Topiramate
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Topiramate use in pregnancy has been linked to birth defects and lower birth weight in the baby, as well as altered learning and behaviour in children who were exposed in the womb.
Topiramate is occasionally used in pregnancy if no other medicine will work to treat epilepsy.
What is it?
Topiramate (Topamax®) is a medicine used to treat epilepsy and to prevent migraine.
Benefits
What are the benefits of taking topiramate in pregnancy?
Topiramate prevents seizures, which can be dangerous or even life-threatening and can also lead to pregnancy complications. It is only used in pregnancy when other anti-seizure medications are not suitable.
Topiramate is not usually used to prevent migraine attacks during pregnancy as there are alternatives that are considered to be safer for the baby.
Risks
Are there any risks of taking topiramate during pregnancy?
Some studies have suggested that there is an increased chance of cleft lip and palate in the baby following use of topiramate in early pregnancy. Overall, it is very clear that most babies exposed to topiramate in the womb do not have cleft lip and palate.
Topiramate use in pregnancy has been linked to lower birth weight in the baby.
Studies have also shown that children who were exposed to topiramate in the womb have a higher chance of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intellectual disability.
Because of these possible risks, women of childbearing potential who take topiramate should be enrolled on a ‘pregnancy prevention programme’. This involves pregnancy tests when prescriptions are issued and the use of reliable contraception.
Drugs used to treat epilepsy can affect folic acid levels. UK guidelines state that women taking anti-seizure medications while trying to conceive and during pregnancy should be prescribed a high dose folic acid supplement (5mg/day).
Alternatives
Are there any alternatives to taking topiramate?
Topiramate is generally only prescribed in pregnancy when epilepsy cannot be controlled with a different drug. In these cases, a specialist will help you to weigh up the risk from uncontrolled seizures to both you and your baby compared to the risk from drug exposure.
Women planning a pregnancy should be offered a medication review with their epilepsy specialist to determine whether topiramate is still the most suitable medicine.
If you take topiramate to help prevent migraines, you should speak to your doctor who will be able to prescribe a different medicine while you are pregnant.
Women with an unplanned pregnancy while taking topiramate should be reviewed as soon as possible by their GP or specialist.
No treatment
What if I prefer not to take medicines during pregnancy?
It is very important to take any medicines prescribed to treat epilepsy. Uncontrolled seizures can be serious and can lead to pregnancy complications.
Doctors will only prescribe medicines when absolutely necessary and will be happy to talk about any concerns that you might have.
Pregnant women should not stop or reduce the dose of topiramate unless this has been advised by their GP or specialist.
Will my baby need extra monitoring?
All pregnant women in the UK will be offered a very detailed anomaly scan at around 20 weeks of pregnancy as part of their routine antenatal care. No extra monitoring for major birth defects is required following topiramate use in pregnancy.
Are there any risks to my baby if the father has taken topiramate?
We would not expect any increased risk to your baby if the father takes topiramate.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.