Topamax (Topiramate) and Alcohol: How It Works

Table of ContentsView AllTable of ContentsHow It WorksEffectivenessSide EffectsHow to UseOther Medications

Table of ContentsView All

View All

Table of Contents

How It Works

Effectiveness

Side Effects

How to Use

Other Medications

Topamax (topiramate) is an anti-seizure medication usually prescribed for people with epilepsy, but it can also be prescribed to help people who are alcohol-dependent tostop drinking. Research involving Topamax and alcohol reveals some evidence that it may decrease alcohol intake.

Topiramate is used off-label for the treatment ofalcohol use disorder, meaning that it is not FDA approved for this purpose. However, it is recommended in the 2015 United States Department of Veterans Affairs / Department of Defense Practice Guideline for the Management of Substance Use Disorders for people who have moderate-to-severe alcohol use disorder.

At a GlanceTopamax may reduce alcohol cravings, which can help people reduce their drinking. While not FDA-approved for this purpose, it may be prescribed off-label to help some people quit alcohol; however, it is important to note that it is not the only medication that can be used to treat alcohol use disorder. Side effects of Topamax can include drowsiness, tingling in the limbs, difficulty concentrating, and changes in appetite. This medication may also increase the risk of suicidal thoughts and behaviors.

At a Glance

Topamax may reduce alcohol cravings, which can help people reduce their drinking. While not FDA-approved for this purpose, it may be prescribed off-label to help some people quit alcohol; however, it is important to note that it is not the only medication that can be used to treat alcohol use disorder. Side effects of Topamax can include drowsiness, tingling in the limbs, difficulty concentrating, and changes in appetite. This medication may also increase the risk of suicidal thoughts and behaviors.

Topiramate and Alcohol Cravings

Topamax has been shown toreduce alcohol cravingsin people who have alcohol use disorder. It is not completely clear exactly how it works from a biochemical standpoint, but there are some possible mechanisms that have been suggested.

One explanation is that drinkers get pleasure from alcohol because it triggers the release ofdopamine, a positive feedback chemical in the brain. Drinking also alters GABA, an inhibitoryneurotransmitter.

Topamax’s Effectiveness for Alcohol Use Disorder

Since Topamax was first considered as a treatment for alcohol use disorder, a number of studies have been done to test its effectiveness. Research shows that it is an effectivetreatment optionin terms of its ability to reduce harmful drinking patterns.

The results of studies done so far suggest that low doses of topiramate can:

That said, topiramate is not effective for every aspect of alcohol use disorder. It has been found to be more effective for people who have certain characteristics, for instance, including those with alcohol cravings, drinking obsessions, and habitual drinking.

There is also some evidence that topiramate may be more effective for treating alcohol use disorder in people who have certain genetic patterns.

Topamax or topiramate is not considered effective in the treatment ofalcohol withdrawal symptoms.

Side Effects of Topiramate

While topiramate can help people with alcohol use issues, it doesn’t always come without side effects. All epilepsy medications (like Topiramate) come with a warning of their potential to increase suicidal thoughts and behaviors. This is of particular concern if you have a history ofdepressionor other mental health conditions.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

Other side effects of topiramate can include:

How to Use Topamax for Alcohol Use Disorder

For the treatment of alcohol use disorder, topiramate dosage can range from 75 milligrams per day to a maximal dose of 300 milligrams per day.Your doctor may start at the lowest dose and gradually increase it until the desired response is achieved.

Once you’re ready to stop taking it, it is recommended that you slowly decrease your topiramate dosage. Also, avoid abruptly stopping this medication without your healthcare provider’s consent.

Mixing Topamax and Alcohol Increases Side EffectTopiramate is generally not recommended for use when consuming alcohol. Mixing Topamax and alcohol can cause them to interfere with each other, resulting in negative side effects. Combining Topamax and alcohol may cause difficulty speaking, confusion, sleepiness, and memory difficulties.

Mixing Topamax and Alcohol Increases Side Effect

Topiramate is generally not recommended for use when consuming alcohol. Mixing Topamax and alcohol can cause them to interfere with each other, resulting in negative side effects. Combining Topamax and alcohol may cause difficulty speaking, confusion, sleepiness, and memory difficulties.

However, your healthcare provider may suggest using it even if you are still trying todecrease your alcohol use. Consuming Topamax and alcohol can be more dangerous for some people. If you are an older adult, your body breaks down alcohol more slowly.This means that you may experience worse side effects if you mix Topamax and alcohol.

Women may also be prone to experiencing worse side effects because they are more likely to have higher blood alcohol concentrations after drinking.

Other Medications for Alcohol Use Disorder

Each of these medications works somewhat differently. Antabuse does not reduce cravings but makes the person feel sick from consuming alcohol, increasing the reinforcement to stay abstinent. Naltrexone and Campral help to reduce cravings in people who have already quit drinking.

Medications used to treat alcohol use disorder are helpful but counseling, actively engaging in strategies to reduce alcohol consumption, and, most importantly, a decision to quit are important aspects of recovering fromalcohol addiction.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

