Trokendi XR (Topiramate) for Migraine

What Members Say Top Tips Side Effects Copay Help FAQs

Trokendi XR (topiramate) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for preventing migraine in individuals 12 years of age and older.

What Members Say

MHT logo These insights are based on 136 comments about Trokendi XR from MyMigraineTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Once-daily dosing feels simpler to manage than multiple daily doses.
Migraine frequency often drops, sometimes after dose increases or combination treatment.
Fewer migraine days can make work, sleep, and daily activities more manageable.
Long-term prevention can remain helpful for months or even years.

Considerations:

Sleepiness, grogginess, and feeling drugged can interfere with daily functioning.
Anxiety, cognitive slowing, and memory or concentration problems can occur.
Alcohol must be avoided within six hours before and after each dose.
Insurance coverage, copays, and refill access can create treatment disruptions.

How Trokendi XR Works and How It’s Taken

Trokendi XR is a type of seizure medicine that works by changing how certain brain signals are sent. The exact way it helps prevent migraine is not fully known.

The drug works on many pathways. It blocks sodium channels, affects GABA and glutamate pathways, and slows carbonic anhydrase, which may help calm overactive nerve activity linked to migraine.

Doctors prescribe Trokendi XR when a person 12 years or older needs treatment to help prevent migraine attacks.

Trokendi XR is given as an extended-release capsule by mouth, typically once daily. Doctors usually raise the dose slowly over several weeks until the regular daily dose is reached.

Typical Dosing for Migraine

The recommended starting dose of Trokendi XR for migraine is 25 milligrams by mouth once daily for the first week.

Doctors usually increase the dose each week to 50 milligrams in week 2, 75 milligrams in week 3, and 100 milligrams in week 4.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Trokendi XR

MHT logo These insights are based on 136 comments about Trokendi XR from MyMigraineTeam members.

Members who use Trokendi XR often talk about balancing possible benefits with side effects, cost, and day-to-day functioning. Many say it helps to stay in close touch with a neurologist, watch for side effects that affect daily life, and give the medication some time while tracking whether migraine symptoms improve.

1

Give it time, and keep track of whether migraine attacks improve.
“It took about four months before I started feeling any relief, but now each month that passes I seem to feel a little better.”
2

Talk to your doctor about dose adjustments if results or side effects change.
“I did notice the difference between the change in my dosage.”
3

Let your doctor know if cost or insurance coverage is a problem.
“My insurance company will stop covering it in October this year. It is a very expensive drug, and the drug company has a savings card program that has helped with my copays.”

Connect with others who understand life with migraine. Join MyMigraineTeam for free.

Trokendi XR Side Effects

In clinical trials of Trokendi XR for the preventive treatment of migraine in people ages 12 years and older, the most common side effects occurred in about 6 percent to 51 percent of people. These include:

Tingling or “pins-and-needles” feelings in the arms or legs
Not feeling hungry
Weight loss
Change in taste
Diarrhea
Nausea
Trouble with memory
Decreased feeling or sensitivity on the skin
Upper respiratory tract infection
Abdominal pain

Serious Side Effects and Warnings

Trokendi XR can cause serious side effects that may require immediate medical attention. These include:

Serious eye problems — These include a sudden decrease in vision, eye pain, acute myopia, or angle-closure glaucoma, which can lead to permanent vision loss.
Visual field defects — Changes in side vision may be reversible after stopping the medicine.
Decreased sweating and high body temperature — This can lead to overheating, especially in hot weather.
Metabolic acidosis — Too much acid in the blood can affect bones, kidneys, and growth in children or fetuses.
Suicidal thoughts or actions — Watch for new or worsening depression, mood changes, or thoughts of self-harm.
Cognitive or mental health effects — These may include confusion, trouble concentrating, slowed thinking, sleepiness, or behavior changes.
Fetal harm — If used during pregnancy, this medication may cause a higher risk of birth defects such as cleft lip, cleft palate, and being small for gestational age.
Serious allergic reactions — These include anaphylaxis or angioedema, which can cause swelling of the face, lips, tongue, or throat, and trouble breathing.
DRESS or multiorgan hypersensitivity — This severe drug reaction can include fever, rash, and organ problems.
Serious skin reactions — These include Stevens-Johnson syndrome or toxic epidermal necrolysis, which can cause severe blistering or peeling skin.
High ammonia levels in the blood, with or without brain effects — Hyperammonemia or hyperammonemic encephalopathy can cause unusual sleepiness, vomiting, or mental status changes.
Kidney stones — Hard deposits in the kidneys can cause pain, nausea, or blood in the urine.
Increased risk of bleeding — Bleeding may happen more easily than usual.
Low body temperature when used with valproic acid — Hypothermia can cause shivering, confusion, or extreme tiredness.

Get medical help right away if you think you are having a serious reaction.

How To Save on Trokendi XR

Supernus Pharmaceuticals, the manufacturer of Trokendi XR, offers a copay savings and support program. Eligible people with commercial insurance may pay as little as $0.

The program also offers benefit verification, prior authorization assistance, and claims and appeals support. To learn more, visit the Trokendi site, or call 866-398-0833.

What To Know Before Taking Trokendi XR

Before starting Trokendi XR, your doctor may check your blood sodium bicarbonate level (to help screen for metabolic acidosis).

Tell your doctor if you have any allergies to topiramate or any ingredients in Trokendi XR.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, and supplements.

Also tell your doctor if you have or have had kidney problems, liver problems, eye problems, mood problems, depression, suicidal thoughts or actions, or conditions that may raise your risk of metabolic acidosis. For children, ask the doctor about possible effects on growth and bones.

Do not use alcohol within six hours before or six hours after taking Trokendi XR. Do not take Trokendi XR if you have had a hypersensitivity reaction to topiramate, Trokendi XR, or any of its ingredients.

Trokendi XR is also FDA approved to treat certain types of seizures.

If you miss one dose of Trokendi XR, take it as soon as you remember. If it is less than six hours before your next dose, wait and take your next dose at the regular time. If you miss more than one dose, call your healthcare provider for instructions.

Tell your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding. Trokendi XR can harm a fetus. If you can become pregnant and are not planning a pregnancy, use effective contraception.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Trokendi XR?

In two adult studies, people taking 100 milligrams of immediate-release topiramate had a mean reduction of 2.1 migraine headaches per four weeks. People taking placebo (an inactive treatment) had mean reductions of 0.8 and 1.1 migraine headaches per four weeks.

In a study of adolescents ages 12 to 17, the 100-milligram dose led to a 28 percent greater reduction from baseline in monthly migraine attack rate than placebo. Results show it can reduce migraine frequency for some people, but not everyone responds the same way.

Can Trokendi XR cause sleepiness or thinking problems when used for migraine?

Yes. Trokendi XR can cause sleepiness or drowsiness. It can also cause cognitive side effects such as confusion, difficulty concentrating, slow reactions, and difficulty with memory. People are advised not to drive or operate machinery until they know how the medicine affects them.

How often is Trokendi XR taken for migraine?

For migraine prevention, the recommended total daily dose is 100 milligrams taken once a day in people ages 12 and older. The capsule can be taken with or without food, but it should be swallowed whole and not chewed, crushed, or sprinkled on food.