It does not increase the risk of arrhythmias, valve disease, or myocardial infarction, although studies to date excluded patients with known cardiac problems. Because patients had a dose-dependent increase in heart rate, the FDA is requiring postmarketing evaluation of cardiovascular safety. In animal and human studies, topiramate has been associated with a risk of cleft lip. Common side effects are dose dependent and include dry mouth, constipation, paresthesia, insomnia, irritability, and altered taste sensation. The benefit of this weight loss is not known. Over two years, systolic and diastolic blood pressure will be lowered by 3 to 5 mm Hg, and in patients with type 2 diabetes mellitus, A1C levels will be lowered by 0. It is unknown if weight loss is sustained after stopping the medication.

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