How Topiramate Is Used for the Treatment of Alcoholism

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Topamax (topiramate), an anti-seizure medication usually prescribed for people with epilepsy, is also prescribed for helping alcohol-dependent individuals stop drinking. It is used off-label for the treatment of alcoholism and alcohol use disorders, 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-severe alcohol use disorder. 

How Topiramate Works

Topiramate has been shown to reduce alcohol cravings for people who have alcoholism and alcohol use disorders. It is not completely clear exactly how it works from a biochemical standpoint, but there are some possible mechanisms that have been suggested.

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 its effect on alcohol cravings and alcohol use by interacting with GABA and potentially decreasing the release of dopamine, which is involved in the pleasure caused by alcohol consumption.


For the treatment of alcohol use disorder or alcoholism, topiramate is generally increased to 75 mg per day, although it can be increased to a maximal dose of 300 mg per day for control of seizures in epilepsy.

Topiramate is generally not recommended for use when consuming alcohol, as topiramate and alcohol can interfere with each other, causing negative side effects. However, your doctor may suggest using it even if you are still trying to decrease your alcohol use.

It's recommended that you slowly decrease your topiramate dose if you will stop taking it, and avoid abruptly stopping this medication without your doctor's consent.

Topiramate Effect on Alcohol Use Disorders

Since topiramate was first considered as a treatment for alcohol use disorders, a number of studies have been done to test its effectiveness. The studies show that topiramate is an effective treatment option in alcohol use disorders, specifically in terms of reducing the harmful drinking patterns of alcohol use disorders.

Symptomatic Relief

The results of the studies done so far suggest that low doses of topiramate can reduce cravings for alcohol, can reduce the pleasure of drinking alcohol, and can ameliorate the anxiety and mood instability that may occur when you quit drinking. It also produces a substantial effect on improving the maintenance of abstinence and reducing alcohol use.

Types of Alcohol Use that Respond to Topiramate

Topiramate is not effective for every aspect of alcohol use disorders. It has been found to be more effective for people who have certain characteristics, including alcohol cravings, drinking obsessions, and habitual drinking. It is not considered effective in the treatment of alcohol withdrawal symptoms. There is some evidence that topiramate may be more effective for treating alcohol use disorder in people who have certain genetic patterns.

The Side Effects of Topiramate

While topiramate can help you with your drinking problem, you may experience 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 problems.

Other side effects of topiramate include:

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

Other Medications for Alcohol Use Disorder

Three medications, Antabuse (disulfiram), naltrexone, and Campral (acamprosate) are currently approved by the FDA for treating alcohol use disorders U.S.

Each of these medications works somewhat differently. For example, Antabuse does not reduce cravings, but it makes a drinker feel sick from consuming alcohol, increasing the reinforcement to stay abstinent. Naltrexone and Campral have been shown to reduce cravings in alcoholics who have already quit drinking.

A Word From Verywell

Medications used to treat alcohol use disorders are helpful, but counseling, strategies to reduce alcohol consumption, and, most importantly, a decision to quit, are important aspects of recovering from alcohol addiction.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Department of Veteran Affairs. VA/DoD clinical practice guideline for the management of substance use disorders.

  2. 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

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

  4. 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

  5. National Alliance on Mental Illness. Topiramate.

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

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