9 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Salisbury-Afshar E, Fleming M.Identification of and treatment for unhealthy alcohol use in primary care settings.Am Fam Phys. 2019;99(12):733-734,U.S. Department of Veteran Affairs.VA/DoD Clinical Practice Guideline For the Management of Substance Use Disorders.Paparrigopoulos T, Tzavellas E, Karaiskos D, Kourlaba G, Liappas I.Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study.BMC Psychiatry. 2011;11:41. doi:10.1186/1471-244X-11-41Manhapra A, Chakraborty A, Arias AJ.Topiramate pharmacotherapy for alcohol use disorder and other addictions: a narrative review.J Addict Med. 2019;13(1):7-22. doi:10.1097/ADM.0000000000000443National Alliance on Mental Illness.Topiramate.Guglielmo, R., Martinotti, G., Quatrale, M.et al.Topiramate in alcohol use disorders: review and update. CNS Drugs. 2015;29:383–395. doi:10.1007/s40263-015-0244-0Meier P, Seitz HK.Age, alcohol metabolism and liver disease.Curr Opin Clin Nutr Metab Care. 2008;11(1):21-26. doi:10.1097/MCO.0b013e3282f30564National Institute on Alcohol Abuse and Alcoholism.Women and alcohol.Winslow B, Onysko M, Herbert M.Medications for alcohol use disorder.Am Fam Physician.2016 Mar 15;93(6):457-465.Additional ReadingNational Institute on Drug Abuse.Principles of Drug Addiction Treatment: A Research-Based Guide.U.S. Food and Drug Administration.Topiramate - topiramate tablet, film coated: Highlights of prescribing information.

9 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Salisbury-Afshar E, Fleming M.Identification of and treatment for unhealthy alcohol use in primary care settings.Am Fam Phys. 2019;99(12):733-734,U.S. Department of Veteran Affairs.VA/DoD Clinical Practice Guideline For the Management of Substance Use Disorders.Paparrigopoulos T, Tzavellas E, Karaiskos D, Kourlaba G, Liappas I.Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study.BMC Psychiatry. 2011;11:41. doi:10.1186/1471-244X-11-41Manhapra A, Chakraborty A, Arias AJ.Topiramate pharmacotherapy for alcohol use disorder and other addictions: a narrative review.J Addict Med. 2019;13(1):7-22. doi:10.1097/ADM.0000000000000443National Alliance on Mental Illness.Topiramate.Guglielmo, R., Martinotti, G., Quatrale, M.et al.Topiramate in alcohol use disorders: review and update. CNS Drugs. 2015;29:383–395. doi:10.1007/s40263-015-0244-0Meier P, Seitz HK.Age, alcohol metabolism and liver disease.Curr Opin Clin Nutr Metab Care. 2008;11(1):21-26. doi:10.1097/MCO.0b013e3282f30564National Institute on Alcohol Abuse and Alcoholism.Women and alcohol.Winslow B, Onysko M, Herbert M.Medications for alcohol use disorder.Am Fam Physician.2016 Mar 15;93(6):457-465.Additional ReadingNational Institute on Drug Abuse.Principles of Drug Addiction Treatment: A Research-Based Guide.U.S. Food and Drug Administration.Topiramate - topiramate tablet, film coated: Highlights of prescribing information.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Salisbury-Afshar E, Fleming M.Identification of and treatment for unhealthy alcohol use in primary care settings.Am Fam Phys. 2019;99(12):733-734,U.S. Department of Veteran Affairs.VA/DoD Clinical Practice Guideline For the Management of Substance Use Disorders.Paparrigopoulos T, Tzavellas E, Karaiskos D, Kourlaba G, Liappas I.Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study.BMC Psychiatry. 2011;11:41. doi:10.1186/1471-244X-11-41Manhapra A, Chakraborty A, Arias AJ.Topiramate pharmacotherapy for alcohol use disorder and other addictions: a narrative review.J Addict Med. 2019;13(1):7-22. doi:10.1097/ADM.0000000000000443National Alliance on Mental Illness.Topiramate.Guglielmo, R., Martinotti, G., Quatrale, M.et al.Topiramate in alcohol use disorders: review and update. CNS Drugs. 2015;29:383–395. doi:10.1007/s40263-015-0244-0Meier P, Seitz HK.Age, alcohol metabolism and liver disease.Curr Opin Clin Nutr Metab Care. 2008;11(1):21-26. doi:10.1097/MCO.0b013e3282f30564National Institute on Alcohol Abuse and Alcoholism.Women and alcohol.Winslow B, Onysko M, Herbert M.Medications for alcohol use disorder.Am Fam Physician.2016 Mar 15;93(6):457-465.

Salisbury-Afshar E, Fleming M.Identification of and treatment for unhealthy alcohol use in primary care settings.Am Fam Phys. 2019;99(12):733-734,

U.S. Department of Veteran Affairs.VA/DoD Clinical Practice Guideline For the Management of Substance Use Disorders.

Paparrigopoulos T, Tzavellas E, Karaiskos D, Kourlaba G, Liappas I.Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study.BMC Psychiatry. 2011;11:41. doi:10.1186/1471-244X-11-41

Manhapra A, Chakraborty A, Arias AJ.Topiramate pharmacotherapy for alcohol use disorder and other addictions: a narrative review.J Addict Med. 2019;13(1):7-22. doi:10.1097/ADM.0000000000000443

National Alliance on Mental Illness.Topiramate.

Guglielmo, R., Martinotti, G., Quatrale, M.et al.Topiramate in alcohol use disorders: review and update. CNS Drugs. 2015;29:383–395. doi:10.1007/s40263-015-0244-0

Meier P, Seitz HK.Age, alcohol metabolism and liver disease.Curr Opin Clin Nutr Metab Care. 2008;11(1):21-26. doi:10.1097/MCO.0b013e3282f30564

National Institute on Alcohol Abuse and Alcoholism.Women and alcohol.

Winslow B, Onysko M, Herbert M.Medications for alcohol use disorder.Am Fam Physician.2016 Mar 15;93(6):457-465.

National Institute on Drug Abuse.Principles of Drug Addiction Treatment: A Research-Based Guide.U.S. Food and Drug Administration.Topiramate - topiramate tablet, film coated: Highlights of prescribing information.

National Institute on Drug Abuse.Principles of Drug Addiction Treatment: A Research-Based Guide.

U.S. Food and Drug Administration.Topiramate - topiramate tablet, film coated: Highlights of prescribing information.

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