Topamax For Weight Loss? How and Why it May Work (+ What to use Instead)

Will using Topamax finally help you shed those unwanted pounds?

Maybe, but before you use it there are some things you need to know. 

In this guide you will learn how Topamax works for weight loss, why it may be effective, the side effects it can cause, what dose you need for it to work and other weight loss medications to compare it to

Let's jump in: 

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What is Topamax (Topiramate)?

Obesity, it seems, is turning out to be a much more complex disease than was once thought. 

We tend to think of weight gain as a simple equation and one which can be solved by manipulating the number of calories that we consume and the amount that we burn. 

The problem with this strategy is that it has an abysmal success rate around 1%. 

So, with 99% of people failing to lose weight and keep it off, many people have started to look to their doctor or to prescription medication to help with weight loss

But do these prescription medications (from your Doctor) actually help with weight loss?

The answer is yes, but not always (and not always as much as you'd like them to). 

And that's where Topamax steps in, the topic for today's conversation.  

Topamax, otherwise known as Topiramate, is a prescription medication which was actually originally designed to treat the condition epilepsy (1).

weight loss in patients taking topamax vs placebo

It was found, though, that people who took Topamax started to notice weight loss (2) in addition to reducing the number of seizures that they had. 

This has obviously sparked great interest among both patients and Doctors as a potential way to lose weight. 

Recently, Topamax has been added to the medication phentermine in a combination weight loss pill known as Qsymia

So, with these concepts in mind, let's talk about who should use Topamax, who should avoid it and how it actually works. 

How Topamax May Help with Weight Loss

Most prescription weight loss medications focus on 1 of 3 very important mechanisms to help with weight loss:

  • Regulation of appetite (3) - Some medications focus on reducing your appetite which causes you to eat less food. These medications do NOT work very well long-term and almost always result in weight gain after you stop taking them. 
  • Regulation of hormones (4) - Other medications focus on "balancing" fat storing hormones such as leptin, insulin or thyroid hormones. Medications that focus on hormone balance tend to work long-term because they are treating the "root" of the problem. 
  • Regulation of metabolism (5) - Lastly, some other prescription medications help your body by increasing the number of calories that you burn. Medications that focus on this aspect usually result in long-term weight loss as well. 

Each prescription medication works slightly different from other medications which are why some tend to work better than others. 

In general, the more areas that your weight loss medication "attacks" the better and long lasting your results will be. 

For this reason, you generally want to avoid medications which focus solely on appetite reduction as a means of weight loss. 

Why?

Because these medications almost always result in the weight being regained once your appetite returns to normal making them largely ineffective! 

So, how does Topamax work? 

#1. Increases Energy Expenditure (Metabolism) 

One of the main benefits to using Topamax is that it may help increase what is known as your resting energy expenditure (6).

This refers to the number of calories that your body burns on a daily basis and is closely correlated with your metabolism. 

One of the biggest reasons that you may regain weight after a diet is due to a damaged metabolism. 

It is well known that reducing caloric intake results in a compensatory drop in your resting energy expenditure. 

Put in simple terms:

As you reduce your calories your metabolism will drop to match the amount that you consume. 

This drop doesn't rebound for YEARS which means that once you start eating a normal amount of food you will now be in a caloric surplus and start to regain weight

Topamax may help to keep the number of calories that you burn "steady" by boosting your metabolism. 

Medications which boost your metabolism are probably the "best" medications for weight loss because you don't necessarily need to alter the number of calories that you consume for weight loss. 

#2. Regulates Appetite

There is evidence to suggest that Topamax also helps by regulating your appetite (7).

And I don't necessarily mean that it reduces your appetite, I mean that it "regulates" it. 

Regulating refers to matching your appetite to the number of calories that you consume. 

In some people, this value is mismatched resulting in the consumption of more calories than what your body actually needs. 

Remember:

Your metabolism can become damaged as a result of dieting and other factors. 

thyroid metabolism reset poster for side bar

If your metabolism is set at 1,500 calories per day and you believe it's at 2,000 calories per day then you may have a mismatch between the amount that you think you need to consume and the amount that you are actually burning. 

