Topiramate, known under the brand name Topamax, is a medication primarily prescribed to treat epilepsy and prevent migraine headaches. It belongs to a class of drugs called anticonvulsants and is available in both oral tablets and sprinkle capsules. While the Food and Drug Administration (FDA) has approved Topamax for these specific conditions, it is sometimes prescribed off-label for weight loss. Off-label use refers to when a drug approved by the FDA for one purpose is prescribed for a different, unapproved purpose. This article explores the use of Topamax for weight loss, its effectiveness, potential side effects, and important considerations.
Understanding Topiramate
Topiramate is an anti-epileptic drug also used as a mood stabilizer in psychiatric patients. It was FDA-approved in 1996 for epilepsy treatment and later, in 2012, for migraine prevention. Aside from its approved uses, Topiramate is also used off-label for bipolar disorder, mood disorders, OCD, and PTSD. Multiple physiological mechanisms are described for Topiramate, enhancing its ability to treat a wide array of seizure types. The main effects associated with Topiramate are to reduce neuronal excitation and to enhance neuronal inhibition. The drug possesses sodium-channel blocking activity, enhancement of cerebral GABA concentrations, and antagonism of the AMPA/kainite receptors, leading to decreased glutamate-mediated excitation and subsequent reduction in neuronal excitation. Topiramate also increases the frequency of GABA-mediated chloride channel opening and increases potassium induction, further alleviating seizures by enhancing neuronal inhibition.
How Topiramate May Contribute to Weight Loss
Although the biological mechanism behind Topiramate-induced weight loss is not well-described, possible mechanisms include lowering calorie intake, decreasing fat gain, and decreased triglycerides and cholesterol levels. Studies show that Topiramate reduces energy deposition without changing food consumption by disrupting efficient energy utilization. This suggests Topiramate can stimulate lipoprotein lipase in brown adipose tissue and skeletal muscle, increasing thermogenesis and substrate oxidation. A review endorses the ability of Topiramate to induce weight loss, which is most significant in patients with a high BMI. Other sources have described that Topiramate may play a role in the gene encoding for neuropeptide Y, which influences the leptin pathway. Leptin, a hormone involved in fat storage, is released by adipose tissue and binds receptors in the hypothalamus, which modulates the secretion of neuropeptide Y. Studies have described reduced leptin levels while patients were on topiramate, which directly correlated with weight reduction. Overall, body weight and metabolism are also constantly regulated by signals from leptin and insulin in the hypothalamus. Pro-opiomelanocortin (POMC) neurons within the arcuate nucleus release melanocortin, which acts on the paraventricular hypothalamus to release thyrotropin-releasing hormone (TRH) and corticotropin-releasing hormone (CRH). Insulin and leptin act on this pathway to regulate metabolism. Topiramate has also been determined to lower fasting blood glucose, cholesterol, triglycerides, and HDL levels. Topiramate is a carbonic anhydrase inhibitor, which can influence the carbonic anhydrate enzymes involved in cellular lipogenesis.
Clinical Evidence and Studies
A 2023 review indicates that Topiramate may be effective for weight loss in adults, despite not being FDA-approved for this purpose. Research studies evaluating Topiramate for weight loss have included adults with a BMI of at least 27 or higher. These studies didn’t evaluate whether Topiramate is effective for weight loss in people younger than 18 years old or with a BMI below 27. Doctors often will not recommend medications for weight loss in people with a BMI below 27, although there may be exceptions.
In one study, adults with obesity who took Topiramate daily for 24 weeks lost an average of 4.8% to 6.3% of their body weight. In another study, adults with obesity and type 2 diabetes who took Topiramate (in combination with metformin) daily for 24 weeks lost an average of 4.5% to 6.5% of their body weight. It’s important to note that these studies combined Topiramate with diet and lifestyle changes. Weight loss results will vary between people who take Topiramate.
Read also: Comprehensive Study: Metformin and Phentermine/Topiramate
Key Studies
- Bray et al. evaluated the efficacy and safety of TPM for weight reduction in obese and healthy participants. The mean percent weight loss from baseline to week 24 was −2.6% in the placebo group and −5.0%, −4.8%, −6.3%, and −6.3% in the TPM groups.
