Is Topiramate Safe to Take While Pregnant?
Topiramate is a generic, prescription medication classified as an anticonvulsant. It’s also approved as a weight loss aid when combined with phentermine. The brand name version of topiramate used to treat seizures is called Topamax. Topiramate can be used to treat epilepsy in children and adults. It can also be used to treat Lennox-Gastaut syndrome in children. Along with seizures, topiramate is frequently prescribed to prevent migraines and reduce the number of migraines a person has. Topiramate is believed to work by decreasing abnormal overexcitement in the brain. Patients are warned that topiramate can help control certain symptoms including seizures and migraines, but it doesn’t cure them. Some of the symptoms of topiramate can include nervousness, headache, drowsiness, weakness and a sense of numbness or tingling in the hands and feet. When using topiramate, people shouldn’t do anything that requires coordination or mental alertness until they know how it will affect them. Topiramate can interfere with the effectiveness of oral contraceptives that contain estrogen. Also, if topiramate is being used to treat seizures, it shouldn’t be discontinued suddenly. Sudden discontinuation of topiramate can increase the likelihood of rebound seizures.
There are certain reasons a woman might wonder if topiramate is safe to take while pregnant. First, she may already be prescribed to take it for the treatment of seizures or migraines. After becoming pregnant, she may wonder if it’s safe to continue using topiramate. Migraines can also be a symptom of pregnancy so a woman may wonder if she can start using topiramate to treat this condition. Topiramate is a category D drug in the U.S., meaning it likely shouldn’t be used during pregnancy. This category is based on FDA guidelines. The FDA has categories in place that indicate whether a medication is considered safe or unsafe during pregnancy. The categories are based on research currently available. Research can include animal studies and, in some cases, controlled or observational studies on humans. The FDA describes category A drugs as being safe during pregnancy. There’s no evidence of harm in animal or human studies with category A drugs. Category B drugs haven’t shown harm to fetuses in animal studies, but well-controlled human studies may not be available. Most drugs are category C. There’s evidence of potential fetal risks in animal studies, but there aren’t well-controlled studies looking at effects in humans. Category D drugs do have risks that have been demonstrated. They’re rarely prescribed during pregnancy unless the benefits significantly outweigh the potential risks. This is the case with topiramate.
The use of topiramate, particularly during the first trimester, is linked to an increased risk of birth defects. According to a study published in the American Journal of Obstetrics and Gynecology, using topiramate while pregnant can increase the chance of an oral cleft in a baby. An oral cleft can include a cleft lip, and it may or may not include a cleft palate. Seizure medicines, in general, are also linked to congenital heart defects, urinary tract defects and neural tube defects. The greatest risk of birth defects appears to be when topiramate is combined with valproate, which is also an epilepsy drug. Taking topiramate while pregnant doesn’t mean a baby will definitely be born with a defect, but the risks may be more significant than they would be otherwise. The higher the dose of topiramate used during pregnancy, the higher the risk of birth defects in some cases. However, if you are currently taking topiramate and you become pregnant, don’t stop using it without first speaking to your doctor.
If a pregnant woman is concerned about her use of topiramate, she should talk to her doctor about whether or not alternatives exist. These alternatives will likely depend on the condition being treated. If topiramate is used to treat epilepsy, a doctor may advise a woman to continue using it. Uncontrolled seizures can pose a clear and significant risk to a mother and a fetus. Complications of seizures during pregnancy can include slowing of the fetal heart rate, decreased oxygen reaching the fetus and fetal injury including placental abruption or a miscarriage caused by trauma during a seizure. A seizure during pregnancy can also trigger preterm labor. There may be other options besides topiramate that a doctor can prescribe to control seizures. A healthcare provider might not only explore other medicines but may lower dosage levels to minimize fetal exposure.
If topiramate is prescribed to treat migraines, it can be a different situation. While migraines can be difficult to cope with, they don’t pose a risk to the fetus even if they’re untreated. In this case, the use of topiramate is less likely to be continued during pregnancy. A doctor might work with a pregnant patient to find other options to treat migraines that are safer and have a lower risk of birth defects associated with their use.
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