In some instances, your brain may also send signals to your body to consume more food even though you don't need it. 

These scenarios are becoming more and more common with conditions such as leptin resistance. 

Topamax may help with weight loss (8) by regulating the appetite center of your brain or your hypothalamus. 

#3. Enhances Thermogenesis

Topamax has also been shown to increase fat oxidation in both brown fat tissue as well as skeletal muscle (9).

Brown fat helps to provide your body with heat and is a crucial part of metabolism maintenance. 

Burning more calories in your muscles (skeletal muscles) may also be a way to improve metabolism and caloric burn day in and day out. 

This mechanism is not well understood but it appears that, through these mechanisms, Topamax may help increase the amount of energy and heat that your body produces. 

Why am I not Losing Weight on Topamax?

Let's face it:

Not all weight loss therapies work for all people. 

Even if your brother or sister used Topamax for weight loss (and it worked) doesn't mean it will work for you. 

Each of us has a different genetic composition and a different reason for weight gain. 

You may have gained weight due to extreme stress, due to binging or overeating or simply due to hormone imbalances such as menopause. 

The treatment for each of these will be different and they can't all be solved by one medication. 

So one of the main reasons that Topamax may not be working for you is because you are targeting the wrong problem. 

Other factors include:

  • It's not targeted to your weight gain - See above. Other common causes of weight gain include: insulin resistance, leptin resistance, binge eating disorder, menopause, thyroid disease and so on. 
  • You are not using the right dose - This usually isn't a problem but it's worth considering. We will discuss dosing below. 
  • There are better medications available to you - Not everyone will do well on Topamax and that's ok. Listen to your body and don't take the medication just because you really want it to work. 
  • You aren't combining it with a healthy diet or with exercise - No matter which weight loss medication you use you should always combine it with a healthy diet and exercise. Using weight loss medications by themselves often does not work. 
  • You haven't been using it long enough (10) - Weight loss should NOT be extreme and occur over a period of a few weeks. Long lasting weight loss often takes months and months to achieve. Topamax may take 6-8 weeks to kick in then months after that for more weight loss. 
  • Side effects of the medication may be causing weight gain - Some weight loss medications can paradoxically cause weight gain instead of weight loss. Be sure that you are not GAINING weight while taking Topamax. 

Topamax Dosage

The goal with dosing is to achieve a balance between dose and results. 

With this in mind, you'll want to use the smallest dose possible that still results in weight loss. 

For most people, this will be somewhere between 50 to 200mg per day (11).

Using this strategy will help reduce the negative side effects of this medication (listed below). 

You might find more success in combining Topamax with other weight loss therapies, supplements and diets as a means to help keep your dose low. 

Side Effects

While Topamax may be effective for weight loss it doesn't come without cost. 

Because this medication was originally designed to treat seizures (epilepsy) it works primarily by acting on the brain. 

It does this by "slowing down" the brain which may result in symptoms such as fatigue, brain fog, slow thinking and overall sluggishness (12).

These symptoms may be tolerable for some people, but for others, such as those who need a sharp mind for work, it may not be acceptable. 

It's always important to weigh the potential benefits vs the risks of using any therapy, including weight loss medications. 

You can see a long list of potential side effects of Topamax below:

  • Fatigue
  • Drowsiness
  • Diarrhea
  • Nausea
  • Brain fog
  • Slow thinking or poor cognition
  • Memory problems
  • Dizziness
  • Flu-like symptoms

The good news is that many of these symptoms tend to be dose-related, meaning the higher your dose the more likely you are to experience them. 

If you begin to experience these symptoms you may find relief by reducing your dosage to compensate or by adding another weight loss medication to your regimen. 

This is not a complete list of side effects, so just realize you may experience some not on this list. 

If you experience anything which you feel is serious, while using Topamax, make sure you discuss those symptoms with your Doctor! 

