Can Topiramate (Topamax) Help You Lose Weight?

Does Off-Label Topiramate Support Weight Management?

“Doctors will find out that certain medications do certain things effectively, and then will start using them for that purpose,” Dr. Rogers says. “Part of the reason that topiramate may not be FDA-approved for weight loss is that although research has found that it can be effective, researchers don’t yet fully understand how it achieves this weight loss effect.”

A doctor might prescribe topiramate for weight loss if other options haven’t worked, have led to severe side effects, or are too costly for the patient, she adds.

“It all comes down to what insurance will cover, what works, and what the patient can afford,” Rogers says. “If a patient also lives with migraine, a doctor might choose topiramate to try to achieve both effects with a single medication.”

How Much Weight Do People Lose on Topiramate?

Studies of topiramate often involve people with a BMI of 27 or higher. Research has not assessed its effectiveness in people with a lower BMI or those under 18 years of age.

How Can Taking Topiramate Lead to Weight Loss?

• Altering Metabolism A leading theory suggests that topiramate changes the way the body uses energy, which can cause increased fat burning. Researchers have also observed that it can lower fasting blood glucose, triglycerides, and low-density lipoprotein (LDL, or “bad”) cholesterol, while increasing levels of high-density lipoprotein (HDL, or “good”) cholesterol. This could also support weight loss by improving metabolism.
• Altering Reward Pathways Topiramate may alter food-related reward pathways in the brain, nervous system, and hormonal system. This may help to improve a person’s appetite control.
• Loss of Taste Taste impairment is a known side effect of topiramate and may contribute to weight loss by making certain foods less desirable.

More research could help confirm the mechanism by which topiramate supports weight management. In the meantime, its use for weight loss will remain off-label.

Topiramate and Combination Therapy: Is It Safe?

However, Rogers notes that phentermine is technically a kind of amphetamine, which is a controlled substance that may pose a risk of abuse in some people. It may not be suitable for everyone who requires weight loss support.

Side Effects and Risks of Topiramate

The side effects of topiramate commonly include the following:

• Blurred vision
• Skin sensations, including burning, prickling, or tingling
• Unsteadiness or clumsy movements
• Confusion
• Continuous, uncontrolled eye movements, including rolling the eyes and moving them back and forth
• Dizziness
• Double vision
• Feeling lethargic
• Red or painful eyes
• Increase pressure in the eyes
• A general increase in mental and physical sluggishness
• Memory issues
• Changes to the menstrual cycle
• Menstrual pain
• Increased nervousness
• Changes to speech or language
• Concentrating or attention issues
• Fatigue
• Weakness

A range of less common side effects can also occur, including:

• Mood changes, including aggression, agitation, irritability, feeling low, or reduced emotions overall
• Chest pain
• Fever and chills
• Red, bleeding, or irritated gums
• Stomach pain
• Sleep issues

Rarely, topiramate can cause changes to or issues with urination, such as:

• Reduced bladder control
• Peeing more often
• Blood in the urine
• Increased pain or difficulty while peeing

It can also rarely lead to:

• Breathing problems
• Swelling
• Pale skin
• Nosebleeds
• Side or lower back pain
• Itching or a skin rash
• Hearing loss

Other side effects are possible. Talk to your healthcare professional if you experience unwanted physical changes after you start to take topiramate.

Is It Safe to Lose Weight Quickly?

Rogers says that it’s critical to get plenty of protein and hydration while losing weight to avoid adverse effects.

The Takeaway

• Topiramate is an FDA-approved drug for treating epilepsy and preventing migraines that doctors sometimes prescribe off-label to promote weight loss.
• Studies report slow weight loss of 5 percent to more than 9 percent, depending on the dose a person takes, although how it works isn’t yet clear.
• Topiramate is generally well tolerated, but it can cause a range of side effects in some people and is a neurological medication that needs a specialist prescription.
• If you want to stop taking topiramate, speak to a clinician about tapering and monitoring, as rapid cessation can be dangerous for people taking it for its labeled use.