This sheet talks about using topiramate in a pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What is topiramate?

Topiramate is an antiepileptic medication used to prevent seizures and migraine headaches. It has also been used to treat alcoholism, eating disorders, tremors, obesity, diabetes and psychiatric disorders such as bipolar disorder. Topiramate is sold under the brand names Topamax®, Trokendi XR®, Qudexy XR®). It is also part of a weight loss drug called Qysymia®.

I take topiramate. Can it make it harder for me to get pregnant?

Studies have not been done to see if topiramate use could make it harder for women to get pregnant. Studies have found that the long-term use of seizure medications in women with a seizure disorder might be associated with irregular periods and difficulty getting pregnant.

If you are taking topiramate and planning a pregnancy, talk to your healthcare providers before getting pregnant. Women taking topiramate are advised to take a higher dose of folic acid for at least 3 months before becoming pregnant to help lower the chance for birth defects.

The use of topiramate at the same time as birth control medications may make the birth control product less effective. Please discuss this with your healthcare provider if you take topiramate and want to take birth control medications.

I just found out I am pregnant. Should I stop taking topiramate?

Talk with your healthcare providers before making any changes to this medication. Having a seizure or untreated maternal psychiatric disorder while pregnant may be harmful to the pregnancy. The benefits of taking topiramate must be weighed against the potential risks to the pregnancy. Depending on your situation, your healthcare provider may advise against changing or stopping your medication.

Does taking topiramate increase the chance for miscarriage?

Miscarriage can occur in any pregnancy.  Studies have not been done to see if topiramate increases the chance for a miscarriage.

Does taking topiramate in the first trimester increase the chance of birth defects?

In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. While most children born to women who take topiramate during pregnancy do not have a birth defect, some studies suggest that topiramate use in the first trimester may increase the chance that a baby will be born with a cleft lip and/or a cleft palate (split lip or opening in the roof of the mouth). This chance is expected to be 1 in 100 (1%) or less.

The chance for a birth defect might be affected by the dose of topiramate, the level of topiramate in the blood, whether topiramate is taken alone or in combination with other antiepileptic medications, and possibly other factors. However, because having a seizure or untreated psychiatric illness can be harmful to both mother and baby, it’s important to talk with your healthcare providers before making any changes to this medication.

Could taking topiramate in the second or third trimester cause other pregnancy complications?

Some studies have suggested that topiramate might be associated with babies being smaller than expected or having low birth weight.

Does taking topiramate in pregnancy cause long-term problems in behavior or learning for the baby?

One small study has suggested that taking topiramate during pregnancy might have an effect on learning and motor coordination. Another small study did not notice problems in verbal abilities or IQ scores when testing these children between the ages of 5 and 9 years. There is not enough evidence to determine if taking topiramate affects baby’s behavior and learning.

Can I breastfeed while using topiramate?

Topiramate passes into breast milk. Babies usually have very low levels of topiramate in their systems, and side effects or harmful effects in the nursing baby are rarely reported. If you suspect the baby has any symptoms, such as diarrhea, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

If a man takes topiramate, could it affect his fertility (ability to get partner pregnant) or increase the chance of birth defects?   

Some antiepileptic medications may cause abnormal sperm, resulting in infertility in men. However, there is no specific information on topiramate and male fertility. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

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