Topamax + Wellbutrin (or Topamax + Phentermine)

If you've been on my blog before you know I've discussed how other medications, such as Wellbutrin, can help with weight loss. 

You might be thinking that it's a potentially good idea to combine these medications together to enhance your results. 

And you may be right in that logic. 

Qsymia is a medication which has already done just that. 

Qsymia is the combination of Phentermine and Topamax in one pill (13).

Each pill contains around 3.75mg of Phentermine and about 23mg of extended release Topiramate

This dose can be increased up to 15mg of Phentermine and 92mg of Topiramate. 

topamax can be combined with other weight loss medications

You can get by with smaller doses of Topamax if you combine medications together, so instead of using Topamax by itself at 200mg per day you can use it in combination with phentermine and use only half the dose. 

The same may also be potentially true for combining Wellbutrin with Topamax. 

But because these medications can both interfere with neurotransmitters, using them together should be done very cautiously. 

I'm personally of the belief that, even though they may work, there are better options available for weight loss. 

The problem with some of these other medications is that they can be more difficult to get when compared to Topamax or Wellbutrin. 

Because of this, it's important for you to know all available options. 

Other Weight Loss Medications

It's important to realize that Topamax isn't the only game in town. 

There are actually many other potentially useful weight loss medications that you can draw from if necessary. 

If you've tried Topamax and it hasn't worked for you, or you experience significant negative symptoms, or you are afraid to try it, then you might find success with other medications. 

I've included a list of weight loss medications below that may also be useful:

  • Saxenda/Victoza - These medications primarily help by regulating leptin and insulin. 
  • Phentermine - This medication is an appetite suppressant and also may help boost metabolism. 
  • Wellbutrin - Wellbutrin works in a variety of ways and may help people with certain conditions. 
  • LDN (low dose naltrexone) - LDN can help reduce inflammation and help with weight loss, especially in those with autoimmune diseases. 
  • Qsymia - (Discussed in this article)
  • T3 thyroid hormone - T3 is the active thyroid hormone and can help boost metabolism in those with thyroid disease. 
  • hCG - This hormone can be used by itself to help regulate sex hormones such as estrogen, progesterone and testosterone. 
  • Testosterone - Testosterone can be used by itself to help increase muscle mass which may help improve metabolism. 
  • Metformin - Metformin helps regulate insulin resistance and can be combined with other medications for weight loss. 
  • Contrave - Contrave is another combination medication which includes LDN and Wellbutrin. 

Conclusion

Topamax is a medication which can potentially help with weight loss. 

It seems to work by regulating appetite, improving metabolism and helping your body burn more calories

That being said, it's not for everyone. 

This medication carries with it some serious side effects that should not be ignored. 

Don't worry though, because if it doesn't work for you there are still many other options available to you!

Now I want to hear from you:

Have you used Topamax for weight loss?

Did it work for you? Why or why not?

Did you experience any negative side effects? If so, what helped alleviate them?

Leave your comments and questions below! 

References (Click to Expand)

This post was most recently updated on August 23rd, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

36 thoughts on “Topamax For Weight Loss? How and Why it May Work (+ What to use Instead)”

  1. Would Topamax or any of the other 2 items that you posted on here help me with weight loss if I no longer have a Thyroid?

    • Hi Donna,

      There’s no reason why they wouldn’t work, but it’s always more difficult to lose weight after thyroidectomy so it may not work as well compared to those who still have a thyroid.

  2. Thanks for your article, Dr. Childs. I know you mention that the list of side effects is not a complete list, but I feel it’s important to mention increasing depression and suicidality as major side effects as well. I experienced this recently after trying topamax for bulimia again after unsuccessfully using it years ago. Within a couple of days, all I could think of was killing myself. I was slow physically yet had racing thoughts. I would sleep slightly better but be jolted out of sleep into the suicidal thinking. It took me a few more days to connect the dots but I realized what was going on in time to not follow through with a very detailed plan of how I would kill myself. After a bit of research, I found that I am just one of many who have had similar reactions. I’m passively suicidal at baseline due to being enslaved by the beast I call bulimia. I try everyday to live normally, only to end up bingeing and purging for up to 12 hours at a time and spending hundreds of dollars every few days on food. I was really hoping Topamax would be helpful but it’s just not worth the impact on mood/cognition etc for me.

