Does Metformin Interact with Topiramate?
Metformin and Topiramate have a contraindicated drug interaction according to U.S. FDA drug labeling data. Metformin is contraindicated with topiramate due to risk of metabolic acidosis. The mechanism involves topiramate-induced metabolic acidosis. Patients taking both medications should consult their healthcare provider before starting, stopping, or changing the dosage of either drug. This information is based on official FDA drug labeling sourced from OpenFDA and the NIH National Library of Medicine.
- Severity
- Contraindicated
- Topiramate Class
- Cytochrome P450 3A4 Inducers
- Management
- Do not take together
- Data Source
- U.S. FDA via OpenFDA
How This Interaction Works
The interaction between Metformin and Topiramate occurs because topiramate-induced metabolic acidosis. Clinically, this means metformin is contraindicated with topiramate due to risk of metabolic acidosis. Because of the severity of this interaction, these medications are contraindicated — meaning they should not be taken together under any circumstances. If you are currently taking both, contact your healthcare provider immediately to discuss alternatives.
What To Tell Your Doctor or Pharmacist
If you are taking Metformin and your doctor is considering prescribing Topiramate (or vice versa), make sure to:
- Inform your doctor and pharmacist of all current medications, including over-the-counter drugs and supplements
- Ask whether the benefits of combining these medications outweigh the risks for your specific situation
- Ask what symptoms to watch for that would indicate the interaction is causing problems
- Ask about alternative medications that do not interact with your current regimen
- Ask how frequently you should be monitored while these are co-prescribed
- Never stop or change either medication without first consulting your healthcare provider