Rankings / Metabolic Health

Topiramate

Metabolic Health · Anticonvulsant

Also known as: Topamax

Tier B-

High-risk evidence profile

Reviewed by Read Off Label · Last reviewed · How we grade

gabaprescription
High-risk evidence profile
5.8 / 10
Tier B-
Ev 8 Bn 5 Sf 3.5

Bottom line

Read Off Label grades Topiramate as B- (5.8/10) based on strong evidence, med benefit magnitude, and a med-high-risk safety profile.

Its high-risk evidence profile reflects a Safety score of 3.5/10; reported benefits and harms can differ by indication, dose, route, duration, and population.

Qsymia (phentermine + topiramate ER) is FDA-approved and shows ~10% weight loss.

Studied, labeled, or reported-use context: 25-100 mg PO daily (monotherapy off-label); 23-92 mg + phentermine 3. — Rx; not individualized guidance.

Citation correction in progress

2 PubMed links were found to be unrelated to this entry and removed from public output. The remaining sources are shown below, but this row's claims and score still need a full source-by-source revalidation.

What the evidence says

Qsymia (phentermine + topiramate ER) is FDA-approved and shows ~10% weight loss. Topiramate alone has off-label use. Strong teratogen; pregnancy exposure is contraindicated in product labeling.

Mechanism

GABA potentiation; AMPA/kainate glutamate antagonism; carbonic anhydrase inhibition; appetite suppression mechanism unclear; dysgeusia may play a role

Studied, labeled, or reported dose & route

25-100 mg PO daily (monotherapy off-label); 23-92 mg + phentermine 3.75-15 mg in Qsymia

This records doses and routes described in studies, approved labeling, clinical practice, or documented use. It is not individualized guidance and does not establish safety; context changes with indication, formulation, health history, monitoring, and other medicines.

Citations

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Common questions

What does the evidence show about Topiramate's effects?
Read Off Label rates the evidence for Topiramate as Strong and the benefit magnitude as med, producing an overall grade of B- (5.8/10). Qsymia (phentermine + topiramate ER) is FDA-approved and shows ~10% weight loss.
What safety findings are reported for Topiramate?
Topiramate has a med-high risk profile in the database. Med-High (cognitive slowing, paresthesias, kidney stones, teratogenic cleft palate; acute angle-closure glaucoma / acute myopia — rare but vision-threatening) Legal status: Rx.
What does the low Safety score for Topiramate represent?
The Safety score is 3.5/10. It records the substantial harms described for one or more use contexts; the Benefit score, indication, dose, route, duration, population, and legal status remain separate parts of the evidence profile.
What doses or routes are reported for Topiramate?
25-100 mg PO daily (monotherapy off-label); 23-92 mg + phentermine 3.75-15 mg in Qsymia This is context from studies, approved labeling, clinical practice, or documented use; it is not individualized guidance and does not establish safety.
How does Topiramate work?
GABA potentiation; AMPA/kainate glutamate antagonism; carbonic anhydrase inhibition; appetite suppression mechanism unclear; dysgeusia may play a role

This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.