  3. I took Topomax for treatment of migraine in the past. The first time I took it I was in my 30’s and already fairly thin. I started to drop weight right away, so the doc took me off. I tried it again in my early forties (by then I had started to gain some weight-obesity runs in my family) so the benefit out weighted the risk. I took it for 3 years with no problem. I did loose some weight but not excessive amounts and it was working to treat the headaches. My neurologist bumped up my dose and it started to impact my personality so I stopped. Now I am coming up in 50, going through menopause and gaining weight like crazy. I have tried to restart on the end several times but it doesn’t seem to have the same effect. Does stopping and restarting have a negative effect on the effectiveness of the drug? I think if I stick with a smaller dose it could continue to help with migraines and maybe help me shed a few pounds. Have you had an experience with this? Thank you Grace

  4. Hello,

    How to maintain the weight loss after getting off Topamax? (On a 50-75mg dose)

    I am taking it for migraines but also enjoyed the weight loss that came with, however, I do not want to take it forever… but also do not want to gain back the sluggish extra pounds I couldn’t lose with diet and exercise. Thank you!

  5. My husband was prescribed Topamax for migraines. He did lose weight and his appetite was drastically reduced. He had to discontinue Topamax due to the severe side effects. The side effects were worse than the migraines. The worst one was probably the brain fog, spotty vision, and severe irritability. However, for weight loss, he did lose 10 lbs I believe on 50 mg a day.

    • Hi Tamar,

      I agree. I am not a huge fan of Topamax for the reasons you stated, but in some cases, it may be ideal to lose 50 pounds and deal with the side effects for a short period of time (though, not in the case of your husband it seems).

  6. Hello Dr. Childs, I have been on Topamax for almost 6 months for mainly weight loss and it has helped me a lot. I started out at 280LBS now down to 215 that’s 65 LBS!!! I’m on 25mg morning and night and I’m getting ready to turn 57. Just pray I can keep it off!!!

      • Is there anything I can take that will work like topamax for weight loss? I dropped weight so well on it but it then caused acne, then frequent urination. It’s the only thing that helped me lose weight. I’ve been on phentermine but it stopped working.

    • Hi,

      I was on Topamax for a couple of months. And I lost 10 kgs. I was taking 200 mg per day. I was taking it because I wanted to lose weight. But now even I consume the tablet it doesn’t suppress my appetite any longer. Earlier it did and that’s how I lost the weight. I had smaller meals. Now I crave for sweets cheese and what not. I have started having hunger pangs. I am going to gain all the weight and will turn obese again. Will you help, please.

  7. Hi! So I was on Topamax before back in 2016 for nerve damage due to lung surgery (long study) anyways I lost some weight on it which was great because I had a few pounds to lose and my hormones have been all jacked up since 2013 since I have been on the NuvaRing continuously (skipping periods due to endometriosis and lung collapse). Anyways I came off Topamax for almost 9 months cause my hair was falling out a lot and we were trying to rule it out (turns out the was clonazepam) anyways I’m back on it again cause the nerve damage was getting to me again physically and mentally. I will be at 50mg twice a day in about a week. I’m also on Wellbutrin for depression. First timer on depression meds. Lucky me. Anyways I’m at 300mg a day on that. If Topamax helped me with weight loss before, Will it help me again this second time? I’m 31 going to be 32. And will the Wellbutrin help too? My doc says they both would help with weight. But was not sure if Topamax is as effective the second time. And if Wellbutrin will help or hinder results. Thank you, sir!

