Trokendi XR (topiramate)

What is Trokendi XR?

Trokendi XR is a brand-name prescription drug that’s used for:

• Treatment of epilepsy (seizure disorders). For epilepsy, Trokendi can be given to people ages 6 years and older with:
  • partial-onset or primary generalized tonic-clonic seizures, for which this drug can be prescribed alone or in combination with other seizure medications
  • seizures related to Lennox-Gastaut syndrome, for which this drug is given in combination with other seizure medications
• Prevention of migraine. For preventing migraine, Trokendi can be given to people ages 12 years and older.

Trokendi XR contains an extended-release form of topiramate. It belongs to a class of medications called anticonvulsants. These drugs are typically used to prevent seizures. However, they can also help prevent migraine headaches.

Trokendi XR comes as capsules that are taken by mouth once each day. It’s available in four strengths: 25 mg, 50 mg, 100 mg, and 200 mg.

Effectiveness

Clinical studies showed that the immediate-release form of topiramate (the active drug in Trokendi XR) was effective in treating certain seizure disorders and preventing migraine.

Additional studies also showed that Trokendi XR is equivalent to topiramate. This means that for equal doses, the level of medication in people’s bodies is about the same for both Trokendi XR and topiramate. As a result, researchers concluded that Trokendi XR would also be effective to treat seizures and prevent migraine.

For details on the effectiveness of topiramate, please see the “Trokendi XR uses” section below.

Trokendi XR generic

Trokendi XR is available only as a brand-name medication. It’s not currently available in generic form.

Trokendi XR contains the active drug topiramate in an extended-release form. This means that the medication is released slowly into your body over the course of the day.

Trokendi XR side effects

Trokendi XR can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Trokendi XR. These lists do not include all possible side effects.

Your side effects may vary from those listed below, depending on whether you’re taking Trokendi XR to treat epilepsy or prevent migraine.

For more information on the possible side effects of Trokendi XR, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be bothersome.

More common side effects

The more common side effects of Trokendi XR can include:

• tingling in your arms and legs
• loss of appetite
• weight loss
• speech problems, such as slurred speech
• feeling tired or drowsy
• dizziness
• feeling nervous
• fever
• nausea
• changes in vision, such as blurry vision
• reacting slowly
• upper respiratory infection, such as a cold
• trouble remembering things
• pain in your belly
• diarrhea
• decreased sensation (feeling) in your skin
• changes in the way things taste
• hair loss
• depression
• weakness
• losing control of certain body movements
• constipation

Most of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Trokendi XR aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Eye problems, such as vision loss, glaucoma, and acute myopia (sudden nearsightedness). Symptoms can include:
  • decreased ability to see
  • pressure in your eyes
  • eye pain
  • redness in your eyes
• Decreased sweating and fever. Symptoms can include:
  • not sweating in hot temperatures
  • increased body temperature
  • chills
• Metabolic acidosis (increased acid level in your blood). Symptoms can include:
  • feeling confused
  • feeling tired
  • not being hungry
  • increased heart rate
  • breathing quickly
• Hyperammonemia (high ammonia level in your blood). Symptoms can include:
  • feeling tired
  • vomiting
  • breathing quickly
• Kidney stones. Symptoms can include:
  • pain in your back or abdomen
  • pain or burning when urinating
  • blood in your urine
  • nausea or vomiting
  • fever
• Serious skin reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. Symptoms can include:
  • skin rash
  • fever
  • cough
  • body aches
• Depression and suicidal thoughts or behaviors, which are discussed in the section below called “Side effect details.”
• Allergic reactions, which are discussed in the section below called “Side effect details.”

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on several of the side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Trokendi XR. It’s not known how often people have allergic reactions to Trokendi XR. In clinical trials, no one had an allergic reaction to the medication.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Trokendi XR. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Weight loss

You may have weight loss while you’re taking Trokendi XR. In clinical trials, 6% of people ages 16 years and older who took 50 mg of immediate-release topiramate daily for epilepsy had weight loss. In comparison, 17% of the people taking 400 mg of the medication each day also had weight loss.

In people taking 100 mg of immediate-release topiramate daily for migraine prevention, 9% had weight loss. In comparison, 1% of the people taking a placebo (treatment with no active drug) had weight loss.

It’s possible that when you take Trokendi XR you may lose weight. This may happen because the medication can decrease your appetite, which makes you feel less hungry than usual. If you have weight loss that’s bothersome to you, talk with your doctor about ways to reduce this side effect.

Hair loss

Hair loss is a possible side effect of immediate-release topiramate, but it’s not very common. In clinical trials, 3% of people (ages 16 years and older) taking 50 mg of immediate-release topiramate daily for epilepsy had hair loss. In comparison, 4% of the people taking 400 mg of the drug each day had hair loss.

However, no one taking the topiramate for migraine prevention reported hair loss during the studies.

If you have hair loss while you’re using Trokendi XR, talk with your doctor. They may suggest ways to prevent hair loss, or they may recommend switching your medication.

Depression and suicidal thoughts or behaviors

Trokendi XR can increase your risk of depression and suicidal thoughts or behaviors. It’s very important that you, and your family and friends, watch for symptoms of depression. These symptoms can include:

• having thoughts about suicide
• feeling sad
• trouble sleeping
• feeling agitated or panicked
• other changes in your mood or behavior

In clinical trials of people taking any seizure drug, the risk of suicidal thoughts or behavior was about two times greater in people taking a seizure drug than it was in people taking a placebo (treatment with no active drug). In the trials, 0.43% of people taking a seizure drug had suicidal behavior or thoughts. In comparison, 0.24% of people taking a placebo had the same result.

If you have any symptoms of new or worsening depression, talk with your doctor right away. They can recommend ways to improve this condition. They may also recommend switching your seizure medication.

Side effects in children

During clinical studies, in children ages 6 to 15 years who took topiramate for epilepsy treatment, the most common side effects were fever and weight loss.

Also in the studies, in children ages 12 to 17 years who took topiramate for migraine prevention, the most common side effects were:

• belly pain
• lack of appetite
• upper respiratory tract infections, such as a cold
• tingling in their arms or legs

Trokendi XR dosage

The Trokendi XR dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using Trokendi XR to treat
• your age
• your weight
• other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Trokendi XR comes as capsules that are taken by mouth, usually once each day. It’s available in the following strengths: 25 milligrams (mg), 50 mg, 100 mg, and 200 mg.

Dosage for migraine prevention

The typical dosing of Trokendi XR for migraine prevention is the same for both adults and children ages 12 years and older.

For migraine prevention, your doctor will start you on a low dosage of Trokendi XR. They’ll increase your dosage each week over the first 4 weeks of treatment. Starting at a low dose helps to decrease any side effects that you may have from the drug.

During the first week of Trokendi XR treatment, you’ll take 25 mg by mouth each day. During the second week of treatment, you’ll take 50 mg daily. During your third week of treatment, you’ll take 75 mg daily.

In your fourth week of treatment, you’ll take 100 mg daily. This dosage will be continued for as long as your doctor recommends. The recommended maintenance (long-term) dosage for migraine prevention is 100 mg of Trokendi XR daily.

Depending on any side effects that you have, your doctor may increase your dose more slowly than it’s typically increased.

Dosage for epilepsy when Trokendi XR is used alone

Trokendi XR is approved for use alone to treat either partial-onset or primary generalized tonic-clonic seizures. For more information on these seizure disorders, please see the section below called “Trokendi XR uses.”

