Before Using This Medicine

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

Other medical problems—The presence of other medical problems may affect the use of topiramate. Make sure you tell your doctor if you have any other medical problems, especially:

• 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