  8. Been on Topamax for over a year for weight loss because I am on antidepressants and medications for bipolar disorder and Fibromyalgia that cause weight gain. Taking 50mg 2x a day. Do you have a better recommendation for me Dr. Childs? (Latuda and Gabapentin, previously Zoloft)

  9. I used Topomax for close to 9 years then I went off I was up to 200 mg a day. I was taking fur migraines and I did lose weight 30-45 lbs with diet/exercise as well. Then I wanted another baby so I went off for almost 4 years. I did gain 32 lbs from being pregnant and had another 15 or so to lose pre-baby. Now I have a lot of weight to lose this time and still get terrible migraines. My question is trying this and another weight loss give me side effects of withdrawal if I get to maintain weight as well, I have fibromyalgia and arthritis ( car accident ) so I am hoping this will help with losing weight and my back pain.

  10. I’ve used this medication and I did great but the weight came back. I’m taking armour thyroid as well for my thyroid problem. I can’t take phentermine because I take Xanax for other reasons. I will assume that it’s because my thyroid is not working right and I also need to watch my calorie intake as well as exercise. I was 138 now I’m 164… Ugh

    • Hi Lakeisha,

      It’s probably more related to metabolic damage and how you lost the weight (calorie restriction), but your thyroid, which controls your metabolism, is no doubt playing a role as well.

  11. My doctor just prescribed me Wellbutrin and topromax. Do you think I will have a huge increase in side effects? Would my weight loss increase with this combination?

  12. I find this very interesting. I have been on Topamax 400mgm twice a day for numbness in my feet and back pain after a lumbar fusion 4 years ago for at least 2 years and Wellbutrin 150mgm Er for at least a year. I have certainly lost a considerable amount of weight over the past year. Originally the doses of Topamax were started lower and the Wellbutrin was started at a lower dose and I have only been on that for about a year and a half. Interesting information though thank you.

  13. I take Topiramate for my Binge Eating Disorder. I’ve always taken 75mg in the AM and 50mg at HS. In the beginning I had the tingling in my hands and feet. But I was told it was only a side effect and would cause no long term issues. It didn’t last long, and it only returned if I missed a dose. A couple weeks ago I decided to increase my HS dose to 75mg because I felt like my appetite was getting increasing/feelings of binge eating increasing. I’ve noticed some changes in my vision (I don’t normally wear glasses), a little bit of dizziness when I lay down, and some headaches. Can I expect these side effects to dissipate on their own as my body adjusts to the new dosage?

    Thanks!

    Dawn, Kansas Nurse

  14. Hi, I’m on Topiramate for 3 weeks now. In addition to obesity I have SPD (sensory processing disorder). I present like a binge eater but it’s really the SPD, we either don’t eat or eat all the time. Anyway the net result is the same as binge eating. For the first time in my life I’m not a slave to food. Everyday I wake up wondering if this is real and praying it will last. The pounds are coming off with zero will power involved. I can eat anything I want because I just don’t want. I’m posting this in the hopes another SPD’r might stumble across it.

  15. My GP started me on Topiramate to prevent abdominal migraines. I started on 25mg and a week later went up to 50mg. A couple of days after the higher dosage I started with extreme diarrhoea and fatigue. My GP thinks this is rare and dropped me back to 25mg. I don’t want the abdominal migraines either.

  16. Melissa did it work for you in that year??? I’m bipolar as well and having to start Latuda yet I’m terrified of weight gain…I asked a new Dr for Topomax. I hope it worked for you…not sure why you’re asking for another one??

  17. Hi Doctor,

    My doctor recently put me on Topamax to help me lose weight and I’m also on Wellbutrin for depression. I took 50mg once daily of Topamax for about one week and just today he doubled that dose to 100mg once daily. I haven’t lost any weight yet and the side effects I’ve noticed in my first week include bloating, frequent urination, metallic tasting and extreme dry mouth and the frequent urge to drink a lot of water. I can also tell my metabalism is working faster or else my blood pressure is up 🙂 (hoping it’s the former). I haven’t really noticed a change in my eating habits yet except maybe once or twice I have felt full sooner than normal. So my questions are as follows:

    Do you think I’m scaling up to quickly in my dosages?
    How do you know when you’ve reached the dose that’s right for you?
    Is once a day only making a difference opposed to taking twice daily?
    What’s the difference between taking it once in the morning compared to once at night?
    Should I notice a weight loss after one week or too soon to tell?
    Is mixing with Wellburtin a good or bad thing (I was confused by the article above)?
    What is the longest a person can stay on Topamax and remain healthy?