In adults and children ages 10 years and older who are taking Trokendi XR alone to treat epilepsy, the dosage is increased very slowly over time. This is done to decrease the side effects that they may have and get their body used to the medication slowly.

If you’re taking Trokendi XR alone for epilepsy treatment, the typical starting dosage of Trokendi XR is 50 mg taken by mouth daily for the first week of treatment.

During the second week of treatment, your dosage will be increased to 100 mg daily. During the third week, your dosage will be 150 mg daily. During the fourth week, your dosage will be 200 mg daily. Then during the fifth week of treatment, your dosage will be 300 mg daily.

Starting in the sixth week of treatment and going forward, your dosage is 400 mg each day.

The recommended maintenance (long-term) dose for adults and children 10 years and older is 400 mg daily when Trokendi XR is used alone for seizure treatment.

Dosage for epilepsy when Trokendi XR is used with other drugs

Trokendi XR is approved for use in combination with other drugs to treat either partial-onset or primary generalized tonic-clonic seizures. For more information on these seizure disorders, please see the section below called “Trokendi XR uses.”

When it’s used with other medications to treat epilepsy, the typical starting dosage of Trokendi XR in adults and children ages 17 years and older is 25 mg to 50 mg daily.

The starting dosage should be increased by 25 mg to 50 mg each week until the recommended maintenance (long-term) dosage is reached. This dosage is as follows:

• 200 mg to 400 mg by mouth each day for people with partial-onset seizures and Lennox-Gastaut syndrome
• 400 mg by mouth once each day for people with primary generalized tonic-clonic seizures

Trokendi XR can also be used with other seizure drugs in children ages 6 through 16 years with partial-onset or primary generalized tonic-clonic seizures. Dosages for this age group are described below in the section called “Pediatric dosage.”

Pediatric dosage

Typical dosages for Trokendi XR for prevention of migraine and treatment of seizures in children are described below.

For migraine headache prevention

In children ages 12 years and older, the typical dosage of Trokendi XR for migraine prevention is the same as it is for adults. See the section above called “Dosage for migraine prevention” for more details.

For epilepsy treatment when Trokendi XR is used alone

Trokendi XR can be used alone in children ages 6 years and older with partial-onset or primary generalized tonic-clonic seizures as their only epilepsy treatment. Dosages for these children are described below.

For children ages 6 to 9 years

For these children, the dosage of Trokendi XR for epilepsy treatment is based on their body weight.

During the first week of treatment, their starting dosage of Trokendi XR is 25 mg by mouth each day. If your child is tolerating the medication well, their doctor may increase their dosage to 50 mg daily during the second week of treatment.

After this, their doctor may increase their daily dosage by 25 mg to 50 mg each week. This is done until your child is at the recommended maintenance (long-term) dose for their body weight. Based on your child’s body weight, their dosage should be above the minimum maintenance dose, but below the maximum maintenance dose.

The recommended dosing ranges for children ages 6 to 9 are described below. For children with a body weight of:

• up to 11 kg (about 24 lb), the maintenance dosage range of Trokendi XR is a minimum of 150 mg daily to maximum of 250 mg daily
• 12 kg to 22 kg (about 26 lb to 48 lb), the maintenance dosage range of Trokendi XR is a minimum of 200 mg daily to maximum of 300 mg daily
• 23 kg to 31 kg (about 49 lb to 68 lb), the maintenance dosage range of Trokendi XR is a minimum of 200 mg daily to maximum of 350 mg daily
• 32 kg to 38 kg (about 69 lb to 83 lb), the maintenance dosage range of Trokendi XR is a minimum of 250 mg daily to maximum of 350 mg daily
• greater than 38 kg (close to 84 lb and over), the maintenance dosage range of Trokendi XR is a minimum of 250 mg daily to maximum of 400 mg daily

For children ages 10 years and older

For these children, the dosage of Trokendi XR for epilepsy treatment is the same as it is for adults. See the section above called “Dosage for epilepsy when Trokendi XR is used alone” for more details.

For epilepsy treatment when Trokendi XR is used with other drugs

Trokendi XR can also be used with other drugs to treat epilepsy in children ages 6 years and older with partial-onset or primary generalized tonic-clonic seizures. It can also be used with other drugs in children ages 6 years and older who have seizures caused by Lennox-Gastaut syndrome. Dosages of Trokendi XR for children are described below.

For children ages 6 to 16 years

For these children, the typical starting dosage of Trokendi XR when it’s used with other seizure medications is 25 mg or less each day. The recommended starting daily dosage for children ages 6 to 16 years is 1 mg to 3 mg of Trokendi XR per kilogram (about 2.2 lb) of their body weight.

In children with a lower body weight, their starting daily dosage may be less than 25 mg daily.

For example, if a child weighs 20 kg (about 44 lb), their starting dosage would be between 20 mg and 60 mg daily. Their doctor may increase their dosage every 1 to 2 weeks by another 1 mg to 3 mg of drug/kg of body weight.

The recommended maintenance (long-term) daily dosage of Trokendi XR in these children is between 5 mg to 9 mg of drug per kilogram of body weight. In the example above, the recommended maintenance dosage is between 100 mg and 180 mg each day.

Your doctor may round the calculated dosage to the nearest available capsule strength of Trokendi XR. They will recommend the safest dosage for your child. The maximum daily dosage of Trokendi XR for seizure treatment in children should never be more than 400 mg per day.

For children 17 years of age

The typical dosage of Trokendi XR in children 17 years of age is the same as it is for adults. See the section above called “Dosage for epilepsy when Trokendi XR is used with other drugs” for more details.

What if I miss a dose?

If you miss a dose of Trokendi XR, call your doctor right away. Depending on how long it’s been since you took your last dose of the drug, they may instruct you to skip the missed dose or to take it as soon as you can.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to take this drug long term?

Trokendi XR is meant to be used as a long-term treatment. If you and your doctor determine that Trokendi XR is safe and effective for you, you’ll likely take it long term.

Trokendi XR uses

The Food and Drug Administration (FDA) approves prescription drugs such as Trokendi XR to treat certain conditions. Trokendi XR may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is prescribed to treat a different condition.

Trokendi XR for migraine prevention

Trokendi XR is FDA-approved for migraine prevention in people ages 12 years and older. According to the World Health Organization (WHO), migraine headaches cause throbbing pain that can last from a few hours up to 2 to 3 days. These headaches are severe enough that they can affect your ability to complete daily routines.

Sometimes, along with head pain, people with migraine can also have nausea and visual changes, such as sensitivity to seeing light. Migraine may be genetic, which means that if people related to you have this condition, you’re more likely to also have it.

If you have migraine, you’re more likely to have epilepsy (seizure disorders) as well. This is because both conditions cause your brain cells to be more sensitive than usual. This sensitivity makes your brain cells overactive if they’re exposed to a certain changes, such as hormonal fluctuations.

Trokendi XR is thought to work by decreasing certain activities in your brain. This is why Trokendi XR can work for people with migraines and for people with epilepsy.

You can see our headache and migraine hub for details about migraine.

Effectiveness for migraine headache prevention

Trokendi XR was shown to be effective by using clinical studies that were done on the immediate-release form of topiramate (the active drug in Trokendi XR). These studies had shown that topiramate was effective in preventing migraine.

In studies, Trokendi XR was shown to be equivalent to topiramate. This means that the level of the medication in people’s bodies was about the same for both Trokendi XR and topiramate. Because immediate-release topiramate can be used to prevent migraine, researchers have concluded that Trokendi XR can also be used for this purpose.

