This sheet is about exposure to topiramate in pregnancy and while breastfeeding. This information is based on available published literature. 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 people 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.

I am taking topiramate, but I would like to stop taking it before getting pregnant. How long does the drug stay in my body?

People eliminate medication at different rates. In healthy 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 people with a seizure disorder might be linked to irregular periods and trouble getting pregnant.

The use of topiramate at the same time as birth control medications may 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. It is not known if topiramate can increase the chance of miscarriage.

Does taking topiramate increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Some studies suggest that topiramate use in the first trimester may increase the chance for certain birth defects such as cleft lip (opening in top lip) with or without cleft palate (opening in the roof of the mouth) 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 may 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 can 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 can 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.

Breastfeeding while taking topiramate:

When the person who is breastfeeding takes up to 200mg of topiramate per day, the medication passes into breastmilk in small amounts. 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 male takes topiramate, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?

There have been reports of loss sexual desire (libido) and erectile dysfunction in males taking topiramate. Studies have not been done to see if topiramate could increase the chance of birth defects above the background risk. 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/.

Selected References:

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