Topamax prescribed specifically as a weight loss aid?

August 29, 2014 1:05 PM

Recently, I was my PCP and inquired about appetite suppressants. (I had taken adipex many years ago, which was great) and she informed me that she did not prescribe Adipex due to the possible cardiac side effects - but that she was prescribing Topamax as a weight loss aid due to the side effect of the medication being loss of appetite. She said it works quite well for a large majority of her patients, but not everyone. Has anyone here been prescribed Topamax specifically for this reason? If so, how well did it work and would you recommend it?
posted by Sara_NOT_Sarah to Health & Fitness (22 answers total)

Here is a previous question about Topamax that touches on the weight loss aspect.

I was on Topamax for neurological reasons for a few years as a teenager and it quite literally made me want to kill myself. I, personally and with no professional medical experience, would not recommend anybody take it unless specifically needed to control the symptoms of a neurological condition.

I did not have fun on Topamax.

If you do end up taking it, strongly consider keeping a mood journal so you are fully aware of any changes should the drug alter your emotional state.
posted by phunniemee at 1:13 PM on August 29, 2014 [4 favorites]

I used to take Topomax for bulimia, which isn't exactly for appetite control but is related (it is supposed to help with impuse controls as well as regulating appetite to some degree). I was on it for 2-3 years. I found it extremely helpful for preventing binging and purging, though I'm not sure how much of that to attribute to impulse control vs. appetite control.

However, it made me EXTREMELY tired; I ended up taking Provigil to counteract the sleepiness, which helped some, but was not ideal. Overall, it was worth it for me for a couple years, then as I recovered, the sleepiness side effect made it so that it wasn't worth it for me.

I did not have any mood issues related to Topomax, either going on it or off it (I was on an SSRI + Abilify at the time).

Overall, I would say that it's worth a try if you struggle with compulsive eating, and it may or may not work out for you.
posted by puppetshow at 1:18 PM on August 29, 2014

Topamax is the devil. Side effects up the wazoo. Food tastes like crap on it. I never lost weight while on it BUT I did have tingling uncomfortable extremities,etc. There is no way I would take it again even if it made me look skinny and gorgeous.
posted by St. Alia of the Bunnies at 1:21 PM on August 29, 2014 [6 favorites]

I forgot to include that I did not have any other negative side effects (besides sleepiness) from Topomax. I was extremely worried about the "dopamax" issues and actually refused to try it for a while, but that ended up being a total non-issue.

Of course, the side effects are obviously real and well-documented, but they hit people differently. One good thing about Topomax is that it's relatively short acting (if I recall correctly, it takes less than a week to leave your system), which is why I finally agreed to try it.
posted by puppetshow at 1:31 PM on August 29, 2014

I know one person who has actually stayed on Topamax, for migraines not weight loss, and it is the only drug that has worked for her. That being said, she weighs around 300 pounds, has not lost any weight, and has most of the really fun side effects. Poor poor memory and general fogginess, and the fantastic metallic taste that won't go away. The only reason she stays on it is that it is at least somewhat less unpleasant than having migraines every day.

When I tried it several years ago, I had the carbonation tastes awful and can't remember anything for more than 3 minutes. It did nothing for my mood issues, and I wasn't less hungry. When I heard it was being given for weight loss, and combined with something else as a new weight loss drug, I was floored. In my opinion there are only 3 good reasons to take this drug, and only when you've tried most of the other options first (seizures, migraines, mood disorders).
posted by monopas at 1:45 PM on August 29, 2014 [3 favorites]

I took it for ten years. I lost fifteen percent of my body weight in the first month. It stayed off for ten years. It came back within a month after stopping. That said, the side effects were not worth it. Aphasia, anger, depression, food tasted bad, ADD, etc. when I stopped, my mom told me that she had been waiting for me to go back to my old self for 10 years. In addition, you also have to do liver function test every few months and go get check ups quite often because of the side effects. It certainly worked as weight loss for me, but I would not ever do it again.
posted by mrfuga0 at 1:58 PM on August 29, 2014 [2 favorites]

Response by poster: If you do end up taking it, strongly consider keeping a mood journal so you are fully aware of any changes should the drug alter your emotional state.

This is a great suggestion! Thank you!
posted by Sara_NOT_Sarah at 1:59 PM on August 29, 2014

A neurologist prescribed Topamax to me for chronic headaches.

This is not a drug to mess around with. MASSIVE side effects - some of them lasting.

While taking it, I was no longer myself and the world was no longer what I'd known. I felt dissociated.

My thinking was impaired. I couldn't focus. I couldn't remember my own zip code.

My ears rang, all the time.

I was dizzy. I was anxious. I was unsteady. Fatigued, but couldn't sleep. Constipation. Dry mouth. Terrible taste in the back of my throat.

From the first dose, I couldn't drink soda - carbonated beverages taste like toxic waste. Food didn't taste right, either.

Aphasia - the most frustrating. I couldn't find the words I was looking for. What did I have for breakfast? That... stuff. Show me a picture of a famous actor -- I know that guy! But his name is GONE from my head. The name of the street I lived on as a child. My friend's dog's name. The name of that company that we used for that thing...

The scary part? 5 years later, I've never fully gotten that part of my brain back. I still can't match names to faces like I used to, or recall book titles or phone numbers or the plot of the movie I just watched last week. Words come out wrong, the wrong word in the wrong order, all the time. Permanent brain fog.

I lost 11 pounds.

Please consider this carefully before doing anything. And good luck.
posted by falldownpaul at 2:28 PM on August 29, 2014 [3 favorites]

I'm on it for epilepsy. I did lose a few pounds the first few months but as stated above.... The side effects are awful. The aphasia is the worst. It's beyond maddning. And I'm asleep by 4:00 every afternoon, coffee or no. I would get off of it but my epilepsy is being controlled and I'm afraid to mess with my drug cocktail. Please don't consider this drug just for weight loss.... The 10 lbs you might lose are very not worth it.
posted by pearlybob at 2:32 PM on August 29, 2014 [4 favorites]

The scary part? 5 years later, I've never fully gotten that part of my brain back. I still can't match names to faces like I used to, or recall book titles or phone numbers or the plot of the movie I just watched last week. Words come out wrong, the wrong word in the wrong order, all the time. Permanent brain fog.

I was considering going on Topamax for atypical migraines occurring a few times a week. I talked with some migraineurs, and they all warned me away from Topamax if I could get anything else at all to work due to these kinds of side effects. I was pretty surprised by your question that this would be offered as a weight loss drug. One of them talked about still having occasional "Topamax moments" where she couldn't remember a word despite being off the drug for years.
posted by jeoc at 2:35 PM on August 29, 2014 [7 favorites]

I looked into this a bit recently when I saw someone else mention topiramate being prescribed for weight loss. FWIW, I've been taking 50mg topiramate (the generic name for Topamax) daily for over a year; it's completely stopped my once-monthly migraines, and I've never experienced any side effects, weight loss or otherwise.

Having said that, I came across these two review articles which indicate that weight loss can be an effect of the drug, though the former says that high initial BMI is correlated with weight loss while taking it.

What I'd heard of before was Phentermine/Topiramate being prescribed in combination as a weight loss drug, where the phentermine is an appetite suppressant and stimulant.
posted by ludwig_van at 2:42 PM on August 29, 2014 [1 favorite]

I took Topamax for another reason years ago and lost a ton of weight very quickly (went from a size 12 to a size 2). While I have been tempted to take it again for weight loss purposes, the side effects aren't worth it, the worst being major cognitive issues, particularly with recall.
posted by amro at 4:17 PM on August 29, 2014 [2 favorites]

My niece was on it for a good part of high school to combat seizures. She lost a ton of weight but her family was seriously making plans for what to do for her after graduation because there was no way she was going to college. She couldn't retain anything she read, couldn't do math, nothing. She went from a bright girl with a promising future to a shell of herself. Scary.
posted by checkitnice at 4:54 PM on August 29, 2014 [3 favorites]

I took it for migraines for years. The weight loss was so-so. However, I did gain a GIANT kidney stone from it. It's no longer something I take.
posted by heathrowga at 5:59 PM on August 29, 2014 [1 favorite]

From anecdotal experience from practicing neurologists who have prescribed and monitored it, weight loss is individual to patient, is more apparent in higher BMI patients, and often only occurs for the first month to titrated dosage. After that time, weight remains stable and often returns after discontinuation of the medication. You have to weigh the risk of side effects against the possibility of weight loss. These are issues your PCP should have discussed with you as well as other pharmacologic and nonpharmalogic alternatives, e.g. lifestyle changes, other medications, surgery, because health history and severity of medical conditions/medications have a sizable impact on the recommendations.
posted by palionex at 6:19 PM on August 29, 2014 [2 favorites]