Clinical trials also looked at using immediate-release topiramate for migraine prevention. People taking 200 mg of topiramate had about two fewer migraine headaches over 28 days. In comparison, people taking a placebo (treatment with no active drug) had only a decrease of about one migraine over 28 days.

Studies also looked at using topiramate for migraine prevention in children ages 12 to 17 years old. Children taking 50 mg of topiramate twice daily had about 72.2% fewer migraine headaches over 28 days of treatment. In comparison, children taking a placebo had 44.4% fewer migraine headaches over 28 days of treatment.

Trokendi XR for epilepsy treatment

Trokendi XR is also FDA-approved to treat certain types of epilepsy (seizure disorders) in adults and children ages 6 years and older. The World Health Organization (WHO) estimates that about 50 million people worldwide have epilepsy.

Seizures occur when you have abnormal electrical activity inside your brain. There are many different types of seizures that can affect many different people. Trokendi XR is approved to treat the following types of seizures:

• Partial-onset seizures. With partial-onset seizures, the abnormal electrical activity starts in only one part of your brain. These seizures are also known as a focal onset aware or impaired awareness seizures. They’re the most common type of seizure that occurs in people with epilepsy. During this type of seizure, you don’t lose consciousness. You may fumble, pick at your clothes, or become unaware of where you are. During a partial-onset seizure, people generally stay awake. It’s very hard for someone else to tell if you’re having a partial-onset seizure, because you won’t lose consciousness, and you may even be able to respond to other people. For people with partial-onset seizures, Trokendi XR can be used alone or in combination with other seizure drugs.
• Primary generalized tonic-clonic seizures. A primary generalized tonic-clonic seizure is also called a convulsive seizure. With convulsions, you’ll have stiff muscles and jerking movements. These symptoms are what most people think of when they hear the term “seizure.” Unlike partial-onset seizures, the abnormal electrical activity of generalized tonic-clonic seizures affects both sides of your brain. The “tonic” phase of the seizure is when your muscles become stiff and you lose consciousness. The “clonic” phase of the seizure is when your arms and legs jerk rapidly. For people with generalized tonic-clonic seizures, Trokendi XR can be used alone or in combination with other seizure drugs.
• Seizures associated with Lennox-Gastaut syndrome (LGS). With LGS, people may have many different types of seizures. They may also have impaired intellectual development or behavioral problems. LGS is very rare and only affects about 2% to 5% of children with epilepsy. Seizures associated with LGS may be hard to control because sometimes they don’t respond to typical seizure drugs. In about 25% of children with LSG, the cause of the condition is unknown. For people with LGS, Trokendi XR is used in combination with other seizure medications.

For more information about these conditions, you can see our epilepsy and seizures hub.

Effectiveness of Trokendi for treatment of epilepsy

Trokendi XR was shown to be effective by using clinical studies that were done on the immediate-release form of topiramate (the active drug in Trokendi XR). These studies found that topiramate was effective in treating certain forms of epilepsy (seizure disorders).

In studies, Trokendi XR was shown to be equivalent to topiramate. This means that the level of the medication in people’s bodies was about the same for both Trokendi XR and topiramate. Because immediate-release topiramate can be used to treat certain seizure disorders, researchers have concluded that Trokendi XR can also be used for these conditions.

Effectiveness of Trokendi XR for seizure treatment when it’s used alone

Clinical studies have shown that topiramate was effective when used alone to treat partial-onset and primary generalized tonic-clonic seizures.

For example, in one study, adults and children ages 6 years and older took topiramate on its own to treat their partial-onset seizures. Between 59% and 76% of people in this study were seizure-free for up to 1 year with treatment.

Effectiveness of Trokendi XR for seizure treatment when it’s used with other seizure drugs

Clinical studies have also shown that topiramate was effective when used with other drugs to treat epilepsy.

One clinical trial looked at adults taking 400 mg of immediate-release topiramate along with other medications for their partial-onset seizures. Of these people, 44% had at least 50% fewer seizures over a period lasting up to 3 months. In comparison, 18% of people who took a placebo (treatment with no active drug) had the same result.

Studies also looked at children taking immediate-release topiramate along with other medications for their partial-onset seizures. Of these children, 39% had at least 50% fewer seizures over an 8-week period. In comparison, 20% of children taking a placebo along with other seizure medications had the same result.

Clinical studies also looked at adults with primary generalized tonic-clonic seizures. Of people taking immediate-release topiramate with other seizure drugs, 56% had at least 50% fewer seizures over a 12-week period. In comparison, 20% of people who took a placebo had the same result.

Studies also looked at people taking immediate-release topiramate in combination with other seizure medications for seizures associated with Lennox-Gastaut syndrome. Of these people, 28% had at least 50% fewer seizures over an 8-week period. In comparison, 14% of people who took a placebo had the same result.

Off-label uses for Trokendi XR

In addition to the uses listed above, Trokendi XR may be prescribed off-label. Off-label drug use is when a drug that’s approved for one use is prescribed for a different one that’s not approved.

Trokendi XR for anxiety

Trokendi XR isn’t approved to treat anxiety. But sometimes it’s used off-label to treat certain types of anxiety disorders, such as post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).

Clinical trials have not yet shown that topiramate (the active ingredient in Trokendi XR) is effective in treating PTSD. However, topiramate has been studied in open-label trials (trials where people know that they’re taking the studied medication). These trials have shown that topiramate may stabilize moods, which can help treat symptoms of PTSD or OCD.

Other studies in people with OCD have shown that topiramate may be used along with other medications (such as certain antidepressants) to decrease symptoms of OCD. However, some studies have shown that topiramate may not help to treat OCD if other medications haven’t worked in the past for the condition.

More studies are needed, both in people with PTSD and those with OCD, before Trokendi XR can be approved to treat these conditions.

If you’re interested in knowing more about treatment options for anxiety, talk with your doctor.

Trokendi XR for binge eating disorder

Trokendi XR isn’t approved to treat binge eating disorder, but sometimes it’s used off-label for this condition. With binge eating disorder, you often eat a larger amount of food than usual, and you feel like you can’t stop eating.

Trokendi XR may ease symptoms of binge eating disorder, especially when it’s taken for 16 weeks or less. Clinical studies show that when Trokendi XR is used on a short-term basis, it may lead to fewer binge eating episodes and fewer impulsive actions. The drug may also lead to weight loss in some people.

However, more studies are needed to know if Trokendi XR can be used long term to treat binge eating disorder. If you’d like to know more about treatment options for this condition, talk with your doctor.

Trokendi XR and children

Trokendi XR is approved for the following uses in children:

• Migraine prevention. For this use, Trokendi XR can be used by children ages 12 years and older.
• Treatment of partial-onset seizures or primary generalized tonic-clonic seizures. For this use, Trokendi can be used by children ages 6 years and older. It can be used alone or along with other seizure drugs for these conditions.
• Treatment of seizures associated with Lennox-Gastaut syndrome. For this use, Trokendi XR can be used by children ages 6 and older. It’s used along with other seizure medications for this condition.

For more information on these conditions, see the sections above called “Trokendi XR for migraine prevention” and “Trokendi XR for epilepsy treatment.”

Trokendi XR and alcohol

You should never drink alcohol within 6 hours before taking or 6 hours after you’ve taken Trokendi XR. Alcohol greatly changes the way that Trokendi XR works inside your body.

