Topiramate & Pregnancy

Topiramate and Pregnancy: What You Need to Know

Disclaimer: “This information is not a substitute for medical advice. Always consult your GP or pharmacist.”

What Is Topiramate?

Topiramate, also known as Topamax, is a drug used to treat seizures and prevent migraines. As with all medications, topiramate has its risks as well as its benefits.

What Are the Risks in Pregnancy?

Mothers taking topiramate during pregnancy have an increased chance of their child:

Being born with birth defects (4 to 9 babies in every 100 babies)
Developing mental development or learning difficulties such as autism spectrum disorder or attention deficit hyperactivity disorder (children have a 2 to 3 times higher risk of these problems).
Having a lower birth weight (around 18 out of 100 babies)

ALL women of childbearing age who are taking topiramate should use effective contraception consistently to prevent pregnancy. They must follow the requirements of the pregnancy prevention programme.

What Is The Pregnancy Prevention Programme (PPP)?

A formal safety protocol designed to reduce the risk of harm to unborn babies from certain medicines known to cause birth defects (teratogenic effects). It is required for patients who are prescribed these medicines and who could become pregnant.

This typically is a discussion with your doctor or pharmacist, and you will need to sign a formal risk acknowledgment form. This confirms that:

You understand the risks of taking medicine during pregnancy
You’ve received counselling from your healthcare provider
You agree to use highly effective contraception
You’ll undergo regular pregnancy testing

You should review this with your GP once a year to review the risks and ensure it is still appropriate for you.

Your GP may also ask you to do a pregnancy test before starting topiramate to rule out pregnancy.

What Is Highly Effective Contraception?

To stay protected against pregnancy you could consider:

Long-acting reversible contraception

Copper or hormonal IUD (coil)
Contraceptive Implant

Permanent contraception

Female sterilization (e.g., tubal ligation)
Male sterilization (vasectomy)

Consult your GP before starting or changing any form of contraception.

What should you do if you are planning to become pregnant?

Contact your GP if you are planning to become pregnant. Do NOT stop your contraception until you have discussed this with your GP.

Your GP may advise you to continue taking contraception for four weeks after your last dose of topiramate to prevent the risk of you becoming pregnant.

What to do if you become pregnant whilst taking topiramate?

Do NOT stop taking your topiramate straight away. Contact your doctor/specialist immediately.

Suddenly stopping topiramate can cause seizures to start again, or last longer in patients with epilepsy.

Your specialist/doctor may advise you to start another medication, and they will explain how to safely switch from one medication to another.

Is topiramate safe during breastfeeding?

Discuss with your GP. Risks may vary depending on the dose and baby’s health.

Need Advice? We’re Here to Help

If you're taking topiramate or considering it, book an appointment with your GP or nurse. We’ll help you understand the risks and choose the safest path forward.

Further sources of information

Leaflet for a patient taking topiramate for migraines:

https://www.medicines.org.uk/emc/rmm/3082/Document

Leaflet for a patient taking topiramate for seizures:

https://www.medicines.org.uk/emc/rmm/3081/Document

Epilepsy Action:

www.epilepsy.org.uk 0808 800 5050

Epilepsy Society:

www.epilepsysociety.org.uk 01494 601 400

Young Epilepsy: