Topamax Dosage for Weight Loss

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What is the proper Topamax dosage for weight loss? The answer is not cut and dried - it depends on a number of factors. When considering Topamax dosage for weight loss, one must take into account the risks of the medication vs. the benefits conferred by it.

What is Topamax?

Topamax (drug name topimirate) is a prescription anti-seizure medication that acts on the frontal cortex of the brain. The main use for Topamax is for control of epilepsy, however, there are several off-label uses including prevention of migraine headaches, treatment of bipolar disorder and weight loss.

While scientists aren't exactly sure how Topamax works, it is believed that it may actually re-wire the part of the brain that controls addiction, as well as calming excitable nerves, among other things.

How Does Topamax Contribute to Weight Loss?

During clinical trials of Topamax for treatment of epileptic seizures, it was discovered that many patients in the trial were losing weight. This side-effect comes from a few different properties of the medication.

  • Patients often find the taste of foods altered in such a way that they are far less palatable. This is especially notable in high fat foods, sweet foods and carbonated beverages.
  • In many patients, even small doses of Topamax either greatly reduce or outright eliminate appetite. Topamax patients often have to be reminded to eat or schedule meals so that they remember to take in adequate nutrition.
  • Topamax seems to work on the addictive centers of the brain, removing the drive behind addictions. Since many overweight people are addicted to food, Topamax may remove this addictive urge.

Side Effects of Topamax

While the above may sound like a dream come true for people desperate to lose weight, Topamax is a powerful drug, and weight loss may come at a price. Some side effects of Topamax include:

  • Brain fog and loss of mental alertness/intelligence (Topamax is sometimes referred to as "dopamax" because of the prevalence of this side effect.)
  • Dizziness
  • Kidney stones
  • Paresthesia (pins and needles/tingling) of the extremities - particularly the hands and feet, although it can also occur in the face and other body parts.
  • Fatigue
  • Confusion
  • Inability to pay attention
  • Coordination problems
  • Nausea
  • Memory loss - particularly a word accessing disorder which makes it difficult to come up with the right word at the right time.
  • Dry mouth
  • Back pain
  • Hair loss

What Is the Right Topamax Dosage for Weight Loss

The Topamax dosage for weight loss can be as low as 25 mg per day or as high as 800 mg per day--usually split into two doses. Because of the side effects, most doctors (and the drug manufacturer) recommend that you slowly ramp up your intake, starting at the smallest dose of 25 mg and working your way up by building the dose over a period of weeks. Your doctor will work with you to determine the most effective dose.

Other Factors to Consider

When considering Topamax for weight loss, you may want to factor the following into your decision:

  • The use of Topamax for weight loss is an off-label use. Clinical trials to establish Topamax as a weight loss drug were actually concluded prematurely because it was determined that Topamax side effects were not well-tolerated by patients using it to lose weight.
  • Many insurers will not cover medications that are prescribed for off-label uses.
  • Patients taking doses over 200 mg a day must taper off of the drug if they choose to stop taking it. Abruptly stopping Topamax at doses above this level can cause seizures, even in patients who have never had a seizure.
  • When discontinuing Topamax, appetite and food cravings return. It is important to learn proper nutrition and exercise strategies in order to maintain weight loss.
  • Many patients report that the weight loss/appetite loss only occurs during the first course of treatment. If Topamax is discontinued and then restarted, results will not necessarily be the same.
  • According to the Topamax package insert, weight loss only occurs in up to 16 percent of those taking it; however, some form of side effects or another occur in well over 50 percent of patients.


It is very likely that relatively small doses of Topamax can cause weight loss in many patients. It is important to note, however, that the FDA has not approved Topamax for the treatment of weight loss. When considering Topamax, work closely with your doctor and make a careful consideration of the side effects. You may decide that you are better off pursing a healthy diet and exercise program. .

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Topamax Dosage for Weight Loss