Usually, Trokendi XR works over a period of time to control seizures or prevent migraine. Drinking alcohol while taking this drug can cause Trokendi XR to break down all at once in your body. This means there’s not enough of the medication left in your body to keep working hours later. This can be very dangerous as the drug won’t be working over many hours like it’s meant to.

If you have questions about the safety of drinking alcohol while taking Trokendi XR, talk with your doctor.

Trokendi XR use with other drugs

Trokendi XR is approved for use along with other seizure medications to treat the following types of epilepsy (seizure disorders):

• partial-onset seizures
• primary generalized tonic-clonic seizures
• seizures associated with Lennox-Gastaut syndrome

Examples of seizure medications that may be used along with Trokendi XR include:

• pregabalin (Lyrica)
• perampanel (Fycompa)
• lacosamide (Vimpat)
• eslicarbazepine (Aptiom)
• rufinamide (Banzel)
• clobazam (Onfi)
• oxcarbazepine (Oxtellar XR)
• lamotrigine (Lamictal)
• levetiracetam (Keppra)

Your doctor may prescribe a medication for you other than those listed here to use with Trokendi XR. Certain medications work better for certain types of seizures. Talk with your doctor about whether you’ll need to take any medications along with Trokendi XR.

Alternatives to Trokendi XR

Other drugs are available that can work to prevent migraine or treat epilepsy (seizure disorders). Some may be a better fit for you than others. If you’re interested in finding an alternative to Trokendi XR, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are prescribed off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is prescribed to treat a different condition.

Alternatives for migraine prevention

Examples of other drugs that may be used for migraine prevention include:

• blood pressure medications, such as:
  • propranolol (Inderal)
  • metoprolol tartrate (Lopressor)
  • verapamil (Calan)
  • diltiazem (Cartia XT)
• antidepressants, such as:
  • amitriptyline
  • nortriptyline (Pamelor)
  • duloxetine (Cymbalta)
  • venlafaxine (Effexor XR)
• seizure medications, such as:
  • valproic acid (Depakene)
  • other forms of topiramate (Qudexy XR, Topamax)
• monoclonal antibodies (drugs made from immune system cells), such as:
  • erenumab-aooe (Aimovig)
  • fremanezumab-vfrm (Ajovy)
  • galcanezumab-gnlm (Emgality)
  • onabotulinumtoxinA (Botox) injections

Alternatives for epilepsy treatment as monotherapy

Certain drugs may be used as monotherapy to treat seizure disorders. With monotherapy, just one medication is used alone to treat the condition.

Examples of other drugs that may be used alone to treat certain types of seizures include:

• carbamazepine (Tegretol)
• lamotrigine (Lamictal)
• divalproex (Depakote)
• levetiracetam (Keppra)
• zonisamide (Zonegran)

Alternatives for epilepsy treatment as adjunct therapy

Certain drugs may be used as adjunct therapy to treat seizure disorders. With adjunct therapy, multiple medications are used together to treat the condition.

Examples of drugs that may be used with other seizure medications to treat certain types of seizures include:

• pregabalin (Lyrica)
• perampanel (Fycompa)
• lacosamide (Vimpat)
• eslicarbazepine (Aptiom)
• rufinamide (Banzel)
• other forms of topiramate (Qudexy XR, Topamax)
• clobazam (Onfi)
• oxcarbazebine (Oxtellar XR)
• lamotrigine (Lamictal)
• levetiracetam (Keppra)

Trokendi XR vs. Topamax

You may wonder how Trokendi XR compares to other medications that are prescribed for similar uses. Here we describe how Trokendi XR and Topamax are alike and different.

About

Trokendi XR contains an extended-release form of topiramate, while Topamax contains an immediate-release form of topiramate. After taking a dose, Topamax releases the drug into your body more quickly than Trokendi XR does.

Trokendi XR releases the medication in your body over a 24-hour period. Because of this, Trokendi XR is taken once each day. In comparison, you’ll usually need to take Topamax twice each day.

Uses

Because Trokendi XR and Topamax each contain the same active drug, their uses are very similar.

Trokendi XR is approved for use in:

• people ages 6 years and older with partial-onset seizures or primary generalized tonic-clonic seizures, for which this drug can be used alone or along with other seizure medications
• people ages 6 years and older with seizures associated with Lennox-Gastaut syndrome, for which the drug is used along with other seizure medications
• people ages 12 years and older for migraine prevention

Topamax is approved for use in:

• people ages 2 years and older with partial-onset seizures or primary generalized tonic-clonic seizures, for which the drug can be used alone or along with other seizure medications
• people ages 2 years and older with seizures associated with Lennox-Gastaut syndrome, for which the drug is used along with other seizure medications
• people ages 12 years and older for migraine prevention

Drug forms and administration

Trokendi XR comes as capsules that are taken by mouth once daily.

Topamax comes as tablets or sprinkle capsules. It’s usually taken twice each day. Topamax sprinkle capsules can be swallowed whole, or they can be opened and sprinkled onto a small amount of soft food, which is then swallowed.

Keep in mind that while Topamax capsules are meant to be opened, Trokendi XR capsules are not meant to be opened. Trokendi XR capsules won’t work properly in your body if they’re opened.

Side effects and risks

Trokendi XR and Topamax both contain the active drug topiramate. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

Your side effects may vary from those listed below, depending on whether you’re taking Trokendi XR to treat epilepsy or prevent migraine.

More common side effects

The more common side effects* that can occur with both Trokendi XR and Topamax, when they’re taken individually, include:

• tingling in your arms or legs
• loss of appetite
• weight loss
• feeling tired or drowsy
• speech problems, such as slurred speech
• dizziness
• feeling nervous
• fever
• nausea
• change in your vision, such as blurry vision
• reacting slowly
• trouble remembering things
• upper respiratory infections such as a cold
• pain in your belly
• diarrhea
• changes in the way things taste

* The more common side effects listed above occurred in at least 10% of people during clinical studies of Trokendi XR and Topamax. For a more detailed list of possible side effects of Trokendi XR, please see the section above called “Trokendi XR side effects.”

Serious side effects

The serious side effects that can occur with both Trokendi XR and Topamax, when they’re taken individually, include:

• eye problems, such as glaucoma, blind spots, and acute myopia (sudden nearsightedness)
• skin reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis
• decreased sweating and fever
• severe allergic reaction
• metabolic acidosis (increased acid level in your blood)
• suicidal thoughts or behaviors
• hyperammonemia (high ammonia levels in your blood)
• kidney stones

Effectiveness

Trokendi XR and Topamax are both approved in certain age groups for the following uses:

• treatment of partial-onset seizures or primary generalized tonic-clonic seizures
• treatment of seizures associated with Lennox-Gastaut syndrome
• prevention of migraine

Trokendi XR and Topamax both contain the same active drug called topiramate. These drugs are considered to be equal in their effectiveness. This means that taking a once daily dose of Trokendi XR is equal to taking a twice daily dose of Topamax. With either Trokendi XR or Topamax, the concentration (level) and effectiveness of the medication in your body are about the same.

Costs

Trokendi XR is a brand-name drug. There is currently no generic form of Trokendi XR. However, there is a generic form of Topamax available, which is called topiramate. Brand-name medications usually cost more than generics.

Trokendi XR usually costs about the same as Topamax costs. But the generic form of Topamax is much cheaper than the brand-name form of Topamax. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Trokendi XR vs. Depakote

Like Topamax (described above), Depakote has uses similar to those of Trokendi XR. Here’s a comparison of how Trokendi XR and Depakote are alike and different.

