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Topiramate for weight loss (Topamax)

Topiramate, also sold under the brand name Topamax, is a prescription anticonvulsant medication used to treat the following conditions:1,2

  • Partial onset seizures
  • Primary generalized tonic-clonic seizures (grand mal)
  • Alcohol use disorder, or alcohol addiction
  • Migraine prevention
  • Weight management

Topiramate may also be used in conjunction with other medicines to manage seizures in individuals with Lennox-Gastaut syndrome.1

 minutes read
Last updated on 
January 18, 2024
Topamax for weight loss
In this article

What are the risks of taking Topamax for weight loss?

Topamax has been used for weight loss in some individuals with binge eating disorder (BED), and though it can be effective in reducing weight, it doesn’t treat the underlying issues of BED. In fact, it can cause disordered eating patterns in people who take it.3

Using Topomax as a weight loss drug can put your health at risk

Research indicates that taking Topamax can be risky to your health, especially for those who have a history of an eating disorder or are vulnerable to disordered eating. One case study assessed seven adolescents who developed disordered eating after taking topiramate. Three of the participants developed an eating disorder after starting Topamax, three had eating disorders prior to taking the medication, and one had been in eating disorder recovery. All of the teens had the same primary symptom of food restriction, while a few also engaged in purging and binging.4

Although following a fad diet like the ketogenic diet doesn’t necessarily mean someone has an eating disorder, it can be considered disordered eating. And if an individual is following the keto diet to lose weight, taking Topamax for weight loss could be especially dangerous due to the severe body weight changes, as well as the risk of metabolic acidosis, which occurs when there’s a buildup of acid in the body.

Metabolic acidosis can cause:5

  • Fatigue
  • Hyperventilation
  • Stupor
  • Cardiac arrhythmias
  • Kidney stones
  • Bone softening
  • Osteoporosis

It can also result in a loss of appetite, leading to even more weight reduction from a reduced-calorie diet, which can exacerbate issues like osteoporosis.5

Topamax for weight loss
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Dangers of rapid weight loss with Topamax

Topamax can lead to rapid weight loss due to appetite suppression. However, losing weight quickly has many health risks, including:6

  • Vitamin and mineral deficiencies
  • Muscle loss
  • Malnourishment
  • Decreased metabolism

Additionally, using Topamax for weight loss can increase the risk of disordered eating behaviors as well as the risk of developing full-blown eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN). In fact, one study showed that teen girls who engaged in extreme dieting were 18 times more likely to develop an eating disorder than those who didn’t diet.7

Further, rapid weight loss can lead to rebound weight gain, something known as weight cycling. Research indicates that weight cycling is worse for your health than never dieting at all and that it can increase your mortality rate or risk of death.8

Topiramate side effects and health risks

Topiramate use for weight loss can cause many adverse effects, such as:1,2

  • Nervousness
  • Drowsiness
  • Numbness in feet or hands
  • Shaking or tremors
  • Nausea, stomach pain, and constipation
  • Excessive menstrual bleeding
  • Missed menstrual periods
  • Bone pain
  • Weight loss

Serious side effects may include:1,2

  • Hyperthermia
  • Suicidal ideation
  • Impaired liver function and liver disease
  • Bloody or cloudy urine
  • Painful urination
  • Usual bruising or bleeding
  • Intense side or back pain
  • Fever 

If you experience any troubling side effects of topiramate or an unusual or allergic reaction, call your doctor immediately. They may advise you to stop taking it or may adjust your dose.

Can you overdose on topiramate?

It is possible to overdose on topiramate. Signs and symptoms of a topiramate overdose include:1

  • Vomiting
  • Seizures
  • Trouble speaking
  • Blurred or double vision
  • Loss of consciousness
  • Agitation
  • Shallow, fast breathing
  • Irregular heartbeat
  • Unresponsiveness 
If you suspect that you or someone else has experienced a Topamax overdose, call 911 immediately. If you are a witness, stay with the overdosing person until first responders arrive to ensure their safety.

