Topamax Interactions: Alcohol, Medications, and Others

Does Topamax interact with other drugs?

Before you start taking Topamax, tell your doctor and pharmacist about any prescription, over-the-counter (OTC), or other drugs you take. Sharing this information with them may help prevent possible interactions.

To learn whether Topamax interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Topamax?” section.

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The following chart lists drugs that may interact with Topamax. Keep in mind that this chart does not include all drugs that may interact with Topamax. For more information about some of these interactions, see the “Drug interactions explained” section.

When should I avoid Topamax?

Certain health conditions or other factors could increase your risk of harm if you take Topamax. These are known as contraindications. In such cases, your doctor may not prescribe this medication for you. Topamax has one contraindication, which is a previous allergic reaction.

If you’ve had an allergic reaction to Topamax or any of its ingredients, your doctor likely won’t prescribe this medication for you. Ask them about other treatments that may be better options.

Does Topamax interact with alcohol?

If you drink alcohol, you should avoid drinking it while taking Topamax. Both alcohol and Topamax reduce activity in your CNS. So consuming alcohol with Topamax can increase the risk and severity of certain side effects, such as:

• dizziness
• sleepiness
• confusion
• difficulty concentrating, remembering, or speaking

In some cases, drinking alcohol with Topamax could cause serious, life threatening side effects. These include:

• respiratory depression (slow, shallow breathing)
• unconsciousness
• coma

If you have concerns about drinking alcohol while taking Topamax, talk with your doctor.

Drug interactions explained

Learn more about certain drug interactions that can occur with Topamax.

Interaction with citalopram

Topamax may interact with citalopram (Celexa), which is a type of antidepressant.

Taking Topamax with citalopram may cause increased levels of citalopram in your body. A higher level of the drug in your body raises your risk of a serious citalopram side effect known as QT prolongation. It’s a type of abnormal heart rhythm.

You may not experience symptoms with QT prolongation. If you do have symptoms, they may include:

• a fluttering feeling in the chest
• dizziness
• fainting
• seizures

What you can do

If your doctor prescribes Topamax and citalopram together, they may adjust your citalopram dosage. If you experience symptoms of QT prolongation, contact your doctor so they can check your heart rhythm. Depending on the test results, your doctor may recommend switching either your Topamax or citalopram treatment.

Interaction with metformin

Topamax can interact with metformin (Fortamet, others), which is a drug used to treat diabetes. Both drugs can cause some similar side effects, including metabolic acidosis (high level of acid in your bodily fluids).

Taking Topamax with metformin could increase the level of metformin in your blood. It’s not known whether this increases the risk of metformin side effects. But taking Topamax with metformin could increase your risk of developing metabolic acidosis since both drugs can cause this side effect.

What you can do

If you take Topamax with metformin, your doctor may order blood tests from time to time to check the level of acid in your blood.

While taking these drugs together, try to drink plenty of nonalcoholic fluids to avoid becoming dehydrated, especially if you have vomiting or diarrhea. Dehydration can raise your risk of metabolic acidosis.

Contact your doctor if you develop symptoms of metabolic acidosis, which may include:

• loss of appetite
• headache
• confusion
• fast, shallow breathing
• increased heart rate
• extreme sleepiness
• feeling weak and generally unwell

If you develop metabolic acidosis, your doctor will likely prescribe medication to treat it. They may also recommend changes to your Topamax or metformin treatment to avoid the interaction happening again.

Interaction with Wellbutrin

Topamax can interact with bupropion (Wellbutrin SR, Wellbutrin XL, others), which is an antidepressant medication. These drugs have some similar side effects, such as sleepiness and memory problems. Bupropion can also make Topamax less effective at managing seizures.

Taking Topamax with bupropion could raise your risk of side effects. Bupropion can also lower your seizure threshold, which means you may be more likely to have a seizure. If you take Topamax for epilepsy, taking bupropion can make it harder for Topamax to manage your seizures.

What you can do

If you take Topamax for epilepsy, your doctor will likely not prescribe bupropion as well. They can discuss with you suitable alternatives.

If you take Topamax for migraine and you also take bupropion, tell your doctor if you have any bothersome side effects. They may recommend switching to a different antidepressant or migraine treatment to avoid the interaction.

Are there other interactions with Topamax?

Topamax may have other interactions. They could occur with foods, supplements, vaccines, or lab tests. Note that the information below does not include all possible interactions with Topamax.

Does Topamax interact with food?

Yes, it can. Following a ketogenic diet while taking Topamax can increase your risk of metabolic acidosis (a high level of acid in your bodily fluids). Untreated metabolic acidosis may increase your risk of kidney stones.

A ketogenic diet is one that’s high in fat and low in carbohydrates and protein. Following this type of diet can help reduce seizures in some people with epilepsy. But it may sometimes increase the amount of acid in the blood. Topamax can also have this effect.

If you follow a ketogenic diet or want to try it while taking Topamax, talk with your doctor. They can discuss with you whether it’s safe to do so while taking Topamax.

Does Topamax interact with supplements?

Before you start taking Topamax, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Topamax and herbs

There are currently no reports of Topamax interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Topamax.

Topamax and vitamins

There are currently no reports of Topamax interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Topamax.

Does Topamax interact with vaccines?

Topamax isn’t known to interact with vaccines. For information about getting certain vaccines during Topamax treatment, talk with your doctor.

