Topiramate Dosing

Topiramate dosing for migraine prevention usually starts at 25 mg once daily but is gradually increased up to 50 mg twice a day. For adults and children age 10 and up who are using topiramate for epilepsy treatment, the recommended dose is 200 mg twice daily. Those who are using the drug in combination with other epilepsy medications generally take 100 mg to 200 mg twice per day. Your topiramate dosage should be taken at the same times each day to maintain an even level of medicine in you blood.

 

Topiramate Dosage: An Introduction

The dose of topiramate (Topamax®) that your healthcare provider recommends will vary depending on a number of factors, including:
 
  • Your age
  • The medical condition being treated
  • Other medical conditions you may have
  • Other medications you may currently be taking.
     
As is always the case, do not adjust your topiramate dose unless your healthcare provider specifically instructs you to do so.
 
Topiramate Dosing for Migraines
The recommended topiramate dose for migraine prevention is 50 mg twice daily. It is recommended to start at a lower dose and slowly work up to topiramate 50 mg twice daily. The manufacturer recommends the following way to increase the dose:
 
  • First week -- 25 mg once daily in the evening
  • Second week -- 25 mg twice daily
  • Third week -- 25 mg in the morning and 50 mg in the evening
  • Fourth week -- 50 mg twice daily.
     
Topiramate Dosing for Epilepsy (Monotherapy)
The recommended topiramate dose for epilepsy as monotherapy (used alone) for adults and children age 10 and up is 200 mg twice daily. The manufacturer recommends slowly increasing the dose as follows:
 
  • First week -- 25 mg twice daily
  • Second week -- 50 mg twice daily
  • Third week -- 75 mg twice daily
  • Fourth week -- 100 mg twice daily
  • Fifth week -- 150 mg twice daily
  • Sixth week -- 200 mg twice daily.
     
Topiramate Dosing for Epilepsy (Adjunctive Therapy)
The recommended topiramate dose for epilepsy as adjunctive therapy (in combination with other epilepsy medications) varies depending on age and the type of seizures. For people age 17 and over, the recommended dose is 100 mg to 200 mg twice daily for partial seizures or 200 mg twice daily for generalized tonic-clonic seizures. The dose should be slowly increased up to the recommended dose, as when used for monotherapy.
 
For children age 2 to 16, the recommended dose of topiramate is 5 mg to 9 mg per kg of weight (about 2.3 to 4 mg per pound), split into two doses per day. The starting dose should be low and should be increased slowly as directed by your child's healthcare provider.
 
(Topiramate Dosing Continued: Page 2)
Add this article to your Favorites     Email this article     Print
Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD
Last reviewed by: Kristi Monson, PharmD;