{"id":56934,"date":"2023-02-06T12:36:18","date_gmt":"2023-02-06T17:36:18","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=56934"},"modified":"2024-10-25T10:53:22","modified_gmt":"2024-10-25T14:53:22","slug":"topiramate-alternatives","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/topiramate-alternatives\/","title":{"rendered":"Topiramate (Topamax) alternatives: What can I take instead of topiramate?"},"content":{"rendered":"

Topiramate is a prescription medication that was originally brought to market as a medication for seizures. It is now also in medications that help prevent migraine headaches and aid in weight loss. Topiramate is classified as a carbonic anhydrase inhibitor anticonvulsant and is available under several different brand names on the market, including Eprontia, Qudexy XR, Topamax, Topamax Sprinkle, Trokendi XR, and Topiragen. The brand name product, Qsymia, combines phentermine as a prescription weight loss product.<\/span><\/p>\n

Seizures<\/span><\/a> are uncontrolled electrical events in the brain that may cause changes in behavior, memory, or consciousness. Partial seizures are the most common type of seizures in adults and occur in only one area of the brain’s cortex. General seizures are more diffuse across the cortex. Seizures may be provoked or unprovoked and are difficult to predict. <\/span><\/p>\n

Approximately 25-30% of first-time seizures are thought to be provoked or brought on by a triggering event such as fever (increased body temperature), brain injuries, sepsis, stroke, or central nervous system (CNS) infections. The term <\/span> describes the disorder in the brain where abnormal signals cause seizures. In the United States, 2.3 million adults and 450,000 children live with epilepsy. Each year, 150,000 new cases are diagnosed. The exact mechanism by which topiramate helps to control epilepsy isn’t fully understood, but it appears to reduce the duration of the abnormal changes in the brain. Topiramate is approved to treat patients as young as two years of age in some dosage forms for seizures.<\/span><\/p>\n

While topiramate does not treat a migraine that has already begun, it has a significant role in therapy in terms of preventing migraines, referred to as prophylaxis. It is approved for migraine prophylaxis in adolescents 12 years of age and older. Again, the exact mechanism for how it provides prophylaxis isn’t completely understood.<\/span><\/p>\n

While topiramate products hold a significant place in therapy for several disorders, there are several reasons why topiramate may not be the best choice for an individual patient. In research done by the manufacturer on epilepsy patients, as many as 20% of patients in some dosing groups <\/span>discontinued topiramate<\/span><\/a> due to adverse events. These adverse events also affect patients taking topiramate for migraines. The most common side effects that lead to discontinuation included difficulty with memory, fatigue, asthenia, insomnia, somnolence, and paresthesia. Some patients also report a change in the way foods taste. For some patients, these adverse events manifest in different ways. For instance, some may have difficulty coming up with specific words as they are speaking or remembering something that just happened. These serious side effects of topiramate use can be concerning to them or those around them.<\/span><\/p>\n

Some forms of topiramate can be very expensive and cost prohibitive. The <\/span>cost of Trokendi XR<\/span><\/a> can approach $1200 per month before insurance, and coverage of the drug is very much dependent upon the plan. However, generic topiramate immediate-release tablets are less than $3 per month without insurance with the use of a SingleCare <\/span>coupon<\/span><\/a>. Many plans may require you to try the generic immediate-release form before they authorize coverage of a more expensive form of topiramate.<\/span><\/p>\n

In other populations, topiramate in all or certain dosage forms may not be the best choice for patients. Those with an allergy to topiramate should look for alternative therapy. Trokendi CR cannot be taken within 6 hours of ethanol ingestion or if there has been ethanol intoxication. Topiramate is generally not appropriate in elderly patients or those with decreasing renal function. Stevens-Johnson syndrome (SJS) has been reported with topiramate treatment, and it should be discontinued immediately if this occurs. Topiramate can not be taken during pregnancy.<\/span><\/p>\n

Topiramate and most seizure medications carry a warning for patients who have a history of depression or suicidal thoughts, as this class of medications could worsen this effect. This could be especially true in pediatric patients; all patients should be monitored closely. If there are signs or symptoms of these thoughts, patients should seek medical help immediately.<\/span><\/p>\n

So what do you do if you think topiramate isn’t right for you? Perhaps you are looking for an option with fewer side effects. Below, we will discuss some alternative options you may have depending on what you are using topiramate for.<\/span><\/p>\n

What can I take in place of topiramate?<\/span><\/h2>\n

There are alternative treatment options to topiramate, but choosing the right alternative will need to take into account several factors. First, the decision to change therapy is one that you should only make with your healthcare professional. The options available to you will depend upon the original indication of why you were taking topiramate in the first place. If you were taking it for seizure disorders, there is a list of viable alternative medication options. If you were taking it for migraine prophylaxis, there are actually a lot of new medications in that field, as well as older, proven medications to choose from. The indication for use and the reason for change will be the primary determining factors for your next best medication therapy option.<\/span><\/p>\n

Below is a list of available alternatives for topiramate treatment in seizure disorder and migraine prophylaxis. This is not a complete list; only your doctor can decide what is appropriate for you. Some drugs used are done off-label<\/span> or without approval from the FDA. Beta-blockers and tricyclic antidepressants in the prevention of migraines are examples of this. <\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
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Compare Topamax (topiramate) alternatives<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n

