Topiramate
Quick read
Topiramate use in pregnancy has been linked to birth defects and altered neurodevelopment in the baby.
Topiramate is occasionally used in pregnancy if no other medicine will work to treat epilepsy.
What is it?
Topiramate (Topamax®) is used to treat epilepsy and to prevent migraine.
Benefits
What are the benefits of taking topiramate in pregnancy?
Topiramate prevents seizures in women with epilepsy, which can be dangerous or even life-threatening and can also lead to pregnancy complications.
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.
Studies have also shown that children who were exposed to topiramate in the womb have a higher chance of autism spectrum disorder (ASD) or intellectual disability. In the background population, around one in every 100 children is diagnosed with ASD. More research is required, but early data suggests that around 3 in every 100 children exposed in the womb to topiramate will be diagnosed with ASD.
Some drugs used to treat epilepsy can affect folic acid levels. UK guidelines state that women taking topiramate while trying to conceive and during pregnancy should be prescribed a high dose folic acid supplement (5 mg/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 the pregnant woman to weigh up the risk from uncontrolled seizures to both woman and 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. 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 a woman 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 the baby if the father takes, or has taken, 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.