- Moradi et al. evaluated the effect of TPM on weight loss in patients with type 2 diabetes. The mean BMI changes were significantly higher, the mean weight loss was significantly higher, and the systolic blood pressure and glycosylated HgA1c were significantly decreased in the TPM group.
- Toplak et al. evaluated the safety and efficacy of TPM in obese patients with type 2 diabetes concurrently treated with metformin. The placebo, TPM 96 mg group, and TPM 192 mg group lost 1.7%, 4.5%, and 6.5% of their baseline body weight.
Dosage and How to Take Topiramate for Weight Loss
Because Topamax isn’t approved for weight loss, there is no standard dose. A doctor will help you determine the best dosage of topiramate for you to take for weight loss. Note: The FDA hasn’t approved these dosages for weight loss. In addition, the Topamax dosage for weight loss may differ from Topamax dosages recommended for the drug’s approved uses of migraine episode prevention and the treatment of some types of epilepsy seizures. Your doctor can advise you on the correct dose for weight loss.
Tablets: Swallow whole. Do not crush, split, or chew the tablet.
Sprinkle capsules: Topamax oral sprinkle capsules can be swallowed whole. You may also open the capsules and sprinkle the contents on soft food, such as applesauce. You should swallow the mixture right away without chewing.
Frequency: Topamax is usually taken once daily at the time your doctor recommends.
Potential Side Effects
Topamax may cause side effects that are mild or severe. The following list includes some of the more common side effects reported in clinical trials of Topamax for its FDA-approved uses. The side effects of Topamax, when taken for weight loss, are expected to be similar. Common side effects of Topamax include: weight loss, abdominal pain, changes in how foods taste, diarrhea, a tingling feeling in your arms and legs (paresthesia). These side effects of Topamax are usually temporary, lasting a few days to weeks. But talk with your doctor or pharmacist if they last longer, bother you, or become severe.
Read also: Antipsychotic-Induced Obesity Treatment
Less common serious side effects of Topamax include: trouble speaking, memory problems, vision changes. Call your doctor right away if you develop serious side effects while taking Topamax.
Topiramate use for weight loss can cause many adverse effects, such as: nervousness, drowsiness, numbness in feet or hands, shaking or tremors, nausea, stomach pain, and constipation, excessive menstrual bleeding, missed menstrual periods, bone pain, weight loss. Serious side effects may include: hyperthermia, suicidal ideation, impaired liver function and liver disease, bloody or cloudy urine, painful urination, usual bruising or bleeding, intense side or back pain, fever. If you experience any troubling side effects of topiramate or an unusual or allergic reaction, call your doctor immediately. They may advise you to stop taking it or may adjust your dose.
Risks and Precautions
Before your doctor prescribes Topamax for weight loss, there’s some important information to keep in mind. The drug may not be a safe option if you have specific medical conditions or other factors affecting your health. Talk with your doctor before taking Topamax if you have: eye problems, such as glaucoma, a job that requires working in hot weather or a hot environment, a kidney condition, such as chronic kidney disease, a breathing condition, such as chronic obstructive pulmonary disease, a ketogenic diet that you follow, chronic diarrhea, depression or other mental health conditions, a history of suicidal thoughts or behaviors, osteoporosis or weak bones caused by another condition, a liver condition, such as cirrhosis, upcoming surgery scheduled, a pregnancy, a baby you are breastfeeding, regular alcohol consumption, an allergic reaction to Topamax or any of its ingredients.
Patients with seizure disorder, bipolar disorder, alcohol use disorder, and panic attacks should be cautious. A risk evaluation is necessary to determine the safety of Topamax for specific medical conditions. Women using oral contraceptives should note that Topamax may reduce the effectiveness of birth control pills. Patients with: chronic lung disease, uncontrolled blood pressure, severe metabolic acidosis, existing heart conditions should avoid using Topamax for weight loss without medical supervision.
