This sheet is about exposure to topiramate in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare provider.
What is topiramate?
Topiramate is a medication that has been 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®. The combination of topiramate and phentermine (Qysymia®) has been used for weight loss.
Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.
Having a seizure while pregnant could be harmful to a pregnancy. Women who have bipolar disorder and stop taking their medication are at increased risk for episodes of depression or mania that might be harmful to both the woman who is pregnant and the pregnancy. For more information on depression in pregnancy, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/depression-pregnancy/.
I am taking topiramate, but I would like to stop taking it before getting pregnant. How long does the drug stay in my body?
The time it takes the body to metabolize (process) medication is not the same for everyone. In healthy non-pregnant adults, it takes up to 5.25 days, on average, for most of the topiramate to be gone from the body.
I take topiramate. Can it make it harder for me to get pregnant?
It is not known if topiramate can make it harder to get pregnant. Studies have found that the long-term use of seizure medications in women with a seizure disorder might be linked to irregular periods and trouble getting pregnant. In one report, women with epilepsy had weight loss and improved menstrual cycling and fertility with topiramate use.
The use of topiramate at the same time as birth control medications might make the birth control less effective. Talk with your healthcare provider if you take topiramate and take or want to take birth control medications.
Does taking topiramate increase the chance of miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. Miscarriage has been reported with topiramate use. However, one study found no increase in the chance for pregnancy loss. As there are many causes of miscarriage, it is hard to know if a medication, the medical condition being treated, or other factors (such as age, health, other exposures) are the cause of a miscarriage.
Does taking topiramate increase the chance of birth defects?
Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like topiramate, might increase the chance of birth defects in a pregnancy. Some studies suggest that topiramate use in the first trimester might increase the chance for certain birth defects such as cleft lip (an opening in upper lip) with or without cleft palate (an opening in the roof of the mouth), heart defects, or hypospadias (when the opening of the penis is on the underside of the penis instead of at the tip). There are also studies that did not report an increased chance of birth defects.
If you are taking topiramate, your healthcare provider might suggest you take a higher dose of folic acid for at least 3 months before getting pregnant to help lower the chance for certain birth defects. Talk with your healthcare provider to find out how much folic acid is right for you. More information about folic acid can be found in our fact sheet here: https://mothertobaby.org/fact-sheets/folic-acid/.
Does taking topiramate in pregnancy increase the chance of other pregnancy-related problems?
Some studies suggest that topiramate might increase the chance of other pregnancy-related problems, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).
Does taking topiramate in pregnancy affect future behavior or learning for the child?
It is not known if topiramate can affect future behavior or learning for the child. There is information that suggested topiramate use in pregnancy might increase the chance of behavior and learning issues, including intellectual disability, autism spectrum disorders, and problems with motor coordination. There are also studies that have not associated topiramate use with neurodevelopmental disorders.
What screenings or tests are available to see if my pregnancy has birth defects or other issues?
Prenatal ultrasounds can be used to screen for some birth defects, such as cleft lip or palate and heart defects. Ultrasound can also be used to watch the growth of the pregnancy. Talk to your healthcare provider about any prenatal screening or testing that are available to you. There are no tests available during pregnancy that can tell how much effect there could be on future behavior or learning.
Breastfeeding while taking topiramate:
When taken in doses of up to 200 mg of topiramate per day, the medication passes into breastmilk in small amounts. Most infants do not experience side effects when exposed to topiramate through breast milk. If you suspect the baby has any symptoms (diarrhea, drowsiness, irritability, or trouble gaining weight), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.
If a man takes topiramate, could it affect fertility or increase the chance of birth defects?
There have been reports of loss of sexual desire (libido) and erectile dysfunction in men taking topiramate. Studies have not been done to see if topiramate could increase the chance of birth defects. In general, exposures that fathers or sperm donors 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/.
Please click here for references
