June 4, 2023

Topamax is a medication that can be used for a couple of different reasons.

Hey guys this is curtis alexander i’m a pharmacist and in today’s video i want to touch on a topic that is discussed a lot which is how do i stop a certain medication and there’s a lot of them that you can stop without too much fanfare but there’s some medications that you really have to be careful a with how you start them meaning you have to start them very

Slowly increase the dose slowly over time and also if you or your doctor decide that you want to stop that it needs to be slowly decreased over time to minimize really some of the withdrawal side effects that you can see from certain medications so if your doctor and and you together decide that hey i want to get off the medication there’s certain steps that you

Have to follow with certain drugs one of those being topamax now topamax is primarily used it can be used for different things but primarily we see it you can use it for migraine prevention you can also use it to control seizures the dosing ranges for both of those things are different and that is going to affect how you lower and stop the medication so obviously

This is something you always discuss with your doctor but i’ve had a number of doctors ask me the best way to stop topamax and and this will kind of serve as a resource in that way as well so i just want to hop right into it okay so we already talked about using it for migraine prevention and seizure control the general rule of thumb when we’re going to stop topamax

Is it can be as quick as a couple weeks it may take months again it’s depending on what we’re treating what the dose is how long patient how long you’ve been on it okay so general rule of thumb if we’re using it for migraines we can decrease it by 25 to 50 milligrams per week if it’s seizure control we can lower it at a higher milligram 50 to 100 milligrams per

Week decrease but we also tend to see higher doses in seizure control so it’s kind of one of those things that sounds like that’ll you’ll be able to stop it faster it’s usually not the case because the doses are higher um the biggest thing i can stress is if you or your doctor unsure it’s always best to side with you’re going to taper it more slowly rather than

Faster which brings up a couple of good questions what will happen if you go too fast well we’re going to see some withdrawal symptoms some of those can be an increase in headaches increase in seizures anxiety insomnia sweatiness some of these withdrawal symptoms you can see if you go too fast what i want to do is walk through a couple of examples just to give

You an idea of what we’re talking about so let’s say and this is actually an example that came up at our clinic not too long ago we had a patient that was taking topamax for seizures at 150 milligrams the bid means twice a day so 150 milligrams twice a day that gives us 300 milligrams total per day so in this particular patient’s case week one we had them do a

Hundred milligrams in the morning and then 150 milligrams in the evening so that gave us 250 the first week so we’re i’m leaning towards the lower end of that range we’re going to decrease it by 50 milligrams a week so we had him do that dose for a week then we dropped it down to 100 milligrams twice a day so now we’re down to 200 and we kept dropping it 50

Milligrams each week so now we’re down to 50 in the morning 100 in the evening then 50 twice a day then finally in the fifth week we’re at 50 once a day we do that for seven days then we stop okay fairly simple but we just have to be patient if anywhere along this line if like if in the first week i noticed that uh we’re seeing you know that we saw a seizure

Or we’re getting some withdrawal symptoms we’ll slow it down okay now let’s look at migraine prevention again the migraine doses are generally lower so in this particular case we’ve got a patient taking 100 milligrams qd means daily just once a day so in the first week what we can do is again i’m going to stay on the low end of the range drop at 25 milligrams

So instead of 100 milligrams we’re going to go 75 per day first week second week 50 a day then of course third week 25 a day we do that for a week then we should be able to stop without any issues okay so again topamax is a drug you have to be very careful with when you start it and when you stop it rule of thumb always go on the slower side don’t do it any

Faster than two weeks um even if it’s a low dose even if i had a patient come to me 50 milligrams a day for migraine prevention i’m still gonna go 25 maybe even for a full two weeks or maybe 25 for a week than 25 every other day for at least two weeks sometimes it’ll take longer sometimes got to go up to three months depending on the dose and just be patient so

This is a couple examples uh for any providers out there who need a little guidance any patients who want to talk to their doctor come up with a game plan hopefully this provides you with a good example so in the comments be sure to subscribe be sure to like in the comments if you want other video topics covered please mention them i can’t promise that i’ll respond

To every comment as i do more videos i’m getting a lot a lot of comments i can’t keep up with them i promise that i read them so please if there’s something you want me to cover let me know also go to curtis-alexander.com i have a free 30 days to health report it covers some of the things for people who maybe you’re on topamax and you want to look at other options

That are more natural i talk about medications but i also talk about options that are outside the drugs and surgery realms that i use myself that i’ve seen other patients use so be sure to check that out it’s free love you to have it so again hope this video was helpful and until the next one have a good one

Transcribed from video
How To Taper Off Topamax (With Examples) By Curtis Alexander Pharm.D.