Provider Briefing: Trokendi XR Availability in 2026

If your patients are reporting difficulty filling Trokendi XR (Topiramate extended-release) prescriptions, you're hearing a consistent signal. While Trokendi XR is not listed on the FDA's official drug shortage database, a practical availability gap has emerged — driven by pricing, payer restrictions, and declining pharmacy stocking of the brand-name product.

This briefing covers what prescribers need to know about the current state of Trokendi XR availability, the clinical implications for your patients, and actionable steps to maintain treatment continuity.

Background: Trokendi XR at a Glance

Trokendi XR is a once-daily extended-release formulation of Topiramate manufactured by Supernus Pharmaceuticals. It is FDA-approved for:

• Partial onset seizures, primary generalized tonic-clonic seizures, and Lennox-Gastaut syndrome (adjunctive therapy, ages 6+)
• Migraine prophylaxis (ages 12+)

Available strengths include 25 mg, 50 mg, 100 mg, and 200 mg capsules. Notably, Trokendi XR capsules must be swallowed whole — they cannot be opened, crushed, or sprinkled, which distinguishes them from Qudexy XR (another extended-release Topiramate product that can be sprinkled on food).

The extended-release formulation provides steady-state plasma levels with once-daily dosing and includes a specific alcohol interaction warning: patients must avoid alcohol within 6 hours before and after dosing, as alcohol alters the drug's release profile.

Timeline: How We Got Here

Trokendi XR was approved by the FDA in 2013. For its first several years on the market, it was the only extended-release Topiramate available. Over time, several developments have eroded its market position:

• 2014–2015: Qudexy XR (another extended-release Topiramate) entered the market, offering a sprinkle-capable alternative
• 2018–2020: Payers increasingly implemented step therapy and prior authorization requirements, favoring generic Topiramate IR
• 2021–2023: Generic Topiramate ER capsules became available, further reducing brand-name demand
• 2024–2026: Declining prescription volume has led many retail pharmacies to reduce or eliminate Trokendi XR inventory

Prescribing Implications

The availability challenges with Trokendi XR have several clinical implications that prescribers should be aware of:

Treatment Continuity Risks

For patients with epilepsy, gaps in medication supply can lead to breakthrough seizures. Patients should never discontinue Topiramate abruptly due to the risk of rebound seizures and status epilepticus. If a patient cannot fill their Trokendi XR prescription, a bridging strategy may be necessary.

Formulation-Specific Considerations

Switching from Trokendi XR to another Topiramate formulation requires attention to:

• Dosing frequency: Trokendi XR is once daily; immediate-release Topiramate is typically twice daily
• Bioequivalence: Extended-release and immediate-release formulations have different pharmacokinetic profiles. Dose adjustments may be needed.
• Administration route: Trokendi XR cannot be sprinkled. If switching to Qudexy XR for a patient who can't swallow capsules, that product does allow sprinkling.
• Alcohol interaction: The alcohol avoidance window is specific to Trokendi XR's extended-release mechanism and may not apply identically to other formulations.

Prior Authorization Burden

Prescribers should anticipate prior authorization requirements from most commercial and government payers. Documentation typically required includes:

• History of inadequate response to or intolerance of generic Topiramate IR
• Clinical rationale for extended-release formulation (adherence concerns, side effect management, steady-state pharmacokinetics)
• Diagnosis confirmation with ICD-10 codes

Current Availability Picture

Trokendi XR remains manufactured and available through pharmaceutical distribution channels. The challenge is at the pharmacy level:

• Chain pharmacies (CVS, Walgreens, Rite Aid): Limited or no routine stocking. May require special order.
• Independent pharmacies: More likely to order on request. Often more experienced with brand-name neurological medications.
• Specialty pharmacies: Some neurology-focused specialty pharmacies carry Trokendi XR regularly.
• Mail-order pharmacies: Often the most reliable source for ongoing prescriptions, particularly those integrated with insurance plans.

Providers can direct patients to Medfinder for providers to help identify pharmacies with current stock.

Cost and Access Considerations

Understanding the cost landscape helps contextualize patient access barriers:

• Brand-name cash price: $1,200–$1,400/month
• With discount cards: Approximately $218/month (SingleCare pricing)
• Generic Topiramate IR: $10–$30/month
• Manufacturer savings card: Available for commercially insured patients through Supernus Pharmaceuticals
• Patient assistance: Supernus Cares program for uninsured/underinsured patients

The stark price differential between brand Trokendi XR and generic Topiramate IR is the primary driver of payer restrictions and the resulting availability issues.

Tools and Resources for Providers

Several resources can help you support patients who need Trokendi XR or a suitable alternative:

Medfinder for Providers

Medfinder's provider portal allows clinical teams to search for medication availability across pharmacies. This can be integrated into prescription workflows to identify stocked pharmacies before sending the prescription.

Therapeutic Alternatives Reference

When Trokendi XR is unavailable, consider the following substitutions based on clinical scenario:

• Same molecule, different formulation: Generic Topiramate IR (twice daily), Qudexy XR (once daily, sprinkle-capable), Eprontia (oral solution)
• Different molecule, same indications: Divalproex (Depakote) for epilepsy and migraine prophylaxis; Lamotrigine (Lamictal) for epilepsy

For a patient-facing comparison, see: Alternatives to Trokendi XR.

Manufacturer Resources

Supernus Pharmaceuticals offers:

• Prescriber support line for availability questions
• Savings card enrollment for eligible patients
• Supernus Cares patient assistance program

Looking Ahead

The trend toward generic utilization and payer cost management is unlikely to reverse. Providers who prescribe Trokendi XR should:

1. Proactively discuss availability with patients before prescribing
2. Document clinical rationale for the extended-release formulation to support prior authorization
3. Have a backup plan — identify an alternative formulation or molecule in case Trokendi XR cannot be filled
4. Leverage tools like Medfinder to reduce patient burden in locating stock

Final Thoughts

Trokendi XR remains a clinically valuable option for select patients who benefit from once-daily extended-release Topiramate. However, the practical barriers to filling prescriptions — driven by cost, payer policy, and pharmacy stocking decisions — require prescribers to be proactive in ensuring treatment continuity.

By understanding the availability landscape and preparing alternative strategies, providers can minimize disruption to patient care. Direct patients to Medfinder for real-time pharmacy availability, and consider enrolling eligible patients in manufacturer savings or assistance programs.

For related provider resources, see our guide on how to help patients find Trokendi XR in stock and how to help patients save money on Trokendi XR.