    Thanks! I know that’s a lot of questions.

    Sincerely, Ashlee P

  18. In 2016, already taking Wellbutrin, I was put on 50mg per day of Topomax. In 6 months, I lost 60 lbs!!!! Then I gained it back due to going off the medication and hormone problems, however, I am currently trying again!!!

  19. Dr. Child, I am curious and have a question for you. I am on Topomax and have been for upwards of 3 years at a dosage of 100mg twice a day for migraines. I did not lose any weight originally nor in the next two years from taking it. However, I purposefully started a weight loss product in November 2017 to lose weight and in a matter of 45 days lost 13lbs and kept it off for 6 months. Then, I started to lose weight at what I would say is a good pace. I don’t need to lose anymore weight at this point, however I continue to do so. I inquired about this to my Neurologist today and he told me that it is my Topomax and that the weight loss can occur at any time while taking it. I want to get your thoughts on this. I am 5’3″ and now weigh in at 98lbs. I started at 129 when the plateau “lifted” if you will, roughly 10 months ago.

    Thank you for your time and insight.

  20. I went on Topomax, and at first, I lost weight. After a few years on it, I started to gain weight. I took it at night just like the doctor said and the dosage was 200 mg. I am now trying to go off of it, and hoping I don’t gain any more weight. I just felt the medicine did not help in losing weight long term. Dr. is this normal that it won’t work for losing weight long term?

  21. Hello,
    My name is Donna. I was just prescribed Topamax 50 mg for insomnia. I also take Wellbutrin 150SR nice a day. I do suffer from headaches and migraines, I feel that is this rx will help both my headaches and insomnia it would be great. But my major concern is the hair loss side effects. I have read countless horror stories of hair falling out in clumps. I am scared to even try because of this. Is it truly a common side effect…. does it effect most ppl that take it? Please help to ease my mind a little.

    Blessings,
    Donna

  22. Hi all –

    I’m a 52 yo F, attorney, went on Topamax for migraines four years ago. I was already taking Wellbutrin for depression.

    I was up to 150mg/day – 75mg am and pm – and the “dope-a-max” factor was off the charts I’d forget words, was totally space cadet – combined with my then undiagnosed ADHD-(Inattentive-type) it was not a good scene. High expectations demanded at work and of myself.

    But…after literally 35 years of struggling, I lost more than 35 lbs. I hit a number I hadn’t seen since high school. Dream come true, right? Best side effect I’d ever experienced…until I got fired. I knew the Topamax was causing the majority of my fogginess, so – in order to get and hold a new job – I (slowly) cut way down to 25 mg per day.

    Long story short: all the weight is back on, plus 5 lbs. Awful work schedule w/2 hour commute cut into my sleep and workout time. So I can’t nail down if it was “just” the Topamax or the perfect storm.

    Got another, wonderful new job. Started my workout routine back up – thought this would be the key. But realized that my eating habits were out of control – I mean, I was HUNGRY, craved sugar (refined, please, thank you), and even knowing the probable effects felt the compulsion to ingest everything in sight. Worse than before I ever took Topamax.

    Now, I’m so miserable (and puffy) that I’m now going to add back another 25mg at night and see where it takes me, maybe also add a few Hail Marys that this’ll kick the weight loss back into gear.

    Remember the scene in “Charlie and the Chocolate Factory” when Violet Beauregard chews the gum and blows up into a blueberry-like ball? That’s me, sans blue.

    Good luck to everyone seeking health answers. Thank you, Dr. Childs, for bringing us all together on this “group think.” 😀

    Molly in Minnesota

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