears topiramate, but it’s not significant and can be avoided by changing the dosage. 

Side effects and risks of topiramate

Common side effects of topiramate include: 

• Numbness, tingling sensation, or burning in the hands and feet
• Drowsiness
• Weight loss
• Loss of appetite
• Trouble speaking clearly
• Dizziness
• Somnolence
• Changes in taste
• Nervousness
• Abdominal pain
• Nausea
• Diarrhea
• Memory impairment
• Confusion

More serious side effects of topiramate include: 

• Unusual mood changes or behaviors such as agitation, mood swings, depression, feeling nervous or irritable, or having suicidal thoughts or considering self-harm. If you experience thoughts of suicide or self-harm, call 988 or visit the nearest emergency room.
• Confusion, problems with walking, clumsiness, dizziness, trouble talking, concentrating, or memory problems
• Unusual drowsiness, tiredness, or weakness
• Bloody or cloudy urine, painful urination, sudden back or flank pain, or kidney stones
• Chest pain, rapid breathing, trouble breathing, irregular heartbeats, slow heart rate
• Vision problems such as eye pain, redness, blurry vision, loss of vision, or swelling around the eye
• Declining alertness, tiredness, vomiting 
• Heat intolerance and decreased sweating
• Blistering, peeling, or red skin rash
• Allergic reaction

Certain medications interact with topiramate, such as:

• Acetazolamide
• Valproate
• Oral birth control
• Lithium
• Metformin
• Amitriptyline
• Anticonvulsant drugs, such as phenytoin or carbamazepine
• Central nervous system depressants, such as benzodiazepines, opioids, and alcohol

These medications can cause metabolic acidosis, reduced efficacy, or worsened side effects. This is not a complete list of drug interactions. Share a complete history of all dietary supplements, over-the-counter, and prescription medications you take with your pharmacist and healthcare team.

How long does it take for side effects to go away?

Many side effects lessen or disappear as your body adjusts to the medication. 

When stopping topiramate, you can expect any side effects you experienced while taking the medication to disappear pretty quickly after the last dose. “Most side effects will lessen after the drug is stopped and will most likely completely fade once the drug is completely cleared, after four to five days, assuming the patient was in a steady state,” says Dr. Shuxiao.

Some people may experience rebound side effects, such as the risk of seizures in those with epilepsy or other types of seizure disorders, and headaches in those who were taking topiramate for migraines. A person using topiramate for chronic weight management may experience weight gain. You should work with your healthcare provider to gradually decrease your dose of medication. Stopping topiramate suddenly can cause fatigue, irritability, or dizziness.

Tapering schedule and discontinuation

When discontinuing use of topiramate, it’s important to taper off, or decrease your dosage, on a specific schedule over a period of weeks instead of stopping the drug all at once. This can help reduce adverse effects and the severity of any withdrawal symptoms or rebound effects. 

The best tapering schedule for you depends on dose, duration of treatment, and condition treated. Work with your healthcare team to determine the best plan. According to Dr. Sultan, one common method is to reduce the dose by 25 mg to 50 mg each week. If you are taking a low dose (e.g., 50 mg), this process could take two to three weeks. If you are taking a higher dose (e.g., 400 mg), it could take up to two to three months.

Extra caution is needed when taking topiramate for epilepsy, since there is the risk of rebound seizures. “Never stop abruptly—especially in seizure or migraine patients,” Dr. Sultan says. “Think slow brake, not sudden stop.” It is not recommended to stop taking topiramate cold turkey, as it can cause seizures, even in a person who did not have them previously. Always seek medical advice from a healthcare professional to figure out the safest way to discontinue topiramate. 

Topiramate alternatives

If topiramate doesn’t work well for you, there are other treatment options. The best alternative medication depends on the condition treated.

Topiramate alternatives
Condition	Medication
Epilepsy	Levetiracetam
	Lamotrigine
	Valproate
Migraine	Propranolol
	Valproate
	Amitriptyline
	Aimovig
Bipolar disorder	Lithium
	Depakote
	Carbamepazine
Binge eating	Vyvanse
	Fluoxetine
Weight management	Wegovy
	Zepbound
	Contrave
	Phentermine