Topamax is a brand-name drug prescribed for migraine headaches and certain types of seizures. Topamax contains the active ingredient topiramate and may not be safe to take during pregnancy and breastfeeding.

Keep reading for specific information about reproductive health and Topamax. For a comprehensive look at Topamax, see this article.

If you can become pregnant, it’s important to consider whether Topamax is a safe choice for you.

Topamax can harm a fetus if taken during pregnancy. Studies show that infants born to females* who took Topamax in pregnancy are more likely to have a cleft lip or cleft palate. (This is also known as an “oral cleft.”) Newborns are also more likely to be small for their gestational age (SGA).

Newborns who are SGA can have a lower birth weight, length, and head size than expected. Newborns are more likely to be SGA when born to females who took a high dose of Topamax or took Topamax throughout their pregnancy.

Pregnancy studies in the United States looked at infants who were exposed to topiramate (the active ingredient in Topamax) in the first 3 months of pregnancy. The studies showed that 1.4% of these infants had oral clefts. In comparison, oral clefts occurred in 0.11% of infants born to females who didn’t have epilepsy and hadn’t taken seizure medications during pregnancy.

These studies also showed that, in the U.S., 19.7% of infants exposed to topiramate during pregnancy were SGA at birth. In comparison, 5.4% of infants born to females who didn’t have epilepsy and hadn’t taken seizure medications during pregnancy were SGA.

If you’re pregnant or can become pregnant, talk with your doctor about the risks and benefits of Topamax. Other medications may be more suitable for you.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” refers to sex assigned at birth.

Pregnancy registry

If you do take Topamax during pregnancy, you’re encouraged to join the North American Antiepileptic Drug Pregnancy Registry. This registry monitors and records congenital anomalies (also called birth defects) or changes affecting infants of females who took antiepileptic drugs, such as Topamax, while pregnant.

The registry helps healthcare professionals collect information about the safety of drugs such as Topamax during pregnancy. This can help you make informed decisions about the treatments you take during pregnancy.

You can register by visiting the program website or calling 888-233-2334.

Topamax can pass into breast milk. Sleepiness and diarrhea have been reported in children breastfed by females taking Topamax.

If you’re breastfeeding or plan to breastfeed, talk with your doctor about the possible risks and benefits of Topamax.

Topamax can harm a fetus if taken during pregnancy. Talk with your doctor for more information about this risk.

If you’re sexually active and can become pregnant, talk with your doctor about your birth control needs during treatment with Topamax.

For females taking Topamax

Females taking Topamax should use an effective method of birth control to help prevent pregnancy. However, Topamax can make birth control drugs that contain estrogen less effective at preventing pregnancy.

Examples of birth control that can be less effective when taken with Topamax include:

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

Topamax treatment can also make certain birth control medications less effective at preventing pregnancy. These include:

If you use birth control that contains estrogen, your doctor may recommend switching to a different type of contraception.

For males taking Topamax

The manufacturer of Topamax hasn’t stated that males taking this drug need to use birth control. If you have questions about your birth control needs, talk with your doctor.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.