Topamax (Topiramate) and Alcohol: How It Works

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 to stop drinking. Research involving Topamax and alcohol reveals some evidence that it may decrease alcohol intake.

Topiramate is used off-label for the treatment of alcohol 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. 

Topiramate and Alcohol Cravings

Topamax has been shown to reduce alcohol cravings in 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 of dopamine, a positive feedback chemical in the brain. Drinking also alters GABA, an inhibitory neurotransmitter.

Topiramate is thought to have an effect on alcohol cravings and alcohol use by interacting with GABA. It also potentially decreases the release of dopamine, which is involved in the pleasure caused by alcohol consumption.

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 effective treatment option in terms of its ability to reduce harmful drinking patterns.

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

• Ameliorate the anxiety and mood instability that may occur when you quit drinking
• Lessen cravings for alcohol and reduce the pleasure of drinking
• Produce a substantial effect on improving the maintenance of abstinence and reducing alcohol use

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.

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 of depression or other mental health conditions.

Other side effects of topiramate can include:

• Change in appetite and ability to taste food
• Drowsiness
• Paresthesias (tingling of the arms or legs)
• Trouble concentrating and other thinking problems

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.

However, your healthcare provider may suggest using it even if you are still trying to decrease 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

Topamax isn't the only drug-based option for people who are trying to reduce or stop alcohol consumption. Three medications—Antabuse (disulfiram), naltrexone, and Campral (acamprosate)—are currently approved by the FDA for treating alcohol use disorder in the U.S.

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 from alcohol addiction.