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Pregnancy, breastfeeding and fertility while taking topiramate

Topiramate and pregnancy

Topiramate has been linked to a small, increased risk of problems for your baby if you take it during pregnancy. Children born to mothers taking topiramate also have an increased risk of long-term problems with learning and development.

For this reason, it's recommended that you use contraception and avoid getting pregnant if you're taking topiramate.

However, it is also important that epilepsy is well controlled during pregnancy, as seizures can harm you and your baby. Topiramate should only be taken in pregnancy after specialist advice, and if the benefits for controlling your epilepsy outweigh the risks.

Talk to your doctor about the benefits and risks of taking topiramate.

If you become pregnant, keep taking topiramate, but talk to your doctor straight away. It's likely that you will need to be seen by a doctor in a specialist epilepsy clinic, who may want to change your medicine.

If you have become pregnant while taking topiramate, it's recommended you take a high dose of folic acid (5mg a day). You can get this from your doctor or midwife.

Ideally it's best to take high dose folic acid for 3 months before you start trying to get pregnant and for the first 12 weeks of pregnancy. Do not worry if you have not taken it before you get pregnant, but start taking it as soon as possible once you know that you are pregnant. It helps your baby to grow normally.

Your baby may need extra monitoring for a few days after they're born. This is because they can sometimes have withdrawal symptoms from topiramate.

Topiramate and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take topiramate while you're breastfeeding.

Topiramate passes into breast milk, and it can sometimes build up in your milk. This could make your baby sleepy or irritable, or make it difficult for them to feed. There has also been one report of it causing diarrhoea in a breastfed baby, but most babies will not have any side effects.

It's important to keep taking topiramate to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual, or seems unusually sleepy or irritable, has diarrhoea or you have any other concerns about them, talk to your pharmacist, midwife, health visitor or doctor as soon as possible.

Topiramate and fertility

There's no evidence to suggest that taking topiramate causes fertility problems in either men or women.

However, speak to your doctor or specialist if you want to try to get pregnant, as they will want to review your treatment to see whether topiramate is still the right treatment for you. It's important to use contraception to avoid getting pregnant while waiting for a review by your doctor.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

Find out more about how topiramate can affect you and your baby on the Best Use of Medicine in Pregnancy (BUMPS) website.

Page last reviewed: 4 April 2022
Next review due: 4 April 2025