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Metabolic issues: Feeling constantly cold, chills, or a low body temperature (signs of metabolic acidosis) Severe gastrointestinal changes: Persistent diarrhea, vomiting, or a total loss of appetite Systemic changes: Unexplained tiredness, a fever or other signs of infection, unusual bleeding, bruising, or long-term concerns like osteoporosis In general, higher doses of topiramate are associated with an increased risk of adverse reactions

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