Ajovy vs. Topamax
See how Ajovy and Topamax compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Ajovy is an injectable CGRP antibody given once a month or once every 3 months, while Topamax is a daily pill that requires several weeks of dose titration.
Ajovy's main side effect is injection site reactions, while Topamax more often causes tingling, fatigue, appetite loss, and thinking-related side effects.
Topamax has a low-cost generic version, while Ajovy has no generic and typically costs far more per month out of pocket.
Ajovy vs. Topamax Drug Summary
Ajovy
Ajovy is a CGRP monoclonal antibody used to prevent migraines in adults and in children 6 and older who weigh at least 45 kg. It's given as a subcutaneous injection either once a month or once every three months. It works by blocking a protein involved in triggering migraine attacks, rather than treating an attack once it starts.
Topamax
Topamax is an anticonvulsant, also FDA-approved to prevent migraines in people 12 and older. It's taken as a daily oral tablet or capsule, starting at a low dose that's slowly raised over several weeks to limit side effects. It's also used to treat certain types of epilepsy.
Ajovy vs. Topamax Side Effects
Ajovy
Topamax
Ajovy vs. Topamax Dosage
Ajovy
Topamax
| STAGE | DOSE | WHEN |
| Starting dose | 225 mg once monthly | At the start |
| Maximum dose | 675 mg every 3 months | If needed |
| Dose changes | 1 increase | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg/day | Week 1 |
| Maximum dose | Up to 200 mg/day | If needed |
| Dose changes | 5 increases | Every week |
Ajovy
| STAGE | DOSE | WHEN |
| Starting dose | 225 mg once monthly | At the start |
| Maximum dose | 675 mg every 3 months | If needed |
| Dose changes | 1 increase | As tolerated |
Topamax
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg/day | Week 1 |
| Maximum dose | Up to 200 mg/day | If needed |
| Dose changes | 5 increases | Every week |
Ajovy vs. Topamax Indications
Ajovy
Ajovy is FDA-approved to prevent migraines before they start, not to stop an attack already underway. It's approved for adults and for adolescents 6 to 17 years old who weigh at least 45 kg. It isn't approved for younger or lighter-weight children.
Preventive treatment of migraine in adults
Preventive treatment of episodic migraine in patients 6 to 17 years old weighing at least 45 kg
Not approved for acute (in-the-moment) migraine treatment
Not approved for children under 6 years old or under 45 kg
Topamax
Topamax is FDA-approved to prevent migraines in people 12 and older, and it also treats several types of epilepsy. Like Ajovy, it isn't approved to stop a migraine once it has already started. Doctors sometimes prescribe it off-label for other conditions, such as weight management, but that use isn't FDA-approved.
Preventive treatment of migraine in patients 12 years and older
Treatment of partial-onset seizures and primary generalized tonic-clonic seizures
Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome
Off-label: sometimes prescribed for weight management, though not FDA-approved for this use
Ajovy vs. Topamax Pros and Cons
Ajovy
Ajovy trades a daily pill for an infrequent injection and has a side effect profile centered almost entirely on the injection site. Because it's a newer biologic with no generic, insurers often require patients to try cheaper options first, and it costs substantially more out of pocket.
Pros
Only needs to be injected once a month, or once every 3 months
No daily pill or multi-week dose titration required
Not linked to cognitive side effects like brain fog or word-finding trouble
Approved for adolescents 6 to 17 years old with episodic migraine
Cons
Injection site reactions occur in a large share of patients
No generic version is currently available
Costs roughly $690 to $1,046 per month without insurance, before savings programs
Can cause or worsen Raynaud's phenomenon
Topamax
Topamax is a well-established, inexpensive option with decades of use, but it requires a slow daily dose increase and carries a distinct set of thinking-related and pregnancy risks. Its cognitive side effects are a common reason patients discontinue it.
Pros
Available as a low-cost generic tablet or capsule
Generic topiramate typically costs roughly $20 to $100 per month without insurance
Also FDA-approved to treat several types of epilepsy
Long track record of clinical use since its 1996 approval
Cons
Requires a multi-week dose titration before reaching a maintenance dose
Commonly causes tingling sensations (paresthesia) in over half of patients
Associated with cognitive side effects like slowed thinking or word-finding trouble
Carries a pregnancy warning for increased risk of birth defects such as cleft palate
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