Another anecdote: I was on topamax for migraines for a few months, until I started forgetting important things like where I lived (I got lost for several hours a few blocks from home), and my wife's name, and common words like "house" and "cat". There's a good reason people call it dopamax.
posted by dmd at 6:32 PM on August 29, 2014 [5 favorites]

topamax for migraine prevention...

me: it makes me fat and stupid.

pcp: it'll do that.
posted by j_curiouser at 6:35 PM on August 29, 2014 [2 favorites]

Now that folks have refreshed my memory (ha)..my spelling skills disintegrated on topamax and my memory went to heck. And you do have to drink a ton of water on it or else you will get kidney stones.

This med is not worth it.
posted by St. Alia of the Bunnies at 7:01 PM on August 29, 2014 [2 favorites]

This WebMD page lists the side effects from Topamax. I've excerpted only those described as common and severe.

Common side effects of Topamax:

Cannot Focus Thoughts Severe
Confused Severe
Difficulty Speaking Severe
Dizzy Severe
Double Vision Severe
Drowsiness Severe
Feeling Weak Severe
Fever Severe
Involuntary Eye Movement Severe
Irregular Periods Severe
Loss of Memory Severe
Nervous Severe
Numbness and Tingling Severe
Painful Periods Severe

There are others common but not severe and uncommon but severe.
posted by dances_with_sneetches at 7:12 PM on August 29, 2014 [2 favorites]

Another piling on that topamax is not a drug to be messed with. Sure, it actually did wonders for my migraines, but the side effects were not worth the price. It made me stupid (they don't call it dopamax for nothing), was going to give me glaucoma, and made everything taste weird. At the time, I chose the daily migraines instead (and have since found other meds that deal with them without the insane side effects).

Going by the posters and other promotional garb in my neuro's office, my guess is the reason it's so commonly prescribed is they have some killer pharmaceutical sales reps.
posted by cgg at 8:56 PM on August 29, 2014 [3 favorites]

Nthing that this is not a drug to screw with, and for something like weight loss? No way. I was prescribed Topamax after 3 days hospitalized for what was diagnosed as atypical presentation of complex migraine. I took it for one whole week. My memory was completely shot, I had all kinds of aphasia (my name? It's.....um......it's my name.), and I was sleeping 15+ hours every night.

When I titrated up to 25mg in the morning and at night, I managed one morning dose. Within 20 minutes, the room was spinning, my speech was slurred to the point that my best friend couldn't understand what I was saying, and I was insanely confused by what was going on. I laid down on my bed, and despite 16 hours of sleep the night before (from which I'd been awake less than an hour), I slept for 7 hours.

You want a good appetite suppressant? Every time you're hungry, drink 8 oz of water and wait 20 minutes. If you're still hungry, eat. You'll be better hydrated, and you'll eat less. Promise. And you won't be a zombie from a strong neurological drug.
posted by The Almighty Mommy Goddess at 9:52 AM on August 30, 2014 [1 favorite]

I was prescribed Topamax as a migraine medication, but my doctor said I would likely lose weight which might help with the migraines.

I gained weight. A bunch of weight. I was kinda fat before I went on Topamax. I am now really fat and I cannot get the weight off.

My doctor was so surprised that I thought I was a one in a million case, but looking at this thread I guess not!

Even if it had worked as a weight-loss aid it's not worth the downsides. My life was like the last couple of chapters of Flowers for Algernon. It's not just subjective, either - I have certain things that I do that also can be an objective test of intelligence (all other Puzzlejuice addicts in the house, holla!) and the difference two days after I went off Topamax was dramatic.

The thing that most concerns me is that it's been six months now and I am pretty sure the cognitive impairment has not fully worn off. For example, on my first draft of this comment I wrote "traumatic" instead of "dramatic." That did not happen before I went on Topamax.

Another common side effect is itching. I itched so badly that I scratched myself until I bled. That's another side effect that hasn't gone away, either, although I'm now on medications to minimize it.

RUN AWAY FROM TOPAMAX.
posted by rednikki at 10:28 AM on August 30, 2014