Topamax (topiramate), a seizure medication usually prescribed for people with epilepsy, is also prescribed to help alcohol addicts stop drinking. It is used off-label to treat alcoholism and alcohol use disorders, which means it is not FDA approved for this purpose.
However, it is recommended in the 2015 U.S. Department of Veterans / Defense Policy Guideline for the Treatment of Substance Disorders for People with Moderate to Severe Alcohol Use Disorder.If youIf you
How topiramate works
Topiramate has been shown to reduce alcohol cravings in people with alcoholism and alcohol use disorders. It is not entirely clear how exactly it works from a biochemical point of view, but some possible mechanisms have been suggested.
Drinkers enjoy alcohol because it triggers the release of dopamine, a chemical with positive feedback in the brain. Drinking also changes GABA, an inhibitory neurotransmitter. Topiramate is thought to have its effects on alcohol cravings and consumption by interacting with GABA and potentially reducing the release of dopamine that is involved in the pleasure caused by alcohol consumption.If youIf you
dose
For the treatment of alcohol use disorders or alcoholism, topiramate is generally increased to 75 mg per day, although it can be increased to a maximum dose of 300 mg per day to control seizures in epilepsy.If youIf you
Topiramate is generally not recommended for alcohol consumption as topiramate and alcohol can interfere with each other and cause negative side effects. However, your doctor may suggest using it even if you’re still trying to reduce your alcohol consumption.
It is recommended that you slowly reduce the dose of topiramate if you stop taking it and to avoid abruptly stopping this medication without your doctor’s approval.
Topiramate effect in alcohol use disorders
Since topiramate was first considered for the treatment of alcohol disorder, a number of studies were conducted to test its effectiveness. The studies show that topiramate is an effective treatment option for alcohol use disorders, particularly in terms of reducing the harmful drinking patterns of alcohol use disorders.If youIf you
Symptomatic relief
The results of the studies done so far suggest that low doses of topiramate can decrease alcohol cravings, decrease the pleasure of drinking alcohol, and alleviate the anxiety and mood instability that can occur when you stop drinking. It also has a significant effect on improving abstinence maintenance and reducing alcohol consumption.If youIf you
Types of alcohol consumption that are responsive to topiramate
Topiramate is not effective in all aspects of alcohol use disorders. It has been shown to be more effective for people who exhibit certain traits, including cravings for alcohol, obsessions with drinking, and habitual drinking. It is not considered effective in treating alcohol withdrawal symptoms. There is some evidence that topiramate may be more effective in treating alcohol use disorders in people with certain genetic patterns.
The side effects of topiramate
While topiramate can help you with your drinking problem, side effects can occur.
All epilepsy drugs, such as topiramate, indicate their potential to increase suicidal thoughts and behavior. This is of particular concern if you have had a history of depression or other mental health problems.If youIf you
Other side effects of topiramate are:
- Changes in appetite and ability to try foods
- sleepiness
- Paresthesia (tingling of the arms or legs)
- Difficulty concentrating and other thinking problemsIf youIf you
Other drugs for alcohol use disorder
Three drugs, Antabuse (disulfiram), naltrexone, and Campral (acamprosate), are currently approved by the FDA for the treatment of alcohol use disorders.If youIf you
Each of these drugs work slightly differently. For example, antabuse does not reduce cravings, but it does make a drinker sick when they consume alcohol, which increases reinforcement to stay abstinent. Naltrexone and Campral have been shown to reduce cravings in alcoholics who have already stopped drinking.
A word from Verywell
Drugs used to treat alcohol use disorders are helpful, but counseling, strategies for reducing alcohol use, and most importantly, making a decision to quit alcohol are important considerations in recovery from alcohol addiction.
If you or a loved one is struggling with substance use or addiction, contact the National Substance Abuse and Mental Health Agency (SAMHSA) helpline at 1-800-662-4357 Information about support and treatment facilities in your area.
Additional mental health resources can be found in our National Helpline Database.