Does Topamax interact with lab tests?

Topamax hasn’t been reported to interact with lab tests. If you’re interested in learning more about having certain lab tests while taking Topamax, talk with your doctor.

Does Topamax interact with cannabis or CBD?

There are currently no reports of Topamax interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). However, according to the American Heart Association, cannabis may worsen some of the known adverse effects of Topamax. For this reason, it’s important to talk with your doctor before using cannabis with Topamax.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Does my health history affect whether I should take Topamax?

Certain medical conditions or other health factors may raise the risk of interactions with Topamax. Before taking Topamax, talk with your doctor about your health history. They’ll determine whether Topamax is right for you.

Health conditions or other factors that might interact with Topamax include:

Eye conditions: Topamax can sometimes cause eye problems, such as glaucoma. If you already have an eye condition, Topamax could make it worse. Talk with your doctor about whether this drug is right for you. If you take Topamax, contact your doctor if you have any changes in your vision.

Liver problems: In people who have liver problems, Topamax may increase the risk of a high level of ammonia in the blood. If you have liver problems, talk with your doctor about whether Topamax is right for you.

Kidney problems: Having kidney problems may affect how your body rids itself of Topamax. These problems may also increase the risk of metabolic acidosis with Topamax. If metabolic acidosis is not treated, it can lead to kidney stones.

If you have kidney problems, tell your doctor before you start taking Topamax. They can let you know whether Topamax is safe for you. If your doctor recommends Topamax for your condition, they may prescribe a dosage that’s different than usual.

Severe breathing problems: People with severe breathing problems may have an increased risk of metabolic acidosis from taking Topamax. If you have a lung condition, such as asthma or chronic obstructive pulmonary disease (COPD), let your doctor know. This will help them determine whether Topamax is a good treatment option for you.

Diarrhea: If you have frequent or uncontrolled diarrhea, you may have an increased risk of metabolic acidosis with Topamax. Your doctor can discuss with you whether Topamax is right for you.

Weak, soft, or brittle bones: Topamax can cause metabolic acidosis. If this side effect goes untreated, it can lead to weakening of the bones. This could worsen conditions such as osteoporosis, osteomalacia, and rickets. If you already have problems with weak, brittle, or soft bones, talk with your doctor about whether Topamax is safe for you to take.

Mental health problems: Taking a seizure medication, such as Topamax, can increase the risk of suicidal thoughts and actions. If you’ve ever had a mental health condition, such as depression or suicidal thoughts, tell your doctor. This will help them determine whether Topamax is right for you.

Pregnancy: If taken during pregnancy, Topamax may harm a fetus. If you’re pregnant or planning to become pregnant, talk with your doctor about other medications that may be safer for your condition. Read more about Topamax and reproductive health.

Breastfeeding: Topamax can pass into breast milk. As a result, it may cause side effects such as sleepiness and diarrhea in a child who is breastfed. If you’re breastfeeding or plan to breastfeed, talk with your doctor about the risks and benefits of taking Topamax. Your doctor can also advise you on other healthy ways to feed a child.

Allergic reaction: If you’ve had an allergic reaction to Topamax or any of its ingredients, your doctor will likely not prescribe Topamax. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Common questions about Topamax and interactions

Find answers to some frequently asked questions about Topamax and possible interactions.

What pain relievers can I take with topiramate (Topamax)?

It’s likely safe to take the pain reliever acetaminophen (Tylenol) with Topamax. There are no specific reports of Topamax interacting with acetaminophen.

But you should talk with your doctor or pharmacist before taking any other pain relievers with Topamax. For example, Topamax can interact with NSAIDs and opioids. For details, see “Does Topamax interact with other drugs?”

Your doctor or pharmacist can advise whether these or other pain relievers are safe for you to take. They’ll also recommend an appropriate dosage.

What allergy medication can I take with Topamax?

Certain allergy medications can interact with Topamax, but there are also many that don’t.

For instance, it’s best to avoid taking antihistamines that have a sedating effect (causes feelings of drowsiness or relaxation) with Topamax. An example of a sedating antihistamine is diphenhydramine (Benadryl). Taking this type of allergy medication with Topamax could make you very sleepy, confused, or unable to concentrate.

However, it’s usually safe to take nonsedating antihistamines such as loratadine (Claritin) or cetirizine (Zyrtec Allergy) with Topamax. It’s also considered safe to use corticosteroid nasal sprays such as fluticasone (Flonase Allergy Relief) with Topamax.

If you need to use an allergy medication while taking Topamax, ask your doctor or pharmacist to recommend a suitable product.

Are there interactions between prednisone and Topamax?

No, Topamax hasn’t been reported to interact with prednisone.

Prednisone is a type of drug called a corticosteroid. It’s used to reduce inflammation (swelling and damage) caused by many conditions. It’s generally considered safe to take Topamax together with prednisone.

If you have questions about taking prednisone with Topamax, talk with your doctor or pharmacist.

How can I prevent interactions?

Taking certain steps can help you avoid interactions with Topamax. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Topamax treatment.

It’s also important to read Topamax’s label and other paperwork that may come with the drug.

You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Topamax, ask your pharmacist to print a copy for you.) If you have trouble understanding this information, your doctor or pharmacist can help.

Taking Topamax exactly as prescribed can also help prevent interactions.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.