Dangers of Rapid Weight Loss
Topamax can lead to rapid weight loss due to appetite suppression. However, losing weight quickly has many health risks, including: vitamin and mineral deficiencies, muscle loss, malnourishment, decreased metabolism. Additionally, using Topamax for weight loss can increase the risk of disordered eating behaviors as well as the risk of developing full-blown eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN). Further, rapid weight loss can lead to rebound weight gain, something known as weight cycling. Research indicates that weight cycling is worse for your health than never dieting at all and that it can increase your mortality rate or risk of death.
Read also: Weight Loss with Contrave and Topiramate
Metabolic Acidosis
If an individual is following the keto diet to lose weight, taking Topamax for weight loss could be especially dangerous due to the severe body weight changes, as well as the risk of metabolic acidosis, which occurs when there’s a buildup of acid in the body. Metabolic acidosis can cause: fatigue, hyperventilation, stupor, cardiac arrhythmias, kidney stones, bone softening, osteoporosis. It can also result in a loss of appetite, leading to even more weight reduction from a reduced-calorie diet, which can exacerbate issues like osteoporosis.
Topiramate vs. Qsymia
Topamax contains the active ingredient topiramate. This ingredient is also in Qsymia, an FDA-approved drug for long-term weight management. (The other active ingredient in Qsymia is phentermine.) To learn how Qsymia compares with Topamax for weight loss, talk with your doctor.
Cost and Accessibility
The cost of Topamax depends on several factors. These can include your prescribed treatment regimen, the insurance plan you have, the pharmacy you use, and your location. Topamax is a brand-name drug. It’s also available as a generic called topiramate. Brand-name drugs usually cost more than generics. Your doctor can help you decide which option is right for you.
Obtaining Topiramate for Weight Loss
If you’re interested in taking Topamax for weight loss, talk with your doctor. They can help determine whether Topamax is a good option for you and provide a prescription. Another way to obtain Topamax is by using a reputable telehealth service, such as Ro Body. A licensed telehealth professional will evaluate your health. If they determine that Topamax may be right for you, they’ll provide an electronic prescription. You can then order the medication through the service. The services also include coaching and other support to help you manage your weight. If you get a Topamax prescription through Ro Body, you should tell your doctor. It’s important that they know about all medications you take.
User Reviews and Important Considerations
User-generated content, such as reviews and ratings, reflects individual opinions and experiences, which may not be representative of scientific or medical facts. It's crucial to consult healthcare professionals for accurate information and guidance.
Positive Reviews
Some users have reported positive experiences with Topiramate, noting its effectiveness in controlling racing thoughts and reducing alcohol cravings. Some users have found it to be a great weight management pill.
Negative Reviews
Other users have reported negative experiences, including feelings of strangeness, tingling sensations, headaches, and fatigue after taking Topamax.
Overdose Information
It is possible to overdose on topiramate. Signs and symptoms of a topiramate overdose include: vomiting, seizures, trouble speaking, blurred or double vision, loss of consciousness, agitation, shallow, fast breathing, irregular heartbeat, unresponsiveness. If you suspect that you or someone else has experienced a Topamax overdose, call 911 immediately. If you are a witness, stay with the overdosing person until first responders arrive to ensure their safety.
The Influence of Diet Culture
People who decide to use medication like topiramate for weight loss are typically influenced by the insidious nature of diet culture. Diet culture is ever-present, in media, pop culture, advertisements, and marketing, at grocery stores, in conversations, at work and in doctor’s offices, on food labels and menus, and beyond. And diet culture, which tells us that body shape and weight are more important than well-being, leads to anxiety about weight gain, body shape, body size, and more. When you choose to use a rapid weight-loss medication like topiramate, you’re subscribing to harmful beliefs about your body and self-worth. This may be an indication that you’re struggling with disordered eating patterns or even an eating disorder.
Seeking Help
It’s never too late or too early to seek help. You can reach out to your doctor for an assessment and a referral or seek treatment on your own. There are plenty of options from in-person treatment at an inpatient or outpatient basis to online eating disorder treatment programs.
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