Can't Get Trokendi XR? Here Are Your Options

If your pharmacy can't fill your Trokendi XR prescription, you may be wondering what alternatives are available. Whether the issue is stock availability, insurance coverage, or cost, the good news is that there are several other medications that treat the same conditions as Trokendi XR.

In this guide, we'll explain what Trokendi XR is, how it works, and walk you through the best alternatives so you can have an informed conversation with your doctor.

What Is Trokendi XR?

Trokendi XR is the brand name for Topiramate extended-release capsules, made by Supernus Pharmaceuticals. It's an anticonvulsant (also called an antiepileptic drug) that's FDA-approved to treat:

• Epilepsy — partial onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome (ages 6 and older)
• Migraine prevention — in adults and children 12 and older

It comes as an extended-release capsule in 25 mg, 50 mg, 100 mg, and 200 mg strengths, taken once daily. The capsules must be swallowed whole — they cannot be opened, crushed, or sprinkled on food.

How Does Trokendi XR Work?

Topiramate, the active ingredient in Trokendi XR, works through several mechanisms in the brain:

• Blocks sodium channels — reducing the rapid firing of nerve cells that causes seizures
• Enhances GABA activity — GABA is a calming brain chemical that helps reduce overexcitement in the nervous system
• Blocks glutamate receptors — glutamate is an excitatory brain chemical, so blocking it helps prevent seizures
• Inhibits carbonic anhydrase — this enzyme plays a role in various body processes, and blocking it contributes to Topiramate's anti-seizure effects

The extended-release formulation in Trokendi XR delivers the medication gradually over 24 hours, allowing for once-daily dosing and steadier blood levels compared to immediate-release Topiramate.

Alternatives to Trokendi XR

If you can't get Trokendi XR, these are the most common alternatives your doctor may consider. Never switch medications on your own — always talk to your doctor before making any changes to your seizure or migraine treatment.

1. Generic Topiramate (Immediate-Release Tablets)

Generic Topiramate tablets are the most widely available and affordable alternative. They contain the same active ingredient as Trokendi XR but are taken twice daily instead of once.

• Cost: As low as $10 to $30 per month
• Availability: Widely stocked at virtually all pharmacies
• Key difference: Twice-daily dosing; tablets can have a bitter taste if broken
• Best for: Patients who don't mind taking medication twice a day and want the most affordable option

Generic Topiramate is the same molecule as Trokendi XR, so the efficacy is similar. The main trade-off is convenience — you'll need to remember two doses per day instead of one.

2. Qudexy XR (Topiramate Extended-Release)

Qudexy XR is another brand-name extended-release Topiramate capsule. Like Trokendi XR, it's taken once daily. However, Qudexy XR capsules can be opened and sprinkled on soft food, which is a significant advantage for patients who have trouble swallowing capsules.

• Cost: Similar brand-name pricing, but may have different insurance coverage
• Availability: May be easier to find than Trokendi XR at some pharmacies
• Key difference: Can be opened and sprinkled on food; available in an additional 150 mg strength
• Best for: Patients who need extended-release Topiramate and want the option to sprinkle

3. Depakote (Divalproex Sodium)

Depakote is an anticonvulsant that works differently from Topiramate. It's FDA-approved for epilepsy and migraine prevention. It increases levels of GABA in the brain and is available as both immediate-release and extended-release tablets.

• Cost: Generic Divalproex is widely available and affordable
• Key difference: Different mechanism of action; different side effect profile (may cause weight gain rather than weight loss)
• Caution: Carries a boxed warning for hepatotoxicity, pancreatitis, and fetal harm — not suitable for women of childbearing age unless other options have failed
• Best for: Patients who cannot tolerate Topiramate or need a different approach

4. Lamictal (Lamotrigine)

Lamictal is another widely used anticonvulsant. It's FDA-approved for epilepsy (partial and generalized seizures) and is often used for mood stabilization. While it is not FDA-approved for migraine prevention, it may be considered in certain cases.

• Cost: Generic Lamotrigine is affordable, typically $10 to $40 per month
• Key difference: Different mechanism (primarily blocks sodium channels and inhibits glutamate release); requires slow dose titration to reduce risk of serious skin reactions
• Caution: Risk of Stevens-Johnson syndrome, especially if titrated too quickly
• Best for: Patients with epilepsy who need an alternative anticonvulsant, especially if they also have mood concerns

How to Talk to Your Doctor About Switching

If you're considering an alternative to Trokendi XR, here are some questions to bring up with your doctor:

• Would generic Topiramate work just as well for me?
• Are there reasons I specifically need the extended-release formulation?
• What are the side effect differences between my options?
• How would we transition safely from Trokendi XR to a new medication?

Important: Never stop taking Trokendi XR suddenly. Stopping an anticonvulsant abruptly can cause rebound seizures, even if you've never had seizures before. Your doctor will create a tapering plan if you need to switch.

Still Want Trokendi XR?

If you'd prefer to stay on Trokendi XR, there are ways to improve your chances of finding it. Use Medfinder to locate pharmacies with Trokendi XR in stock, and explore savings programs to help with the cost.

Final Thoughts

Not being able to fill your prescription is stressful, especially for a medication that manages seizures or prevents migraines. But you have options. Generic Topiramate, Qudexy XR, Depakote, and Lamictal are all potential alternatives depending on your specific condition and needs.

Talk to your doctor about which alternative is right for you, and use tools like Medfinder to check availability of any medication in your area. Your treatment doesn't have to stop just because one formulation is hard to find.