topiramate
Adjunctive therapy • Brands: Topamax, Trokendi XR, Qudexy XR
Last reviewed: 2025-12-30
General information
- Primary label indications include: Epilepsy; migraine prophylaxis (label).
- Class: Adjunctive therapy
- Common US brands: Topamax, Trokendi XR, Qudexy XR
- Therapeutic drug monitoring not routinely recommended.
- Last reviewed: 2025-12-30
Dosing & forms
- Forms/strengths: —
- Frequency: —
- Food: —
- Typical range: —
Mechanism (brief)
Broad-mechanism antiepileptic and migraine-preventive agent (includes voltage-gated sodium-channel effects, enhanced GABA activity, AMPA/kainate antagonism, and carbonic anhydrase inhibition). In psychiatry it is sometimes used off label for alcohol use disorder, binge-eating disorder, and to mitigate antipsychotic-associated weight gain, balancing potential benefit against cognitive and metabolic adverse effects.
Metabolism & Half‑life
- Metabolism: Not extensively metabolized; metabolites formed via hydroxylation, hydrolysis, and glucuronidation (label).
- Half‑life: Single-dose mean 21 h
Therapeutic Drug Monitoring (TDM)
Recommended: No
Monitoring highlights
- —
Sources
- Topiramate tablets prescribing information — DailyMed (2025)
- Topiramate for Treating Alcohol Dependence A Randomized Controlled Trial — JAMA (2007)
- Double-Blind, Randomized, Placebo-Controlled Trial of Topiramate Plus Cognitive-Behavior Therapy in Binge-Eating Disorder — Journal of Clinical Psychiatry (2007)
- Efficacy of Metformin and Topiramate in Prevention and Treatment of Second-Generation Antipsychotic–Induced Weight Gain — The Annals of Pharmacotherapy (2010)
- AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)