How Topiramate Is Used for the Treatment of Alcoholism

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 decreasing the dopamine-induced pleasure caused by alcohol consumption.


For the treatment of alcohol use disorder or alcoholism, topiramate is used at a dose of 25 mg per day, and it is generally increased to 75 mg per day, although it can be increased to a maximal dose of 300 mg per day. This is a relatively low dose, as it is typically started at 100 mg to 200 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.

Among the most important concerns are suicidal thoughts, increased anxiety or aggression, or mood changes. This is of particular concern if you have a history of depression or other mental health problems.

Other side effects of topiramate include:

  • Headaches
  • Change in ability to taste food
  • Missed menstrual periods and excessive menstrual bleeding
  • Drowsiness
  • Paresthesias (tingling of the arms or legs)
  • Trouble concentrating

Other Medications for Alcohol Use Disorder

There are several medications used to reduce alcohol cravings. 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, reducing the pleasurable effects of drinking. 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.

Was this page helpful?

Article Sources