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Topamax (Topiramate)

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Topamax belongs to a family of drugs that are called anticonvulsants (antiepileptics). Its generic name is Topiramate and it is an example of a carbonic anhydrase inhibitor. The drug works on the CNS to prevent episodes of seizures. It normally comes as tablets or pills of different strengths ranging from 15 mg to 200 mg. The sprinkler capsules are more suitable for those who have difficulty swallowing tablets.

Uses/Indications for Topamax

Topamax is used as both a prescription and an off-label drug, depending on the conditions you want to use it for.

It is used as preventive therapy for migraine in people who are 12 years or older. It is also indicated as a single first-line treatment alone for seizures or in conjunction with other drugs for seizures in children who are 2 years or older. Additionally, Topamax is used in treating conditions like generalized grand mal seizures, Lennox Syndrome, and partial-onset seizures.

Some of the reported off-label uses of Topamax are:

  • Bipolar disorders

  • Anxiety

  • Alcohol abuse disorder

  • Pains, including nerve pains and

  • Weight loss

It is important to note that there is not enough scientific evidence to prove that all these off-label uses of Topamax are effective for the purpose that they have been stated for.

Adverse Effects of Topamax

The following adverse effects have been observed in people using Topamax:

  • Skin rash

  • Dizziness

  • Blistering

  • Blurred vision

  • Speech problems

  • Dryness of the skin

  • Extremely high fever ( hyperthermia)

  • Episodes of panic attacks

  • Difficulty in sleeping

  • Mood swings

  • Difficulty in breathing

  • Irregular heartbeats (cardiac arrhythmias)

  • Fatigue

  • Loss of appetite

  • Nausea

  • Stuffy nose

  • Numbness of the muscles

  • Occasional loss of memory


The dose to be taken is dependent on what it should be used for.

Epilepsy (as monotherapy) in pediatrics who are at least 12 years and adults:

The maximum daily dose is 400 milligrams per day, which is usually divided into 2 equal doses. The start dose is 25 mg which should be taken twice daily (morning and evening) in the first week. It is gradually increased by another 25 mg or 50 mg twice daily in the morning and in the evening for a period of 6 weeks.

Epilepsy (Mono Therapy) in children who are between 2 and 9 years:

The dosage for this group is dependent on body weight. A starting dose of 25 mg/kg body weight is administered for seven days. This dose can be suitably adjusted progressively from the second to sixth week while also putting the patient's weight into consideration.

Adjuvant therapy for epilepsy in those who are 17 years and older:

A 200 - 400 mg per day divided into morning and evening doses is suitable for epilepsy in Lennox-Gastaut Syndrome and partial onset seizures. 

For grand mal seizures, 400 mg per day divided into morning and evening doses is recommended.

In children who are between 2 and 16 years, a dose of five to nine milligrams per kilogram body weight divided into 2 doses of morning and evening per day is suitable for the initial seven days of therapy. It can be adjusted as the week progresses.

Preventive Migraine:

For patients who are 12 years and above, 100 mg of Topamax given in 2 divided doses should be administered in the morning and in the evening is suitable.


There are dosage considerations that should be put in place for patients with certain pathologies.

For instance, in patients with renal impairment and those undergoing hemodialysis, the dose should be determined by the doctor after laboratory tests like creatinine clearance have been conducted. Their dose adjustments go hand in hand with the results of clearance tests that are performed routinely for the patients to avoid further worsening of their kidney condition.


Topamax interacts with over 280 drugs, 9 disease conditions, and with alcohol. Some of the drugs that it interacts with are listed below.

  • Amoxapine

  • Acetazolamide

  • Asenapine

  • Azatadine

  • Amitriptyline

  • Astropin

  • Acrivastine

  • Belladonna

  • Bromopheniramine

  • Buprenorphine

  • Brexpiprazole

  • Benztropine

  • Carbinoxamine

  • Chlorpromazine

  • Clozapine

  • Cyclobenzaprine

  • Chlorpheniramine

  • Dexbrompheniramine

  • Dicyclomine

  • Doxylamine

  • Tramadol

  • Zoloft

  • Ethynyl estradiol

  • Flavoxale

  • Glycopyrrolate

  • Haloperidol

  • Imipramine

  • Hydroxyzine

  • Iloperidone

  • loxapine

  • Medroxy progesterone

  • Methformin

  • Norgestrel

  • Orphenadine

  • Procyclidine

  • Promethazine

  • Quetiapine

  • Trimeprazole

Topamax interacts with the following pathological conditions:

  • Nephrolithiasis (kidney stones)

  • Metabolic acidosis (a condition characterized by an increase in acids produced from body metabolic processes)

  • Hemodialysis

  • Blood dyscrasia (bone marrow depletion)

  • Renal dysfunction

  • Glaucoma

  • Hyperthermia

  • Tendency to commit suicide

Missed Dose and Overdose

If you miss a dose, take it as soon as you remember. However, if the time for your next dose is closer, do skip the missed dose and inform your doctor about any missed doses. In cases of overdose, contact the poison control center emergency numbers.


Topamax should be stored away from sunlight and moisture. Also, it should be suitably stored at a temperature of between 15 and 30 degrees Celsius, away from children and pets.