What to Know About Trokendi XR (Topiramate)

A medication for seizure control and migraine prevention

In This Article

Trokendi XR (topiramate) is an oral prescription medication used for seizure control and migraine prevention. Because it is an extended-release formulation, it is used once per day. 

This medication is believed to work by preventing hyperreactivity of neurons in the brain. It can cause side effects, including weight loss, mood issues, and tiredness. Trokendi XR is not recommended for women who are pregnant or who might become pregnant while taking the medication.

Uses

There are two approved uses of Trokendi XR—migraine prevention and seizure prevention.

  • Seizure prevention: When used for seizure prevention, Trokendi XR can be used as monotherapy without any other anti-epilepsy drug (AED) or adjunctive therapy (along with another AED) for prevention of partial onset or primary generalized tonic-clonic seizures for adults and for children age 6 and older. And it can be used as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS) for adults and children age 6 and older.
  • Migraine prevention: Trokendi XR can be used for migraine headache prophylaxis for adults and for adolescents age 12 and older.

According to the manufacturer, Trokendi XR achieves its effect through four mechanisms:

  • Blocking voltage-dependent sodium channels, which normally stimulate nerve activity
  • Augmenting activity of the gamma-aminobutyrate (GABA), an inhibitory neurotransmitter
  • Inhibiting activity of glutamate, an excitatory chemical
  • Inhibiting the carbonic anhydrase enzyme, an action that may have anti-seizure effects

Off–Label Uses

Topiramate formulations, including Trokendi XR, have been used off-label for appetite suppression and weight loss.

Before Taking

Trokendi XR can be used as the initial treatment, which means that it is not required that you try another AED or migraine prophylaxis before using it.

Precautions and Contraindications

Some precautions are noted on the product label, including the following:

  • This medicine is not considered safe during pregnancy, as topiramate can cause fetal harm when used during pregnancy.
  • It is not safe to use alcohol within 6 hours before or after taking Trokendi XR.
  • If you are taking metformin and have been diagnosed with metabolic acidosis, you cannot take Trokendi XR.

Other Topiramate Formulations

In addition to extended-release formulations, topiramate is available in shorter-acting, slower release formulations.

Trokendi XR and Qudexy XR are long-acting extended release brands taken once per day. Topamax and generic topiramate are taken twice per day.

Dosage

The extended-release capsules are available in 25 milligrams (mg), 50 mg, 100 mg, and 200 mg formulations. The recommended dosage differs based on which condition the drug is being used for and the age and the weight in kilograms (kg) of the person who is using it.

All dosages noted below are according to the drug manufacturer as listed on the product label. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

In general, the recommended dose is lower for adjunctive epilepsy treatment and for migraine prevention than it is for monotherapy for epilepsy.

  • Adult Dose for Epilepsy: When used for adults, the highest recommended dose is 400 mg per day. As monotherapy, this medication is started at a dose of 25 to 50 mg per day, with a weekly increase of an additional 50 mg per day until the target dose is reached. As adjunctive therapy, it is started at 25 mg per day and increased by an additional 25 mg per week until the target dose is reached.
  • Pediatric Dose for Epilepsy: Dosing in children 6 to 10 years old is based on weight. It is recommended that children take it at nighttime. For monotherapy, it can be started at 25 mg per day and increased by 25 mg each week until a target dose of approximately 10 mg/kg per day.
  • Pediatric Adjunctive Therapy for Epilepsy: For adjunctive therapy, children can start with a dose of 1 mg/kg to 3 mg/kg once per day. Each week the dose can be increased by 1 mg/kg/day to 3 mg/kg/day until seizure control is attained without intolerable and/or undesirable side effects. The maximum recommended dose for children is 5 mg/kg to 9 mg/kg once per day.
  • Migraine: For migraine prevention, Trokendi XR is started at a dose of 25 mg per day. It can be increased by 25 mg each week until a maximum recommended target dose of 100 mg per day is reached.

While there is a maximum recommended dose, your doctor might not prescribe the highest recommended dose if your symptoms are well controlled with a lower dose.

Modifications

If you have kidney failure you need a modified dose of Trokendi XR whether you are on dialysis or not. You would need to take approximately half of the recommended dose of Trokendi XR if you have kidney failure with a creatinine clearance less than 70 mL/min/1.73 m2). And if you are being treated with hemodialysis, you may need an additional dose of topiramate because dialysis can remove the medication from your system.

How to Take and Store 

You can take Trokendi XR with or without meals. You should swallow the whole capsule without breaking it, sprinkling it on food, chewing or crushing it.

The capsules should be stored in tightly closed containers protected from moisture and light. It should be stored at a room temperature of 25 C (77 F). You can briefly take it in a temperature ranging from 15 C-30 C (59 F-86 F).

Side Effects

You may experience side effects when using Trokendi XR. You may not have any negative effects, you could experience tolerable side effects, and you may experience such severe side effects that you need to stop taking the medication.

Common Side Effects

The most common side effects that occur with Trokendi XR are:

  • Cognitive symptoms, including word-finding difficulties, attention and concentration problems, and/or slowed thinking
  • Paresthesia (tingling or numbness of the body)
  • Gastrointestinal problems
  • Decreased appetite and weight loss

Other common symptoms include:

  • Somnolence and fatigue
  • Mood swings
  • Depression
  • Kidney stones
  • Suicidal ideation and/or behavior
  • Oligohydrosis (decreased sweating)

Severe

A number of severe issues can occur as a result of taking Trokendi XR, including:

  • Visual field defects (decreased peripheral vision)
  • Acute myopia associated with secondary angle closure glaucoma—symptoms include sudden decreased vision and/or eye pain
  • Increased risk of bleeding
  • Hyperchloremic, non-anion gap, metabolic acidosis—this is decreased serum bicarbonate and it causes hyperventilation (rapid breathing), fatigue, decreased appetite, heart rhythm irregularities, or loss of consciousness

Interactions

This medication can interfere with other medications. Drug interactions with Trokendi XR include:

  • Oral contraceptives: Using Trokendi XR may decrease the effects of oral contraceptives.
  • Phenytoin or carbamazepine: Using these AEDs with Trokendi XR can decrease your body’s concentration of Trokendi XR.
  • Lithium: Using Trokendi XR can alter levels of lithium, a medication used for treatment of mania that can occur with bipolar disorder.
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Article Sources
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  1. Food and Drug Administration. Trokendi XR label.Updated January 2018.

  2. O'neal W, Hur EE, Liranso T, Patel B. Real-world assessment of treatment with extended-release topiramate (Trokendi XR) and comparison with previous immediate-release topiramate treatment. J Comp Eff Res. 2018;7(11):1095-1105. doi:10.2217/cer-2018-0074

  3. MedlinePlus. Topiramate. Updated December 15, 2017.