Drug name<\/span><\/td>\nUses<\/span><\/td>\nDosage<\/span><\/td>\nSavings options<\/span><\/td>\n<\/tr>\n
Topamax (topiramate)<\/span><\/td>\nMonotherapy or adjunct therapy for partial or generalized tonic-clonic seizures, adjunct treatment of Lennox-Gastaut syndrome, migraine prophylaxis<\/span><\/td>\n100 mg to 200 mg by mouth twice daily<\/span><\/td>\nTopamax coupons<\/span><\/a><\/td>\n<\/tr>\n
Keppra (levetiracetam)<\/span><\/td>\nTreatment of partial seizures, adjunct treatment of myoclonic seizures, adjunct treatment of generalized tonic-clonic seizures<\/span><\/td>\n1,500 mg by mouth twice daily<\/span><\/td>\nKeppra coupons<\/span><\/a><\/td>\n<\/tr>\n
Tegretol (carbamazepine)<\/span><\/td>\nTreatment of generalized tonic-clonic seizures, partial seizures<\/span><\/td>\n400 mg by mouth four times daily<\/span><\/td>\nTegretol coupons<\/span><\/a><\/td>\n<\/tr>\n
Depakote (divalproex sodium)<\/span><\/td>\nMonotherapy or adjunct treatment of absence seizures, complex partial seizures, tonic-clonic seizures, myoclonic seizures, acute mania with bipolar disorder, migraine prophylaxis<\/span><\/td>\n15 to 60 mg\/kg\/day in at least 2 divided doses<\/span><\/td>\nDepakote coupons<\/span><\/a><\/td>\n<\/tr>\n
ONFI (clobazam)<\/span><\/td>\nAdjunct treatment of Lennox-Gastaut syndrome<\/span><\/td>\n20 mg by mouth twice daily<\/span><\/td>\nONFI coupons<\/span><\/a><\/td>\n<\/tr>\n
Vimpat (lacosamide)<\/span><\/td>\nMonotherapy and adjunct treatment of partial seizures, adjunct treatment of generalized tonic-clonic seizures<\/span><\/td>\n150 mg to 200 mg by mouth twice daily<\/span><\/td>\nVimpat coupons<\/span><\/a><\/td>\n<\/tr>\n
Neurontin (gabapentin)<\/span><\/td>\nAdjunct treatment of partial seizures with or without secondary generalized tonic-clonic seizures<\/span><\/td>\n300 mg to 600 mg by mouth three times per day<\/span><\/td>\nNeurontin coupons<\/span><\/a><\/td>\n<\/tr>\n
Lyrica (pregabalin)<\/span><\/td>\nNeuropathic pain, adjunct treatment of partial seizures, fibromyalgia<\/span><\/td>\n50 mg by mouth three times per day<\/span><\/td>\nLyrica coupons<\/span><\/a><\/td>\n<\/tr>\n
Dilantin (phenytoin)<\/span><\/td>\nTreatment of tonic-clonic seizures, treatment of status epilepticus<\/span><\/td>\n4 to 7 mg\/kg\/day by mouth in one, two, or three doses per day, depending on the dosage form<\/span><\/td>\nDilantin coupons<\/span><\/a><\/td>\n<\/tr>\n
Emgality (galcanezumab)<\/span><\/td>\nMigraine prophylaxis, treatment of episodic cluster headache<\/span><\/td>\n240 mg subcutaneously as a loading dose, followed by 120 mg subcutaneously once monthly<\/span><\/td>\nEmgality coupons<\/span><\/a><\/td>\n<\/tr>\n
Inderal LA (propranolol ER)<\/span><\/td>\nChronic stable angina, atrial fibrillation\/ flutter, paroxysmal supraventricular tachycardia (PSVT), hypertension, reduction of mortality after myocardial infarction, migraine prophylaxis<\/span><\/td>\n60 mg to 240 mg by mouth once daily<\/span><\/td>\nInderal LA coupons<\/span><\/a><\/td>\n<\/tr>\n
Nurtec ODT (rimegepant)<\/span><\/td>\nAcute treatment of migraine with or without aura, episodic migraine prophylaxis<\/span><\/td>\n75 mg by mouth every other day<\/span><\/td>\nNurtec ODT coupons<\/span><\/a><\/td>\n<\/tr>\n
Verelan (verapamil)<\/span><\/td>\nTreatment of variant angina and chronic stable angina, rapid conversion of PSVT, atrial fibrillation\/ flutter, hypertension, migraine prophylaxis<\/span><\/td>\n80 mg by mouth three to four times per day (**use is off-label)<\/span><\/td>\nVerelan coupons<\/span><\/a><\/td>\n<\/tr>\n
Aimovig (erenumab)<\/span><\/td>\nMigraine prophylaxis<\/span><\/td>\n70 mg or 140 mg subcutaneously once monthly<\/span><\/td>\nAimovig coupons<\/span><\/a><\/td>\n<\/tr>\n
Tenormin (atenolol)<\/span><\/td>\nAngina pectoris, hypertension, reduction of mortality after myocardial infarction, migraine prophylaxis<\/span><\/td>\n100 mg by mouth once daily (**use is off-label)<\/span><\/td>\nTenormin coupons<\/span><\/a><\/td>\n<\/tr>\n
Ajovy (fremanezumab)<\/span><\/td>\nMigraine prophylaxis<\/span><\/td>\n225 mg subcutaneously once monthly or 675 mg subcutaneously every 3 months<\/span><\/td>\nAjovy coupons<\/span><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Other alternatives to topiramate<\/span><\/h3>\n