About

Trokendi XR contains the drug topiramate, while Depakote contains divalproex (also called valproic acid).

Uses

Trokendi XR is approved for use in:

• people ages 6 years and older with partial-onset seizures or primary generalized tonic-clonic seizures, for which this drug can be used alone or along with other seizure medications
• people ages 6 years and older with seizures associated with Lennox-Gastaut syndrome, for which the drug is used along with other seizure medications
• people ages 12 years and older for migraine prevention

Depakote is also used to treat certain types of seizures in people ages 10 years and older. It’s approved for use alone or in combination with other seizure medications to treat complex partial and simple or complex absence seizures. Depakote can also be used in combination with other seizure drugs to treat other types of seizures.

Like Trokendi XR, Depakote is also used for migraine prevention. However, Depakote is only approved for this purpose in adults.

In addition to treating seizure disorders and preventing migraine, Depakote is also used to treat manic episodes. These episodes can occur as a part of bipolar disorder.

Drug forms and administration

Trokendi XR comes as capsules that are taken by mouth once each day.

Depakote comes as extended- or delayed-release tablets that are taken by mouth. It can be given once or twice daily depending on your dosage.

Delayed-release tablets have an extra coating (called enteric coating) on their surface that stops the medication from releasing into your body until after it passes through your stomach. However, extended-release tablets are made to release the drug slowly, over a certain period of time.

Depakote is also available as sprinkle capsules that can be opened and sprinkled onto soft food, which is then swallowed.

Side effects and risks

Trokendi XR and Depakote both contain medications that can help control seizures or prevent migraine. These medications can cause similar and different side effects. Below are examples of these side effects.

Your side effects can vary from those listed here, depending on whether you’re taking Trokendi XR to treat epilepsy or prevent migraine.

More common side effects

These lists contain examples of more common side effects that can occur with Trokendi XR, with Depakote, or with both drugs (when taken individually).

• Can occur with Trokendi XR:
  • tingling in your arms and legs
  • speech problems, such as slurred speech
  • reacting slowly
  • having trouble remembering things
  • changes in the way things taste
  • depression
  • fever
  • weight loss
• Can occur with Depakote:
  • headache
  • weakness
  • vomiting
  • tremor (shakiness)
  • flu-like symptoms, such as fevers, chills, and muscle aches
• Can occur with both Trokendi XR and Depakote:
  • feeling tired or drowsy
  • changes in your vision, such as blurry vision
  • belly pain
  • loss of appetite
  • losing control of certain body movements
  • diarrhea
  • respiratory infections, such as bronchitis
  • nausea
  • feeling nervous
  • dizziness

The more common side effects listed above occurred in at least 10% of people during clinical studies of Trokendi XR and Depakote. For a more detailed list of possible side effects of Trokendi XR, please see the section above called “Trokendi XR side effects.”

Serious side effects

These lists contain examples of serious side effects that can occur with Trokendi XR, with Depakote, or with both drugs (when taken individually).

• Can occur with Trokendi XR:
  • eye problems, such as glaucoma, blind spots, and acute myopia (sudden nearsightedness)
  • decreased sweating and fever
  • metabolic acidosis (increased acid level in your blood)
  • kidney stones
  • skin reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis
• Can occur with Depakote:
  • liver failure
  • pancreatitis (inflammation of your pancreas)
  • bleeding disorders
  • hypothermia (body temperature below 95°F/35°C)
  • severe fever and rash called drug reaction with eosinophilia and systemic symptoms (DRESS)
  • thrombocytopenia (low platelet level in your blood)
• Can occur with both Trokendi XR and Depakote:
  • hyperammonemia (high ammonia level in your blood)
  • severe allergic reaction
  • suicidal thoughts or behaviors

Effectiveness

Trokendi XR and Depakote have different FDA-approved uses, but they’re both used to treat certain types of seizures and to prevent migraine.

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Trokendi XR and Depakote to be effective for treating certain seizure disorders and preventing migraine.

Although Trokendi XR has not yet been compared in clinical trials Depakote, topiramate (the active drug in Trokendi XR) has been compared to Depakote. In one clinical trial, either Depakote or topiramate was given to people with migraine to see if their number of migraine headaches could be reduced.

In the trial, 58% of people taking topiramate and 51% of people taking Depakote reported having 50% fewer headaches than they had prior to treatment. However, more clinical trials are needed to compare the effectiveness of Trokendi XR and Depakote for migraine prevention.

Costs

Trokendi XR and Depakote are both brand-name drugs. There is a generic form of Depakote called divalproex. However, there isn’t a generic form for Trokendi XR. Brand-name medications usually cost more than generics.

Trokendi XR costs more than the brand or generic version of Depakote. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Trokendi XR interactions

Trokendi XR can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Trokendi XR and other medications

Below are lists of medications that can interact with Trokendi XR. These lists do not contain all the drugs that may interact with Trokendi XR.

Before taking Trokendi XR, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Trokendi XR and certain seizure medications

Taking Trokendi XR along with certain seizure medications may lower the level of Trokendi XR in your body. These seizure medications include phenytoin (Dilantin) and carbamazepine (Tegretol).

If you need to take these medications with Trokendi XR, your doctor may increase your dosage of Trokendi XR. This helps ensure that Trokendi XR can work properly to treat your seizure disorder or prevent migraine.

Using Trokendi XR with a seizure drug called valproic acid (Depakote, divalproex sodium) may cause you to have a very low body temperature (hypothermia). This condition can be very dangerous if it’s not treated.

Taking Trokendi XR with valproic acid can also cause an increased level of ammonia in your blood (hyperammonemia). This condition can lead to very serious side effects such as feeling tired, vomiting, or seizures. It can even lead to a brain condition called encephalopathy, which can be life-threatening.

If you need to take Trokendi XR with valproic acid, your doctor will monitor the amount of ammonia in your blood. They’ll also watch to see if you have a decreased body temperature.

Trokendi XR and other carbonic anhydrase inhibitors

Carbonic anhydrase inhibitors are a type of medication that block carbonic anhydrase in your body. This action is thought to help prevent migraine and treat certain types of seizure disorders.

Trokendi XR is an example of a carbonic anhydrase inhibitor that is used for migraine prevention and seizure disorder treatment. However, other carbonic anhydrase inhibitors can be used for other conditions, such as glaucoma and motion sickness.

Taking Trokendi XR along with another carbonic anhydrase inhibitor may increase your risk of having metabolic acidosis (a high level of acid in your blood). It can also increase your risk of kidney stones.

Examples of carbonic anhydrase inhibitors include:

• acetazolamide
• zonisamide (Zonegran)
• dichlorphenamide (Keveyis)
• methazolamide
• dorzolamide (Trusopt)

If you’re taking two carbonic anhydrase inhibitors at the same time, your doctor may check certain blood tests more often during treatment to monitor you for metabolic acidosis. They’ll also ask about any side effects that you may have. This helps your doctor to make sure you don’t have metabolic acidosis or kidney stones during treatment.

Trokendi XR and drugs that suppress your central nervous system

It’s possible that taking Trokendi XR may cause central nervous system (CNS) depression. With CNS depression, your breathing rate and heart rate may be lowered. The use of Trokendi XR with alcohol or certain other medications that may also suppress your CNS hasn’t been studied.

However, it’s possible that using Trokendi XR with alcohol or these certain other medications may cause your breathing rate and heart rate to be much slower than usual.

