Topiramate: Side Effects & Uses in Addiction Treatment

2 min read · 6 sections

What is Topiramate?

Topiramate is an anticonvulsant and nerve pain medication which was first developed to treat epileptic and other types of seizures.

Topiramate has also been used to treat migraines and, more recently, weight loss. Along with these functions, the drug shows promise in treating certain forms of addiction, including alcoholism and cocaine addiction. It is this last function that has been most recently discovered and is still being studied as a viable component of addiction rehab.

The labeling provided by the Federal Drug Administration (FDA) defines topiramate a sulfate-substituted monosaccharide, also known as a sugar sulfamate. It was originally developed for the treatment of epileptic seizures. It is known as brand names Qudexy XR, Trokendi XR, and Topamax in the U.S.

Among other actions, topiramate appears to affect the gamma-aminobutyric acid (GABA) pathway in the body. This neurotransmitter is involved in the excitability of the nervous system, and is the suspected reason that topiramate can have a positive affect on people who are addicted to drugs like alcohol and cocaine.

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The History of Topiramate

According to an article from a drug information organization called Center Watch, Topamax, a brand name of topiramate, was developed by Ortho-McNeil Pharmaceutical and was approved by the Federal Drug Administration (FDA) in 1997 for use in treating seizures. Based on information from the FDA, topiramate was approved in 2012 to be used in combination with another drug, phentermine, for weight loss. Topamax was then additionally FDA-approved for treating migraines in 2014.

Because of the way topiramate acts in the body, starting in about 2004, the drug was tested for and has shown promise in various uses in addiction treatment.

However, it has not yet been approved by the FDA for these off-label uses.

Topiramate Dose & Half-Life

According to the drug label information provided by the FDA, Topamax topiramate is available in 25 mg, 50 mg, 100 mg, and 200 mg tablets or as 15 mg and 25 mg “Sprinkle Capsules” that can either be taken whole or opened up to sprinkle the coated beads of medicine in the capsule over a spoonful of soft food like yogurt or applesauce.

For dosing, people who are prescribed topiramate for treating seizures are started at 50 mg per day and increased to an optimal maintenance dose of 400 mg per day, according to an article from the journal Neuropsychiatric Disease and Treatment.

The half-life of the drug is about 20 to 30 hours, and it takes about four days to build up to a steady state in the body.

Topiramate Side Effects

As described by the National Library of Medicine on MedLine Plus, there are many potential side effects, such as:

  • Uncontrollable eye or muscle movements
  • Shakiness in one part of the body
  • Weakness
  • Tingling in the extremities
  • Weight loss
  • Drowsiness

A number of severe side effects can happen as well, including but not limited to:

  • Constipation
  • Vision problems
  • Inability to focus or speak clearly
  • Chest pain
  • Shortness of breath
  • Heart problems
  • Worsening of seizures

A person on topiramate should not stop taking the medicine without the help of a doctor, because it might cause seizures to occur even in those who have never had them before.

Topiramate Overdose

As with any drug, overdose is possible and is exacerbated by use with other drugs or alcohol. If you believe you or someone you love may be experiencing an overdose, please seek medical attention immediately. Signs and symptoms of overdose include some of the more severe side effects listed above as well as:

  • Stomach pains
  • Low blood pressure
  • Problems with coordination and thinking

Topiramate in Addiction Treatment

Early research into using topiramate for addiction treatment involved studies of alcohol use. More recently, studies into using topiramate for alcohol use disorder, like this one from the American Journal of Psychiatry, have shown that the drug can help people reduce heavy alcohol use. The research showed that 200 mg per day in combination with counseling worked for people who wanted to cut down but not completely eliminate their drinking.

In addition, a recent study in JAMA Psychiatry demonstrated that topiramate built up over time to a 300 mg maintenance dose helped people who were struggling with cocaine addiction to reduce the average number of times they used cocaine over the course of a week. This is a positive development considering that there are no known drugs so far that are confirmed to be able to treat cocaine addiction.

Other studies have shown similar results, in combination with cognitive-behavioral therapy and other supportive treatments.

Because of the side effects and risks of this drug, it is important that a doctor oversee its use in any type of treatment. If it is prescribed to aid in addiction recovery, it should be part of a professional, medically supported rehab program that includes psychiatric and social therapy and support. In addiction, it is important to continue taking the medication even if symptoms subside and only stop use on the advice of a doctor who can make sure that the person can withdraw from the topiramate prescription safely.

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