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. Topamax or topiramate is not considered effective in the treatment of alcohol 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 of depression or other mental health conditions. Other side effects of topiramate can include: For more mental health resources, see our National Helpline Database.
Change in appetite and ability to taste foodDrowsinessParesthesias (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. 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. 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. However, your healthcare provider may suggest using it even if you are still trying to decrease your alcohol use.
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.
A Word From Verywell
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. For more mental health resources, see our National Helpline Database.
