I Forgot Why I Cake Topamax
I <3 Topamax
Why Don’t They Just Make Planes out of Black Boxes?
This is the stuff you actually need to be concerned about if you are currently taking, or considering taking, a medication. The black box 1 and other warnings are side effects that can be especially hazardous, if not fatal. These are often, but not always, what a med is most notorious for, e.g. The Lamictal Rash is a black box warning.
If a drug has a black box warning then a verbatim copy of it from its full US PI sheet will be here. We may comment on any black box warning. E.g. Translate doctorese, note just how rare the problem is, or how the warning is the result of the nexus of panic and politics. Any other warnings of note, the pregnancy category, and comments about them, will go here as well. As with Topamax’s side effects, if you want to see them all, you’ll need to read the PI sheet. If you want to be
paranoid pharmacophobic thorough, check Summary of Product Characteristics (SPCs) or other PI-equivalents we’ve found from other countries on the page of allegedly useful links. The US PI sheets have all the warnings you need to be actually concerned about, but once in awhile one will show up in some commie country on an overseas SPC before a PI sheet.
Black Box Warnings
Black Box Comments
Look at that. No black box warning. Not a one. Topamax might make you dumber than a box of rocks, keep you from sweating when it gets hot, turn your kidneys into gravel pits, and any kids you might have will look like…you don’t want to know, but it won’t kill you.
Not that any of the other meds on this site are likely to kill you, it’s just next to impossible for Topamax to kill you.
Topamax (topiramate) Other Warnings & Things to Worry About
- Oligohidrosis (decreased sweating) hyperthermia (increased body temperature). Children and the vaguely-defined “elderly” are especially susceptible to these, which often happen together.
- Kidney stones.
Medicated For Your Protection
Topamax (topiramate) Pregnancy Category
D-Will probably harm your baby
Pregnancy Category Comments
Topamax has been recently downgraded from pregnancy category C to D.
TOPAMAX® (topiramate) can cause fetal harm when administered to a pregnant woman. Data from pregnancy registries indicate that infants exposed to topiramate in utero have an increased risk for cleft lip and/or cleft palate (oral clefts). When multiple species of pregnant animals received topiramate at clinically relevant doses, structural malformations, including craniofacial defects, and reduced fetal weights occurred in offspring. TOPAMAX® should be used during pregnancy only if the potential benefit outweighs the potential risk. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus. Topamax PI sheet
Fun Fact: the newly-approved diet drug Qsymia, a combination of phentermine and extended-release topiramate, is pregnancy category X; and not just because phentermine is category X due to losing a lot of weight during pregnancy is extremely dangerous. Nope, it’s due to Topamax’s effect. But if you compare the data in the Topamax PI sheet with the Qsymia PI sheet it looks like Topamax by itself is more likely to cause problems, because OrthoMcNeilJanssenFoetusInterruptus, or whatever they’re calling themselves these days, included data from the UK Registry, with its much higher rate of oral clefts2.
So why is topiramate considered category D for one application and category X for another? Because epilepsy and migraines are more serious conditions than obesity. And Qsymia is an add-on to eating less and exercising more - AKA the exact same thing you’re supposed to do with the miracle diet pills they advertise heavily on TV in December and January. Migraines may not kill you, even if you wish they would, but a seizure can kill you immediately. Obesity takes a long time to kill you. That’s the difference.
What Do the Pregnancy Categories Mean?
Pregnancy categories A, B, C, D, and X are used to quantify both risk and the risk-to-benefit ratio. They are relatively neutral when it comes to severity of birth defects.
The only difference between categories A and B is that the drug companies conducted human trials to get that A rating, while the B rating means there has been no reported birth defect of any kind since the drug has been on the market. With both A and B, no matter how much of either med researchers give to critters, their cute little babies are just fine. Until dissected to prove there is no problem.
Category X is fairly straight-forward. You take this drug while pregnant, possibly pregnant, or potentially pregnant, your kid will be born with three arms and a total of two fingers. There are also plenty of alternatives available. So unless you’ve tried absolutely everything else already, and you insist on damning some innocent child to the same brain cooties that you have, talk to your doctor about another med.
It’s the meds that are categories C and D are difficult. C means animals gave birth to mutants when given anywhere from sub-therapeutic to ridiculously high amounts of the medication in question, and there have been reports of human birth defects that may be to probably are3 due to taking the med. Sometimes the data from the field are so vague (e.g. all or almost all the women were taking at least one other medication), and the critters didn’t spawn Roger Cormanesque offspring on anything lower than 50 times the maximum human dosage, that it’s pushing a C+ to B-. The important thing is category C meds are first-line drugs while category D meds are often, but not always, second- or third-line drugs.
For more information, see the Federal Regulations covering PI sheets and the FDA’s Summary of Proposed Rule on Pregnancy and Lactation Labeling. They’re both remarkably clear for legal / bureaucratic documents. Doubly so considering the FDA published them.
