Topiramate And Birth Control Interaction

We must remember the topiramate and birth control interaction! The case: A 33 year old female has had an increase in the frequency of migraines over the last few months.  She has had about 6 episodes in the last month.  These episodes have lasted nearly 24 hours each.  The mirgraines have greatly impacted her quality of life and her triptan use has been escalating.

She was initially placed on propranolol 10 mg twice daily and was titrated upward over a period of a few weeks.  She did not like the propranolol and wanted to use a different medication as the propranolol “zonked” her out.  The sedative side effect started even at the low dose and got worse as the dose was increased.

She was transitioned to topiramate with relatively good success.  He migraines went down to about 1 per month on average.  Three months following initiating the topiramate, she found out that she was pregnant.  She had been taking birth control on a regular basis and did not understand how this happened.

The topiramate and birth control interaction is a significant one and in this patient population where pregnancy is a concern and migraines can coexist, it can be a challenge to try to find an agent that prevents migraines and also doesn’t cause issues pertaining to pregnancy.  Also remember that valproic acid is usually avoided due to risk to the baby if a patient does become pregnant.

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  1. Shelley

    Thought there was a dose limit?

    • Eric Christianson

      Great comment Shelley! I believe there is some thought that lower doses of topiramate may not have this impact. I’m not aware of any solid literature as to what that cut off is. I’d rather play it safe than sorry on this one. Did you have a link to any articles that discuss/research the lower doses of topiramate and/or higher doses of estradiol necessary? – thanks again

  2. Flopez

    Solid reminder.

  3. koyakuttymeletath

    Still drug interaction is not considering or just forget while prescribing or dispensing medicines

  4. Nwanosike Ezekwesiri

    Your posts have been incisive and valuable. I’ve been following them for 3 months now. Thanks for being a stakeholder in my career progression. More power to your elbows…

    • Eric Christianson

      thank you so much! – best to you! – Eric

  5. Brenda

    Does topirammate affect the essure birth control as well?

  6. Brenda

    Does topiramate affect the essure birth control as well

  7. Betty-Ann

    What if she stays on Topiramite, what adjustment/substitution to her birth control would be best suited?


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Written By Eric Christianson

January 4, 2017

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