Q:  Side Effects of Topamax

Hi Dr. Phelps,

I take Topomax and Prozac, and I have searched and searched the web for listings of the known side effects, but not found a couple of things that have been bothering me.  Since I've started the Topomax (which I started after the Prozac) I not only feel tired (which IS listed among the known effects) but my joints feel very achey, and sometimes I  feel numbness or burning/tingling in my hands but more often my feet.  Is this possibly related?  Also, I can't find out anywhere whether the Topomax is tough on my liver - I had hepatitis once, so I was just curious.

Thanks in advance,
Ms. A


Dear Ms. A' -- 
The numbness/tingling is a well-recognized, common side effect.  Weak/tired is another recognized side effect.  I'm not so sure about the ache-y joints, that's not been common in my experience with it so far.  It's on the "extended" list in the PDR, as you can see below, but these lists run the risk of being overinclusive, as you can probably tell.  I've highlighted the problems I've seen repeatedly off the top list (although my use is still fairly minimal so far); note that many are redundant: 

• More common side effects may include:
  Abdominal pain, abnormal coordination, abnormal vision, agitation, anxiety, appetite loss, back pain, breast pain, chest pain, confusion, constipation, depression, difficulty with concentration, difficulty with memory, dizziness, double vision, drowsiness, fatigue, flu-like symptoms, indigestion, language problems, leg pain, loss of coordination, menstrual problems, mood problems, nausea, nervousness, nose inflammation, rash, sinusitis, slowing of movements, sore throat, speech problems, tingling or burning sensations, tremors, weakness, weight loss
  
• Less common side effects may include:
  Abnormal gait, abnormal menstrual bleeding, acne, aggressiveness, allergy, apathy, bladder infection, changes in taste, bloody urine, body odor, bronchitis, cough, decreased awareness, decreased mobility, decreased sensitivity, diarrhea, digestive inflammation, dry mouth, exaggerated sense of well being, eye pain, feelings of illness, feelings of unreality, fever, fluid retention, frequent urination, gas, gum inflammation, hair loss, hallucinations, headache, hearing difficulties, heart palpitations, hot flushes, hyperactivity, impotence, increased sweating, involuntary muscle movement, irritable bladder, joint pain, kidney stones, loss of balance, loss of consciousness, low sex drive, mood swings, muscle ache, muscle tension, muscle weakness, nosebleeds, painful or difficult urination, personality problems, pinkeye, ringing in the ears, sensitivity to touch, severe itching, shivers, shortness of breath, sleeplessness, suicidal tendencies, swelling, upper respiratory infection, urinary infection, urinary incontinence, vaginal infection, vomiting, weight gain