Unpacking the problem of using medications like topiramate for “weight loss”

People who decide to use medication like topiramate for weight loss are typically influenced by the insidious nature of diet culture. Most people aren’t even aware of how much diet culture affects us, our relationship to food, our movement, our bodies, and the decisions we make daily.

Diet culture is ever-present, in media, pop culture, advertisements, and marketing, at grocery stores, in conversations, at work and in doctor’s offices, on food labels and menus, and beyond. And diet culture, which tells us that body shape and weight are more important than well-being, leads to anxiety about weight gain, body shape, body size, and more.

Diet culture even influences medical decisions. In 2012, the Food and Drug Administration (FDA) approved a combination weight-loss medication consisting of phentermine and topiramate.9 These decisions come on the heels of the so-called “obesity epidemic,” which has pathologized living in a larger body, associating fatness with disease. However, weight isn’t an accurate indicator of health, and pathologizing fatness only reinforces fatphobia, diet culture, and healthism.

Just because a medication like Topamax has been approved for weight loss, that doesn’t mean using it is without its risks, both physical and psychological. When you choose to use a rapid weight-loss medication like topiramate, you’re subscribing to harmful beliefs about your body and self-worth. This may be an indication that you’re struggling with disordered eating patterns or even an eating disorder.

It’s never too late or too early to seek help

You can reach out to your doctor for an assessment and a referral or seek treatment on your own. There are plenty of options from in-person treatment at an inpatient or outpatient basis to online eating disorder treatment programs like Within Health.

Our virtual program, which offers compassionate and individualized care, grants you the flexibility to attend treatment and therapy when it works best for you and your schedule.

Call (866) 293-0041

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Topiramate. (2022). National Library of Medicine. Retrieved April 11, 2023.
  2. Fariba, K. A., Saadabadi, A. (2023). Topiramate. In: StatPearls [Internet].
  3. McElroy, S. L., Arnold, L. M., Shapira, N. A., Keck, P. E., Jr, Rosenthal, N. R., Karim, M. R., Kamin, M., & Hudson, J. I. (2003). Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. The American journal of psychiatry, 160(2), 255–261.
  4. Lebow, J., Chuy, J. A., Cedermark, K., Cook, K., & Sim, L. A. (2015). he development or exacerbation of eating disorder symptoms after topiramate initiation. Pediatrics, 135(5).
  5. Food and Drug Administration. (2017). Highlights of Prescribing Information: Topamax. Retrieved April 12, 2023.
  6. Fletcher, G. O., Dawes, J., & Spano, M. (2014). The potential dangers of using rapid weight loss techniques. Strength & Conditioning Journal, 36(2), 45–48.
  7. Memon, A. N., Gowda, A. S., Rallabhandi, B., Bidika, E., Fayyaz, H., Salib, M., & Cancarevic, I. (2020). Have Our Attempts to Curb Obesity Done More Harm Than Good? Cureus, 12(9), e10275.
  8. Oh, T. J., Moon, J. H., Choi, S. H., Lim, S., Park, K. S., Cho, N. H., & Jang, H. C. (2018). Body-weight fluctuation and incident diabetes mellitus, cardiovascular disease, and mortality: A 16-year prospective Cohort Study. The Journal of Clinical Endocrinology & Metabolism, 104(3), 639–646.
  9. Lonneman, D. J., Jr, Rey, J. A., & McKee, B. D. (2013). Phentermine/Topiramate extended-release capsules (qsymia) for weight loss. P & T : a peer-reviewed journal for formulary management, 38(8), 446–452.


What is topiramate used for?

Topiramate is primarily used to treat seizures and alcohol use disorder, although it is also prescribed to prevent migraines and manage weight.1,2

Does Topamax cause weight loss?

Yes, one of the side effects of Topamax use is potential weight loss due to appetite suppression.1 However, it should not be used for this purpose; misusing Topamax to lose weight may be indicative of disordered eating.

What are the most common side effects of Topamax?

The most common side effects of Topamax include dizziness, sleepiness, memory problems, confusion, nervousness, weight loss, flushing, and fever.2

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Further reading

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