Meet your 2021 Best of the Best Pharmacy Award winners! Read more >
Skip to main content

Topamax for weight loss: See safety and efficacy info

Topamax is the brand name of a generic medication called topiramate. It’s technically classified as an anticonvulsant that’s used to treat conditions like epilepsy, but it is also used in the management of other conditions such as migraine and bipolar disorder. Topamax is great for treating conditions like this, but many people who take it will experience weight loss as a main side effect. Let’s take a more in-depth look at how safe and effective Topamax is and how it’s related to weight loss.     

Topamax weight loss 

Topamax is approved by the Food and Drug Administration (FDA) to treat epilepsy and prevent migraine, but the prescription drug is also well known for causing weight loss. Even though weight loss may be a positive benefit of taking Topamax, the FDA hasn’t approved it for weight loss alone. 

Topamax causes weight loss because it affects the appetite. People who take it and have a reduced appetite may feel hungry less often and eat less because of this. Studies have shown that Topamax may also speed up metabolism, which means that the body burns calories more quickly.    

Clinical trials have shown that about 6%-17% of people who take Topamax will experience weight loss, and while many people may see this as an added benefit, losing too much weight isn’t a good thing. Most people will experience moderate weight loss from Topamax, says Kuldeep Singh, MD, a weight loss surgeon in the Baltimore area and director of the Maryland Bariatric Center at Mercy Medical Center. Losing weight rapidly can be unhealthy—it may be time to see a doctor if you’re taking Topamax and this happens to you. Maintaining a healthy weight is important, and the best way to find out what target weight is best for you is to ask your healthcare provider. Falling below your target body weight because of Topamax would be another sign that it’s time to talk with your provider.   

Is it safe to take Topamax for weight loss?

Sometimes Topamax can be prescribed off-label to help someone lose weight. Off-label prescribing happens when a doctor writes someone a prescription for a medication that’s approved by the FDA to treat a condition different from what their patient has. This is legal and happens frequently in the medical industry, with an estimated 1 in 5 prescriptions being written off-label.   

A doctor may choose to write someone a prescription for Topamax to help with their weight loss or to treat eating disorders like binging and purging that lead to weight gain. According to Dr. Singh, someone must have a body mass index (BMI) that’s 30 or higher in order to be prescribed any weight loss medication, including Topamax.    

Studies have shown that people who take Topamax for weight loss lose about 11 pounds in comparison to placebo groups if they take the drug for at least four months, and that the weight loss effects of Topamax increase with both duration of treatment and dosage. Studies have also shown that topiramate treatment can increase the chance of statistically significant weight loss by more than sixfold.    

Even though Topamax can be very effective for weight loss, it isn’t safe for everyone. The following groups of people should talk with their doctor before taking Topamax because they may have an increased risk of experiencing serious adverse events if they take it:  

  • People with kidney disease
  • People with lung disease or breathing problems
  • People with liver disease
  • People with eye problems such as glaucoma 
  • People with depression
  • People with suicidal thoughts or behaviors
  • People with osteoporosis 
  • People with metabolic ketoacidosis 

It may be safe for pregnant women to take Topamax if the benefits of taking the medication outweigh its potential risks. It is unlikely Topamax would or should be prescribed in pregnancy for the goal of weight loss. Topamax can cause fetal harm and oral birth defects if it’s taken by pregnant women, which is why it’s prescribed with caution and only when medically necessary. It’s also excreted in human milk, but it’s unknown whether or not it will negatively impact breastfeeding infants. Topamax can make birth control pills less effective, so it’s important to talk with your doctor about using non-hormonal birth control methods if you don’t want to become pregnant while taking Topamax.  

People who aren’t pregnant and who don’t have any of the health conditions mentioned above can safely take Topamax, but they may still experience side effects from taking it. Here are some of the most common side effects of Topamax aside from weight loss:  

  • Dizziness
  • Tiredness
  • Numbness
  • Diarrhea
  • Loss of appetite 
  • Loss of coordination
  • Paresthesia (burning sensations) 

Although it’s rare, Topamax can cause more serious side effects that may require medical attention like confusion, memory problems, trouble concentrating, and trouble speaking. Some people will also experience mental health side effects like depression, panic attacks, mood changes, and suicidal thoughts or behaviors. If you have any of these symptoms you should seek medical advice as soon as possible.   

The other rare side effect of Topamax is eye problems that can lead to vision changes and blindness, which is why it’s so important to call your doctor if your vision starts to change. This list of side effects is not comprehensive; if you’d like a complete list of Topamax side effects ask your doctor or pharmacist for a medication guide.  

If Topamax is causing too many side effects, know that you have other options. The active ingredient in Topamax, topiramate, is also the main ingredient in the weight loss drug Qsymia, which is a combination containing phentermine. According to Dr. Singh, Qsymia is one of the best medications to use long-term in combination with diet and lifestyle changes for weight loss, especially for obese patients with class 1 or class 2 obesity. So if you’re not able to take Topamax because of an underlying health problem or because you’re experiencing too many adverse effects, you might try asking your healthcare professional about Qsymia or other ways to lose weight.  

