Topiramate Dosage and Administration

Introduction to Topiramate

The maximum dose of topiramate depends on the indication, with a maximum studied dose of 1,600 mg/day for epilepsy and 92 mg/day for weight loss as phentermine/topiramate ER (Qsymia) 1

The maximum dose of phentermine/topiramate ER for weight loss is 15 mg phentermine/92 mg topiramate daily, which has demonstrated superior efficacy compared to lower doses 1, 2
The titration schedule for phentermine/topiramate ER starts with 3.75 mg/23 mg daily for 14 days, increasing to 7.5 mg/46 mg daily, and then to 11.25 mg/69 mg daily, and finally to the maximum dose of 15 mg/92 mg daily if inadequate response 1, 2
Discontinue phentermine/topiramate ER if less than 5% weight loss is achieved after 12 weeks on the maximum dose 1, 4

Topiramate should never be stopped abruptly, and instead, should be tapered gradually to minimize seizure risk 1
For phentermine/topiramate ER, patients should take one capsule every other day for at least 1 week before stopping 1
Topiramate is teratogenic and associated with orofacial clefts when exposed during the first trimester, and pregnancy tests are required for women of childbearing potential 1, 5, 4
Topiramate may reduce the efficacy of hormonal contraceptives 3