Bipolar is NOT Contagious
PTSD is NOT Contagious
Epilepsy is NOT Contagious
Mental Illness is NOT Contagious
You don’t have to buy anything. Look around. Share what you like with your Pinterwit friends. Maybe they’ll buy it for you. Probably not.
Drug-Drug, Drug-Supplement, Drug-Food Interactions
Most drug-whatever interactions involve elimination metabolism. With crazy meds the best known example is Lamictal and Depakote or whichever flavor of carbamazepine you’re taking. If you’re taking Depakote you need to take less Lamictal less often. With Tegretol or Equetro you need to take more Lamictal more often. That’s not always the case. Interactions can affect transformation, which is why Paxil + tamoxifen = that breast cancer isn’t going anywhere, because tamoxifen itself doesn’t do shit, your liver turns it into endoxifen (and perhaps others), which does all the dirty work. Interactions can also be potentiations, where one drug enhances the effect of another without slowing its clearance. All patient information leaflets and drug-drug interaction checkers have boilerplate potentiation interactions along the lines of, “two or more antidepressants meds can make you extra drowsy/spacey/ready to go on a tri-state multicide spree.” Alcohol potentiates the sedative effects of TCAs, while alcohol and benzodiazepines potentiate each other4. There can be interactions that are beneficial, and those rarely show up in PI sheets or drug-drug interaction checkers.
Noted Drug-Whatever Interactions
Don’t take Topamax with carbonic anhydrase inhibitors like acetazolamide and brinzolamide.
Topamax + phenytoin or fosphenytoin = less Topamax and more phenytoin/fosphenytoin.
Topamax can cause lithium levels to change in an unpredictable manor. In it states:
In patients, the pharmacokinetics of lithium were unaffected during treatment with topiramate at doses of 200 mg/day; however, there was an observed increase in systemic exposure of lithium (27% for Cmax and 26% for AUC) the US PI sheet
Add to that these two cases reports, Does topiramate elevate serum lithium levels? and Topiramate can cause lithium toxicity and similar warnings in PI/SPCs from other countries.
However, a study referenced in Antiepileptic Drugs has Topamax lowering lithium levels 11% to 16%. The anecdotal evidence is all over the map. So neither, either, or both could happen to you over the course of time. Lithium is almost entirely processed by your kidneys; Topamax is mostly processed by your kidneys and works them pretty hard, so the odds are you’ll retain more lithium if you take the two of them together.
Taking Topamax and Glucophage (metformin HCl) together may not be a good idea, since they do the exact same thing. Both lower blood sugar by being inhibitors of gluconeogenesis, which is the primary mechanism by which Topamax causes weight loss; and why it was initially investigated as diabetes drug back in the 1970s & 80s.
Topamax’s affect on metformin’s clearance, etc. is minor. You’d get the equivalent of a 25% increase in metformin dosage. Since they do the same thing, but there’s not a lot of information on how well Topamax works in that regard, there’s no way to tell how much of Topamax equal how much metformin.
Check for Drug-Drug-Drug Interactions
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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- Topamax’s Full US Prescribing Information
- Poore, Jerod. “Lamictal (lamotrigine): a review of the literature and consumer experience. Highlighting its use, adverse events, and pharmacology from the educated consumers’ perspective.” Crazymeds www.crazymeds.net (2014).
- “Code of Federal Regulations Title 21 PART 201 — LABELING Subpart B—Labeling Requirements for Prescription Drugs and/or Insulin” U.S. Food and Drug Administration website Last accessed 16 July 2014
- “Summary of Proposed Rule on Pregnancy and Lactation Labeling” Last Updated: 11/12/2009 U.S. Food and Drug Administration website Last accessed 16 July 2014
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1 Called "black box warnings" because they appear in a box at the top of the PI sheets, written in big, bold print, and originally surrounded by a thick, black outline. Some companies still put black box warnings in a black box. There is no relationship to the black boxes in airplanes, although I haven't tried burning a number of different PI sheets to see if the black box warnings are still legible in the ashes.
2 Although, really, can you honestly tell me some Brit has a messed-up gob due to a drug his mum took when she was preggers?
3 Don't expect the drug companies to always cooperate in figuring out where on that scale their meds are.
4 Or: Alcohol + TCAs = Die like a 1960s trophy wife. Alcohol + Benzos = Die like a rock star.
If you have any questions not answered here, please see the Crazymeds Topamax discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)
|Last modified on Tuesday, 08 July, 2014 at 16:58:25 by JerodPoore||Page Author Jerod Poore||Date created Tuesday, 11 January 2011 at 13:43:23|
|“Topamax (topiramate): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2011 Jerod Poore||Published online 2011/01/11|
|Citation options to copy & paste into your article:|
|Plain text:||Poore, Jerod. “Topamax (topiramate): a Review for the Educated Consumer.” Crazymeds (crazymeds.net). (2011).|
Topamax, and all other drug names on this page and used throughout the site, are a trademark of someone else. Topamax’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList,
NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!
‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.