Efficacy and safety of topiramate on weight loss: a meta-analysis of randomized controlled trials


  • Disclosure Statement: The authors have nothing to disclose

  • Funding: This study was supported in part by Projeto de Núcleos de Excelência do Ministério de Ciência e Tecnologia, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ 576627-2008-9), and Fundo de Incentivo a Pesquisa of Hospital de Clínicas de Porto Alegre (GPPG 09023). C.K.K is a recipient of a grant from Projeto Nacional de Pós-Doutorado no País (PNPD 03021/09-2). The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.

CK Kramer, Division of Endocrinology of Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003, Porto Alegre-RS, Brazil. E-mail: carolinekkramer@gmail.com


Topiramate was associated with weight loss in clinical trials. We summarize the evidence on the efficacy and safety of topiramate in the treatment of overweight/obesity. The databases Medline, Embase, and Cochrane were searched. Randomized controlled studies with at least 16 weeks of duration that report the effect of topiramate on weight loss and adverse events were eligible for inclusion. Ten studies were included (3320 individuals). Patients treated with topiramate lost an average of 5.34 kg (95% confidence interval [95%CI]−6.12 to −4.56) of additional weight as compared with placebo. According to meta-regression analysis, treatment duration and dosage were associated with the efficacy of topiramate treatment. Evaluating trials using topiramate 96–200 mg day−1, the weight loss was higher in trials with >28 weeks of duration (−6.58 kg [95%CI −7.48 to −5.68]) than in trials with ≤28 weeks (−4.11 kg [95%CI −4.92 to −3.30]). Data of 6620 individuals were available for adverse events evaluation and those more frequently observed were paraesthesia, taste impairment and psychomotor disturbances. The odds ratio for adverse events leading to topiramate withdrawal was 1.94 (95%CI 1.64–2.29) compared with the control group. In conclusion, topiramate might be a useful adjunctive therapeutic tool in the treatment of obesity as long as proper warnings about side effects are considered.