Topamax Sprinkle (topiramate) is an anticonvulsant primarily used to treat migraine headaches and seizures. It can be used in patients age 2 and up for seizures; age 12 and up for migraines. The medication also sees a range of off-label uses, such as for cluster headaches, weight loss, PTSD, and others.

The sprinkle version of this medication differs from regular Topamax in two important ways:

• Sprinkles can be opened and sprinkled on soft foods; regular Topamax tablets must be swallowed whole.
• Sprinkles are available in a maximum dose of 50 mg; regular Topamax is available in 200 mg doses.

Topamax Sprinkles are ideal for those who have difficulty, or an aversion to, swallowing whole tablets. While such individuals are found among all age groups, it is predominantly children who make use of sprinkles.

Children also require smaller doses, making the 50 mg maximum dose of sprinkles more convenient. However, one can open multiple sprinkle tablets to acheive any dose, and experience the same benefit as if it were all taken in a single dose. It is simply a matter of individual preference.

Seizure Management

Topamax Sprinkles are effective at reducing the frequency and severity of seizures, particularly:

• Partial-onset seizures
• Primary generalized tonic-clonic seizures
• Seizures associated with Lennox-Gastaut syndrome

Many patients find the medication stops seizures entirely, while others find the medication only helps. Topamax Sprinkles can be used on their own or with other medications. It's important that the medication be taken every day for full benefit.

Treatment is simple once the adequate dose has been reached. In patients age 10 and up:

• Week 1, start with 50 mg per day, divided into two 25 mg doses, taken morning and night.
• Week 2, switch to 100 mg per day, divided into two 50 mg doses.
• Week 3, switch to 150 mg per day, divided into two 75 mg doses.
• Week 4, switch to 200 mg per day, divided into two 100 mg doses.
• Week 5, switch to 300 mg per day, divided into two 150 mg doses.
• Week 6, switch to 400 mg per day, divided into two 200 mg doses.

In children age 2 to 9, dosage depends largely on weight. Other medications being taken and other medical conditions present can influence dosage as well. As above, dosage should start low and be gradually increased to the daily maintenance dose. In otherwise healthy children, the maintenance dose is as follows:

• Up to 11 kg (24 lbs): 150-250 mg per day, in two divided doses.
• 12 to 22 kg (25 to 49 lbs): 200-300 mg per day, in two divided doses.
• 23 to 31 kg (50 to 69 lbs): 200-350 mg per day, in two divided doses.
• 32 to 38 kg (70 to 84 lbs): 250-350 mg per day, in two divided doses.
• Over 38 kg (85 lbs): 250-400 mg per day, in two divided doses.

It will take about two months of treatment for full benefit to be seen. Treatment may continue for as long as it provides benefits and no adverse effects develop.

Alleviating Migraines

Reducing the frequency and severity of migraines is the other common use of Topamax Sprinkles. Here, too, the medication must be taken every day over the long-term to provide benefit.

In patients age 12 and up:

• Week 1, start with 25 mg once per day.
• Week 2, increase dosage to 50 mg per day, divided into two 25 mg doses.
• Week 3, increase to 75 mg per day, divided into one 25 mg dose and one 50 mg dose.
• Week 4, increase to 100 mg per day, divided into two 50 mg doses.

Off-label, the medication can also be used for cluster headaches; instructions are the same as for migraines except the ultimate daily dose is 200 mg per day, taken in two 100 mg doses. Dosage increases should be no higher than 25 mg per week.

Patients may need to wait about three months for full benefits to be seen. The medication does little for a migraine actually in progress, however; NSAIDs, triptans, or other rescue treatments to immediately address pain and other symptoms can still be used.

Precautions During Use

Topamax Sprinkles are known to be harmful to unborn babies. Women trying to conceive or who are sexually active but do not have access to reliable birth control should not take this medication. If pregnancy is discovered while taking Topamax, speak with a doctor as soon as possible. Keep in mind that if taking this medication for seizures, especially if it has been taken long term, treatment should not stop abruptly.

This medication can increase risk of developing kidney stones, which is why taking each dose with a full glass of water is encouraged. Additional fluid intake will further ensure hydration and lower this risk.

Other medications can interact with Topamax Sprinkles, reducing effectiveness of one or more of the medications involved. This includes over-the-counter medications and supplements. Check with a doctor or pharmacist before taking any other medications while taking Topamax Sprinkles.