Medications that depress your CNS include barbiturates, sedatives, hypnotics, and medications used to treat panic disorders. Examples of these drugs may include:

• alprazolam (Xanax)
• clonazepam (Klonopin)
• diazepam (Valium)
• eszopiclone (Lunesta)
• zaleplon (Sonata)
• zolpidem (Ambien)
• phenobarbital (Luminal)
• pentobarbital (Nembutal)

In some serious cases, CNS depression can cause you to pass out, which can eventually lead to a coma or death. You may also have other side effects, such as feeling depressed, anxious, or irritable. You should avoid alcohol and other medications that depress your CNS while you’re taking Trokendi XR.

Trokendi XR and contraceptive medications

Taking Trokendi XR may cause certain birth control medication to not work as well as usual. Birth control drugs that contain estrogen may be less effective at preventing pregnancy if they’re taken with Trokendi XR.

You may also have an increased risk of breakthrough (unscheduled) bleeding if you’re using certain birth control drugs with Trokendi XR.

Examples of birth control pills that contain estrogen and may interact with Trokendi XR include:

• levonorgestrel/ethinyl estradiol (Lessina, Levora, Seasonique)
• desogestrel/ethinyl estradiol (Bekyree, Karvia)
• norethindrone/ethinyl estradiol (Balziva, Junel, Loestrin/Loestrin Fe, Microgestin/Microgestin Fe)
• norgestrel/ethinyl estradiol (Cryselle)
• drospirenone/ethinyl estradiol (Loryna, Yaz)
• norgestimate/ethinyl estradiol (Ortho Tri Cyclen/Ortho Tri Cyclen Lo, Sprintec, Tri-Sprintec)

The birth control patch, called Xulane (norelgestromin and ethinyl estradiol), and the vaginal ring, called Nuvaring (ethinyl estradiol and etonogesterel), may also be affected by Trokendi XR.

If you’re using any type of birth control drug that has estrogen in it, be sure to talk with your doctor about changes in bleeding patterns and pregnancy prevention. Even if you’re not having breakthrough bleeding, your birth control may not be working as well as it usually does to prevent pregnancy.

Talk with your doctor about which birth control methods will work best for you while you’re using Trokendi XR.

Trokendi XR and hydrochlorothiazide

Taking the diuretic hydrochlorothiazide (Microzide) with Trokendi XR may cause the level of Trokendi XR in your body to increase. It’s not known if this can cause dangerous effects.

If you’re taking both hydrochlorothiazide and Trokendi XR, your doctor may decrease your dosage of Trokendi XR. This can help to prevent your levels of Trokendi XR from getting too high.

Trokendi XR and pioglitazone

Taking a diabetes medication called pioglitazone (Actos) with Trokendi XR may cause a decrease in the level of pioglitazone in your body. As a result, pioglitazone may not work as well as it usually does.

If you’re taking Trokendi XR with pioglitazone, your doctor may monitor your blood sugar level more often than usual to be sure that your blood sugars are within your goal range.

Trokendi XR and lithium

Using lithium (Lithobid) and Trokendi XR together may cause an increased level of lithium in your body. Symptoms of elevated lithium levels can be very serious and include slurred speech, kidney failure, and memory problems. Elevated lithium levels can also cause movement disorders, such as tremors or muscle twitches.

If you’re taking lithium with Trokendi XR, your doctor will monitor the amount of lithium in your blood. They may decrease your dosage of lithium to help prevent your lithium level from being elevated.

Trokendi XR and amitriptyline

Taking Trokendi XR with amitriptyline may increase the levels of amitriptyline in your body. This may cause you to have more side effects of the medication, such as irregular heartbeat, hallucinations, and seizures.

If you’re taking amitriptyline with Trokendi XR, your doctor may decrease your dosage of amitriptyline. They’ll decide this based on how your body is responding to the drugs.

Trokendi XR and digoxin

It’s possible that taking digoxin (Lanoxin) with Trokendi XR may lower the amount of digoxin in your body. This means that digoxin may not be able to work as well as it usually does. It’s not known if this will affect your treatment.

If you’re taking these medications together, your doctor may monitor your digoxin levels more closely than usual. This helps your doctor to be sure that your levels of digoxin aren’t too low.

Trokendi XR and metformin

Taking metformin (Glucophage) and Trokendi XR together may increase the level of metformin in your body. It’s not known if this may cause an increase in side effects. Also, metformin can lower your body’s ability to break down (clear) Trokendi XR.

Taking these drugs together could also increase the level of Trokendi XR in your body.

If you’re taking metformin, talk with your doctor before you start taking Trokendi XR.

Trokendi XR and glyburide

Taking Trokendi XR with the diabetes drug glyburide (Diabeta) may decrease the level of glyburide in your body. This can cause the medication to not work as well as usual to treat your diabetes.

If you’re taking these drugs together, your doctor may check your blood sugar levels more often than usual. This helps your doctor to be sure that your blood sugar levels are within your goal range.

Trokendi XR and diltiazem

It’s possible that taking Trokendi XR with diltiazem (Cartia) can lower the amount of diltiazem in your body. This may prevent diltiazem from working properly for you.

If you take diltiazem, talk with your doctor before starting Trokendi XR.

Trokendi XR and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Trokendi XR. However, you should still check with your doctor or pharmacist before using any of these products while taking Trokendi XR.

Trokendi XR and foods

Diets that are low in carbohydrates and high in fat, such as the ketogenic diet, may cause increased side effects in people taking Trokendi XR. This is because eating high-fat meals increases the level of Trokendi XR in your body. It can also reduce the amount of time that Trokendi XR works in your body.

Ketogenic diets can also increase your risk of kidney stones and metabolic acidosis (an increased amount of acid in your blood). Because Trokendi XR can also cause these side effects, your risk is further increased when using this drug while you’re on a ketogenic diet.

Trokendi XR should be avoided in people who are on a ketogenic diet. This will help to lower the risk of increased side effects.

Sometimes, the ketogenic diet is used to treat epilepsy that’s been difficult to manage, especially in children. It’s important that if you or your child is on a ketogenic diet, you talk with your doctor before starting Trokendi XR.

Common questions about Trokendi XR

Here are answers to some frequently asked questions about Trokendi XR.

Can I use Trokendi XR to treat a migraine headache if I’m having one?

No, Trokendi XR isn’t used to treat migraine headaches when they’re occurring. It’s meant to be used for migraine prevention. Trokendi XR works to reduce the number of migraine headaches that you have. It won’t work to treat a migraine headache while it’s happening.

However, there are other drugs that can be taken to treat a migraine headache that’s already occurring. Examples of these drugs include:

• sumatriptan (Imitrex)
• eletriptan (Relpax)
• dihydroergotamine (Migranal)
• pain medications, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)

For more information on migraine treatment options, talk with your doctor.

Will Trokendi XR make me sleepy?

Yes, it’s possible that Trokendi XR will make you feel sleepy. This is a common side effect of the medication.

In clinical trials of people ages 16 years and older who were taking 400 mg of Trokendi XR daily for epilepsy, 15% felt tired. In comparison, only 10% of the people taking 50 mg of Trokendi XR daily felt tired.

In people taking 100 mg of Trokendi XR daily for migraine prevention, 7% felt tired. In comparison, only 5% of the people taking a placebo (treatment with no active drug) felt tired.

Because of this side effect, you shouldn’t drive or operate heavy machinery until you know how Trokendi XR affects you.