How to take Topamax to lose weight

Topamax can be taken to promote weight loss and help control binging and purging, but it’s important to remember that it isn’t a substitute for going to a doctor and creating a well-rounded weight loss plan. If you’re interested in taking Topamax it’s best to schedule an appointment with your doctor to see if it’s right for you. Your doctor will do a complete physical exam and ask about your medical history. If you and your doctor decide that Topamax can safely help you lose weight, then you may receive a prescription for it.

If you do receive a prescription from your doctor, it’s important to know how to take Topamax to get the best results. The starting dose of Topamax for weight loss is a low dose of 25 mg per day, but this dosage strength can be increased on a case-by-case basis based on each individual’s medical history and how much weight they have to lose.    

In a study conducted by the Journal of Clinical Psychiatry, bipolar and schizophrenic patients who were given an average dose of 195 mg of topiramate per day lost about 22 pounds over time. This shows that the range of Topamax dosages can vary from low to high, and that doctors may increase or decrease the amount of Topamax someone takes based on their individual results over time.  

It can take some time to see weight loss results from taking Topamax. Some people may not notice a difference until they’ve taken the drug for at least four months, while other people may start to lose weight in their first month of taking it. Weight loss results from topiramate are proven to increase over time.    

Topamax can be taken with or without food and is generally taken at the same time each day. It shouldn’t be taken at the same time as certain other medications because of the potential for drug interactions. Here’s a list of medications Topamax should not be taken with:

  • Antiepileptic drugs
  • Carbonic anhydrase inhibitors
  • CNS depressants
  • Oral contraceptives
  • Hydrochlorothiazide (HCTZ)  
  • Pioglitazone
  • Lithium
  • Amitriptyline 

In addition to these medications, Topamax shouldn’t be taken with alcohol because this can cause sleepiness, increase the risk of getting kidney stones, and cause metabolic acidosis. Metabolic acidosis is a condition where too much acid builds up in body fluids, and it can become life-threatening if it goes untreated. If you start to experience rapid breathing, confusion, extreme tiredness, and an increased heart rate while taking Topamax, you should seek medical attention as soon as possible because these are signs that you may have metabolic acidosis.      

Weight gain after Topamax

When someone stops taking Topamax, it’s possible that they might experience weight gain over time, especially if they haven’t been combining Topamax with healthy lifestyle changes. In an observational study done by the National Library of Medicine, discontinuation of Topamax for at least six months showed a trend for returning to a baseline weight. So people may be more likely to return to what they weighed before they started taking Topamax, but this may take some time.  

This return to a baseline weight may happen because the body is no longer experiencing a reduced appetite and faster metabolism. The best way to make sure you’re able to keep weight off after stopping Topamax is to adopt healthy lifestyle changes that will support you on your weight loss journey.   

5 safe ways to lose weight

Topamax can be helpful on your weight loss journey if your doctor approves it, but it’s not the only way to lose weight. Lifestyle changes can help you lose weight and keep it off so that you can enjoy the benefits of weight loss without taking Topamax, while taking it, or after taking it. Here are some of the safest ways to lose weight.  

1. Improve your eating habits

Eating healthy is one of the safest and best ways to lose weight. Being mindful of what and how much you’re eating can help you lose weight if you do it right. For the best advice on what to eat to lose weight you should talk with your doctor, but making some small changes like eating more fruits and vegetables can be a great way to start.  

Processed foods, refined carbohydrates, sugar, and alcohol are all examples of foods that can cause weight gain. Fresh fruits, vegetables, and high-quality proteins like salmon, beans, and eggs are all great examples of foods that the body can easily process and get vital nutrients from.  

2. Exercise regularly 

According to the Centers for Disease Control and Prevention (CDC), exercise not only helps control weight, but it reduces high blood pressure, reduces the risk of Type 2 diabetes, and can even reduce the symptoms of depression and anxiety. People vary in how much physical exercise they need to lose weight, so it’s a good idea to talk with your doctor about how often you should be exercising. Some great exercises for weight loss include walking, biking, swimming, and weight training.   

3. Reduce stress

Stress is linked to many health problems such as anxiety and depression. Feeling stressed can lead to emotional eating, which can lead to weight gain over time. Finding ways to reduce stress may help you lose weight. You might try meditating, yoga, going for walks, or calling a friend or family member. You can also ask your doctor or a counselor for proven ways to reduce stress that will fit into your lifestyle.  

4. Get enough sleep 

According to the Sleep Foundation, a lack of sleep may increase the appetite and lead to metabolic problems. Getting enough sleep can help your body function properly and give you more energy to do things like exercise, which will help you lose weight. Getting enough sleep can also reduce your stress levels, which will help you control any urges you might get to overeat.  

5. Trying safe diet pills & supplements 

There are countless diet pills and supplements on the market that claim to cause weight loss, such as Hydroxycut and glucomannan, but they shouldn’t serve as a substitute for healthy lifestyle changes. “When people go for weight loss medications, most of them do it because it’s easy to do,” Dr. Singh says. “If somebody seriously changes their lifestyle and eating habits first, they will really see a solid improvement with Topamax or other weight loss medications. The mindset is the most important thing. Medications cannot serve as a substitute for proper eating and exercising habits.”