Topiramate: How it Works in Addiction Treatment
Dealing with addiction isn’t easy, but recovery is possible with effective treatment. If you or someone you care about is struggling, you should know that treatment based on a comprehensive recovery plan can help. Depending on a person’s needs, recovery can involve a combination of evidence-based treatments, including behavioral therapy and medication.
In addition to several FDA-approved medications, clinicians may sometimes prescribe medications for off-label indications, including drugs like topiramate (Topamax), to help people with certain substance use disorders.1 Keep reading to learn about topiramate, how it works, topiramate for alcohol use disorder and its potential uses for stimulant addiction, and how to find effective treatment near you.
What Is Topiramate?
Topiramate, available as a generic and in several brand name formulations such as Topamax, is an anticonvulsant medication that is FDA-approved to treat epilepsy (seizures) and migraine headaches in adults.2,3 It has also been investigated for the treatment of alcohol addiction, or alcohol use disorder (AUD), and as an alcohol craving medication, but the FDA has not yet approved topiramate or Topamax for addiction treatment specifically.2,4,5
Some conditional recommendations from the American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) regarding topiramate also include potentially using it to help reduce cocaine use in people with stimulant use disorder, though it is not approved by the FDA for this use.1
Can Topiramate Treat Alcohol Addiction?
Some research has shown promise for topiramate for alcohol addiction management, specifically in terms of reducing alcohol craving and minimizing alcohol withdrawal symptoms, although it has yet to be approved by the FDA for these purposes.5 Studies have explored the link between topiramate/Topamax and alcohol cravings reduction, which suggests that this may be one beneficial way the medication can help people with AUD maintain longer-term abstinence.5
It’s not entirely clear how topiramate works to produce these potential benefits, but researchers propose that, by modulating certain ion channel and receptor activity, topiramate may help to normalize alcohol-related changes within excitatory and inhibitory neurotransmitter systems, thereby decreasing withdrawal effects, cravings, and even lowering activity in the brain’s dopamine reward pathways.1,5
- One study found that, out of 138 males who received either topiramate or a placebo for heavy drinking, topiramate treatment significantly reduced heavy drinking days and increased abstinent days when compared to the placebo group.4
- Two studies found that topiramate helped with reducing alcohol cravings and consuming alcohol in participants. In one study involving 150 participants over the course of 12 weeks, topiramate was shown to decrease cravings and alcohol consumption, while another study involving 85 participants over 14 weeks found that topiramate lowered the number of drinking days, heavy-drinking days, and the total drinks consumed each day.5
- One large 14-week study involving 371 people who presented with alcohol dependence showed that participants who received topiramate drank less heavily and less often, and reported improvements in their drinking behaviors.5
- A meta-analysis of 7 randomized controlled trials of topiramate for AUD involving a total of 1125 participants found that the topiramate group showed a significant increase in the number of days of abstinence and decrease in heavy drinking days when compared to placebo.5
As mentioned above, topiramate has also been investigated for its potential uses in the treatment of stimulant use disorder involving cocaine.1 The ASAM/AAAP Clinical Practice Guideline suggests that clinicians may consider prescribing topiramate alone to help reduce cocaine use, or a combination of topiramate and extended-release mixed amphetamine salts to decrease both cocaine use and craving in people with cocaine use disorder. Additional consideration may be given to its use for people with co-occurring stimulant and alcohol use disorders, given its benefits in reducing drinking.1
Side Effects of Topiramate
As with any medication, people may experience side effects from topiramate. The most commonly reported side effects include:2,3
The above is intended as a guideline to help you understand the more common side effects of topiramate, but other, more serious side effects are possible, including metabolic acidosis and mental health effects like suicidal thoughts.2,3
Additionally, it’s important to understand that topiramate and alcohol should not be mixed.3 Alcohol and topiramate both have the potential to cause central nervous system (CNS) depression, and according to the FDA’s Topamax labelling guide, should be avoided in combination.3
FDA-Approved Medications for Alcohol Use Disorder
The FDA has approved 3 medications for the treatment of AUD, which includes:6,7
- Disulfiram, which works by interfering with the way the body metabolizes alcohol, resulting in highly unpleasant symptoms when a person drinks alcohol, which may act as an alcohol deterrent.
- Acamprosate, which may be prescribed to balance alcohol-disrupted brain chemistry to help minimize protracted withdrawal and alcohol cravings in people with AUD, which may help them reduce or stop their alcohol intake.
- Naltrexone, which blocks the activation of opioid receptors in the brain and, as the reinforcing or rewarding effects of alcohol are partially mediated by the opioid receptor system, can help minimize cravings and lead to reductions in alcohol use.
People who are prescribed topiramate, alcohol use disorder medications, or other adjunctive medications often do so as part of a formal addiction treatment program that involves a whole-person, comprehensive approach to recovery.8 In addition to medication, this approach usually includes a combination of interventions, such as different forms of behavioral therapy, counseling, and aftercare.8 These components are designed to address all of a person’s unique needs, help them build skills that are necessary for long-term sobriety, and allow them to examine the underlying issues that led or contributed to the addiction in the first place.8
Explore Evidence-Based Treatments for Alcohol Use Disorder
American Addiction Centers (AAC) is a leading provider of evidence-based treatment for AUD in the U.S., with addiction treatment centers located across the nation. We take a whole-person approach to recovery and offer customized treatment plans for each person’s unique needs.
Our rehabs offer various levels of care to suit all needs, including medical detox, inpatient/residential rehab, and outpatient treatment, and we are committed to helping you or your loved one start and stay on your recovery journey. Our facilities offer a range of treatment interventions, including medications for addiction treatment, behavioral therapies, professional support and monitoring, and comprehensive aftercare planning to support your long-term recovery.
Reaching out for treatment can be one of the most important decisions you can make for your health and overall well-being. Research has shown that treatment can help people stop drinking alcohol and using drugs, maintain an abstinent lifestyle, and resume responsibilities at home and work.9 Please call us at to connect with a caring admissions navigator, who can help you understand your treatment and payment options, explain the admissions process, and quickly verify your insurance.