Can I take Trokendi XR for weight loss?

Doctors don’t prescribe Trokendi XR for weight loss or weight management. However, it’s possible that you’ll lose weight while you’re taking Trokendi XR. Weight loss is a side effect of the drug in some people. It may occur because the medication can decrease your appetite. However, Trokendi XR shouldn’t be used to help you lose weight.

Weight loss occurred in some people during Trokendi XR clinical trials. Weight loss was seen in 6% of people ages 16 years and older taking 50 mg of Trokendi XR daily for epilepsy. In comparison, weight loss occurred in 17% of the people taking 400 mg of Trokendi XR daily.

In people taking 100 mg of Trokendi XR daily to prevent migraine, 9% had weight loss. In comparison, 1% of the people taking a placebo (treatment with no active drug) had weight loss.

If you’re concerned about weight loss while using Trokendi XR, talk with your doctor about ways to reduce this side effect.

Is it safe for me to drive while I’m taking Trokendi XR?

Possibly. Trokendi XR can slow down your motor skills and lower your ability to think clearly. It can also affect your vision and make you sleepy or dizzy. These effects can make it dangerous for you to drive a car or any other type of machinery.

You shouldn’t drive until you know how Trokendi XR will affect you. If you’ve taken Trokendi XR at your recommended dosage and you’re not having these side effects, talk with your doctor about whether it’s safe for you to drive.

Can Trokendi XR cure migraine or epilepsy?

There aren’t currently any cures for migraine or epilepsy (seizure disorders). However, Trokendi XR can help prevent migraine headaches and control seizures. This may mean that you have symptoms less often or not at all. Trokendi XR can be used long term to control your migraine headaches or seizures.

Trokendi XR cost

As with all medications, the cost of Trokendi XR can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require you to get prior authorization before they approve coverage for Trokendi XR. This means that your doctor will need to send a request to your insurance company asking them to cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Trokendi XR.

If you’re not sure if you’ll need to get prior authorization for Trokendi XR, contact your insurance company.

Financial assistance

If you need financial support to pay for Trokendi XR, help is available. An assistance program and a savings card are available for Trokendi XR. For more information and to find out if you’re eligible for support, call 866-398-0833 or visit the program website.

How to take Trokendi XR

You should take Trokendi XR according to your doctor or healthcare professional’s instructions.

Trokendi XR should be taken once daily. You should take this medication exactly as your doctor prescribed it. Never try to increase or decrease your dosage without first talking with your doctor.

Also, don’t stop taking Trokendi XR without talking with your doctor. Usually, the dosage of this medication needs to be slowly decreased rather than stopped suddenly. Stopping the drug slowly helps to prevent seizures or other serious side effects from occurring.

You should drink lots of fluids while you’re taking Trokendi XR. This helps to prevent kidney stones, which you may develop as a side effect of the medication.

When to take

Trokendi XR should be taken once each day. You should try to take it at the same time every day.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Taking Trokendi XR with food

Trokendi XR can be taken before, during, or after a meal. It doesn’t matter if it’s taken with or without food.

However, it’s important to talk with your doctor before taking Trokendi XR if you’re on a ketogenic diet. Ketogenic diets are low in carbohydrates and high in fats. Sometimes the ketogenic diet is used to control epilepsy that’s difficult to treat, especially in children.

Trokendi XR and the ketogenic diet can each cause metabolic acidosis (increased acid level in your blood). When Trokendi XR is combined with a ketogenic diet, your risk for metabolic acidosis may be increased. This can cause health problems, including kidney stones. If you’re on a ketogenic diet, it’s recommended that you avoid taking Trokendi XR.

Can Trokendi XR be crushed, split, or chewed?

No, you shouldn’t crush, split, chew, or cut open Trokendi XR capsules. These capsules are made to slowly release the drug into your body over a period of time. Opening or chewing the capsules can cause you to get the full amount the drug all at once instead of getting small amounts over a period of time.

This can be very dangerous and may cause levels of the medication to be too high in your body. As a result, your risk side effects may be increased.

It’s important to never open capsules and sprinkle Trokendi XR on your food. Also, avoid chewing, breaking, crushing, or dissolving the capsules. They should be swallowed whole with plenty of water.

How Trokendi XR works

Trokendi XR is approved by the Food and Drug Administration (FDA) to treat certain forms of epilepsy (seizure disorders) and to prevent migraine attacks. For more information on these conditions, see the section above called “Trokendi XR uses.”

Both epilepsy and migraine cause your brain cells to be more sensitive than usual. The sensitivity causes the cells to be overactive if they’re exposed to certain changes, such as a hormonal fluctuations. Because both conditions affect your brain cells similarly, Trokendi XR can be used for people with migraine and people with epilepsy.

It’s not known exactly how Trokendi XR works, but it’s thought that the drug blocks sodium channels in your brain cells. This increases the level of certain brain chemicals, such as gamma-aminobutyric acid (GABA). This change can decrease the electrical activity in your brain, which may decrease the number of seizures or migraine episodes that you have.

Trokendi XR is an extended-release form of topiramate. This means that it releases the drug slowly over time. Because of this, Trokendi XR will give you long-lasting coverage, over 24 hours, with each dose of the drug.

How long does it take to work?

You may not notice any changes in your condition until you’ve taken Trokendi XR for about a month. Because this drug works by increasing the level of certain chemicals in your brain, it may take time to decrease your number of migraine episodes or seizures.

Even if you don’t feel an effect from Trokendi XR right away, it’s important that you keep taking the drug. Talk with your doctor about any changes in your treatment and before you stop taking Trokendi XR.

Trokendi XR and pregnancy

Trokendi XR isn’t safe to use during pregnancy. This medication is known to cause harm to fetuses when it’s taken during pregnancy. Studies show an increased risk of cleft lip and cleft palate in babies exposed to topiramate (the active drug in Trokendi XR) as fetuses.

According to pregnancy studies, about 1.1% of infants exposed to topiramate had an oral cleft. In comparison, oral clefts were seen in 0.12% of infants whose female* parent didn’t have epilepsy and who had no exposure to seizure medications during pregnancy.

Studies also show that babies exposed to topiramate as fetuses had an increased risk of being small for their gestational age (SGA). This usually means that the baby is smaller than the 10th growth percentile, meaning 90% of other babies their age weigh more than these babies weigh.

Babies with SGA can also have other problems caused by their small size. These problems include:

• decreased oxygen levels, which may be caused by trouble breathing or having lungs that aren’t fully developed
• low blood sugar levels
• trouble maintaining a normal body temperature

According to pregnancy studies, 19.7% of infants exposed to topiramate as fetuses were SGA at birth. In comparison, SGA was seen in 5.4% of infants who were born to a female parent without epilepsy and who had no exposure to seizure medications during pregnancy.

A pregnancy registry is available for people taking Trokendi XR or other seizure medications (also called antiepileptic drugs) during pregnancy. The registry is called the North American Antiepileptic Drug (NAAED) Pregnancy Registry. It monitors and records any changes or congenital anomalies (commonly known as birth defects) that may occur in the babies of people who were exposed to these drugs while pregnant. This helps healthcare professionals collect information about the safety of drugs like Trokendi XR during pregnancy.

You’re encouraged to sign up for the registry if you’re pregnant and using a seizure medication, including Trokendi XR. You can register by visiting the program website or calling 888-233-2334.

If you’re pregnant, or planning to become pregnant, talk with your doctor about the safety of using Trokendi XR during pregnancy.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Trokendi XR and birth control

Taking Trokendi XR during pregnancy may cause congenital anomalies (commonly known as birth defects), such as cleft lip or cleft palate. It may also cause your baby to be smaller than usual. Because of these risks, people who are sexually active and able to become pregnant should use contraception while taking Trokendi XR.

It’s possible that Trokendi XR can interact with birth control drugs that contain estrogen. This can make the birth control less effective at preventing pregnancy.

Examples of birth control pills that may be less effective if taken with Trokendi XR include:

• levonorgestrel/ethinyl estradiol (Lessina, Levora, Seasonique)
• desogestrel/ethinyl estradiol (Bekyree, Kariva)
• norethindrone/ethinyl estradiol (Balziva, Junel, Loestrin/Loestrin Fe, Microgestin/Microgestin Fe)
• norgestrel/ethinyl estradiol (Cryselle)
• drospirenone/ethinyl estradiol (Loryna, Yaz)
• norgestimate/ethinyl estradiol (Ortho Tri Cyclen/Ortho Tri Cyclen Lo, Sprintec, Tri-Sprintec)

The birth control patch, called Xulane (norelgestromin/ethinyl estradiol), and the vaginal ring, called Nuvaring (ethinyl estradiol/etonogesterel), may also be affected by Trokendi XR.

If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Trokendi XR. If you’re using a form of birth control that contains estrogen, your doctor may recommend that you use another form of contraception with Trokendi XR.

Trokendi XR and breastfeeding

A small study looked at people who were taking topiramate (the active drug in Trokendi XR) while breastfeeding. The study showed that the drug passed into breast milk. The levels of the drug in breast milk are about the same as the levels in the person who’s taking it. This means that the drug can be passed to and absorbed into the body of a child who is breastfed.

During the study, in babies who received breast milk containing topiramate, the most common side effects were sleepiness and diarrhea.

Because there’s only limited information about Trokendi XR use during breastfeeding, talk with your doctor before breastfeeding while using Trokendi XR. Your doctor can recommend healthy and safe ways to feed your child.

Trokendi XR precautions

This drug comes with several precautions. Before taking Trokendi XR, talk with your doctor about your health history. Trokendi XR may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Suicidal thoughts or behaviors. Taking Trokendi XR may increase your risk of suicidal thoughts or behaviors. If you have a history of depression, mood problems, or suicidal thoughts, talk with your doctor before taking Trokendi XR. Also, call your doctor right away if you develop these problems while you’re taking the drug.
• Kidney problems, such as kidney stones. If you have a history of kidney problems, such as kidney stones, talk with your doctor before taking Trokendi XR. This medication may increase your risk of kidney stones. Your risk is even greater if you take other drugs that also increase your risk of kidney stones, or if you’re on a ketogenic diet. Kidney disease may also increase the level of acid in your blood (called metabolic acidosis). Because Trokendi XR can also cause metabolic acidosis, you may be at an increased risk for this condition if you also have kidney problems. Talk with your doctor about any kidney conditions that you have before starting Trokendi XR. If you have kidney problems, your doctor may check certain blood tests more often during treatment to be sure that your acid levels are safe.
• Liver problems. It’s possible that you can develop hyperammonemia (a high level of ammonia in your blood) while taking Trokendi XR. This can cause serious effects, such as loss of consciousness. If you already have a liver condition, you’re at an increased risk of hyperammonemia. Talk with your doctor about any liver conditions that you have before starting Trokendi XR. Your doctor may check certain blood tests more often during treatment to be sure that your acid levels are safe.
• History of metabolic acidosis (elevated acid level in your blood). Trokendi XR may cause the level of acid in your blood to increase. As a result, you may feel tired and confused. If you’ve ever had metabolic acidosis in the past, you may be at an increased risk of developing it again. Your doctor may check certain blood levels more often during treatment to be sure that your acid levels are safe.
• Weak or soft bones. Having a history of metabolic acidosis may cause osteoporosis (brittle bones). Because Trokendi XR may also cause metabolic acidosis, this can further increase your risk of osteoporosis. If you already have weak bones, talk with your doctor before starting Trokendi XR. They may check certain blood tests more often during treatment to be sure that you’re not developing metabolic acidosis. They may also order bone scans to monitor your bone density.
• Breathing or lung problems. If you have a history of any lung problems or trouble breathing, talk with your doctor before starting Trokendi XR. These conditions may increase your risk of metabolic acidosis (elevated acid level in your blood). Because Trokendi XR may also cause metabolic acidosis, you may be at an increased risk for this side effect.
• Eye problems. It’s possible that Trokendi XR can increase the pressure inside your eye (glaucoma) or cause sudden nearsightedness (acute myopia). If you have a history of any eye problems, especially glaucoma, talk with your doctor before starting Trokendi XR.
• Diarrhea. Having frequent diarrhea may increase your risk of metabolic acidosis (elevated acid level in your blood). Because Trokendi XR can also cause metabolic acidosis, you may be at an increased risk of this condition if you have diarrhea while using this drug. If you have uncontrolled and frequent diarrhea, talk with your doctor before starting Trokendi XR. They may check certain blood tests more often during treatment to be sure that your acid levels are safe.
• Growth problems. Long-lasting metabolic acidosis (elevated acid level in your blood) may cause growth problems, such as delayed growth. Because Trokendi XR can also cause metabolic acidosis, the drug increases the risk of growth problems in people who are already at higher risk of developing growth problems. Your doctor may check certain blood tests more often during treatment to be sure that your acid levels are safe.
• Ketogenic diet. If you are on a ketogenic diet (typically high fat and low carbohydrate), you’re at a higher risk of developing metabolic acidosis (elevated acid level in your blood). Because Trokendi XR can also cause metabolic acidosis, you may be at an increased risk of developing the condition if you’re following a ketogenic diet and taking this drug. Talk with your doctor before starting Trokendi XR if you’re on a ketogenic diet. They may check certain blood tests more often during treatment to be sure that your acid levels are safe.
• Pregnancy. Trokendi XR can cause harm to a fetus. For more information, please see the “Trokendi XR and pregnancy” section above.
• Breastfeeding. It’s not known whether breastfeeding while taking Trokendi XR can be harmful to a breastfed child. Topiramate (the active drug in Trokendi XR) passes into the breast milk of the person taking the medication. For more information, please see the “Trokendi XR and breastfeeding” section above.

Note: For more information about the potential negative effects of Trokendi XR, see the section above called “Trokendi XR side effects.”

Trokendi XR overdose

Using more than the recommended dosage of Trokendi XR can lead to serious side effects. In clinical trials, no one taking Trokendi XR overdosed on the medication.

However, overdoses of topiramate (the active drug in Trokendi XR) have been reported. Overdoses of topiramate can be very serious.

Overdose symptoms

Symptoms of a topiramate overdose can include:

• feeling drowsy
• speech problems, such as slurred speech
• blurry vision
• double vision
• problems with coordination
• decreased blood pressure
• abdominal pain
• dizziness
• depression
• convulsions (sudden, irregular movements)
• decreased ability to think clearly or remember things
• severe metabolic acidosis (elevated acid level in your blood), which can cause tiredness or loss of consciousness
• coma
• in serious cases, death

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Trokendi XR expiration, storage, and disposal

When you get Trokendi XR from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Trokendi XR tablets should be stored at room temperature (77°F/25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms. It should be kept away from moisture and light.

Disposal

If you no longer need to take Trokendi XR and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.