Topiramate for Alcohol Use Disorder (AUD) Treatment

Topiramate is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat epilepsy and prevent migraines.[1] Some doctors also use topiramate to treat alcohol use disorder (AUD), as it can reduce cravings and ease withdrawal symptoms. 

What Is Topiramate?

The FDA considers topiramate an antiepileptic (anti-seizure) medication.[2] It works by decreasing abnormal excitement between brain cells. 

It comes in many forms, all oral, including a tablet, sprinkle capsule, long-acting capsule and solution. Sprinkle capsules and extended-release capsules are taken with food.

How Does Topiramate Work?

Researchers at the FDA aren’t exactly sure how topiramate works in the human body.[2] But studies suggest it has properties that could help to ease seizures and migraines. 

Those properties include the following:

• Blocks sodium channels in the brain
• Augments activity of neurotransmitters (brain chemicals)
• Boosts carbonic anhydrase, which converts carbon dioxide to water

People need to take the medication for several days for peak efficacy. 

Why Do Doctors Use Topiramate for AUD?

While there are three FDA-approved medications for AUD (naltrexone, acamprosate and disulfiram), some doctors use topiramate with other medications or by itself in patients who do not respond or cannot otherwise have one of these other medications.[3]

Three studies suggest how the drug might help with AUD, including the following:

• Research performed in 2006 suggests topiramate can help people reduce their alcohol levels to an amount doctors consider “safe.”[4] 
• A study done in 2011 found that people using topiramate along with other therapies had fewer alcohol cravings, and withdrawal symptoms like depression and anxiety were improved.[5] In this study, people were using other medications too. 
• A 2021 study helped reinforce the previous findings of the studies already discussed. The researchers also used brain scans to show that topiramate reduced the brain’s craving response when people looked at images of alcohol.[6]

Exactly why topiramate works as an AUD treatment is not fully understood. Researchers believe the drug’s ability to change the brain’s reward systems may be the cause. If the drug reduces the sense of reward a person feels when ingesting alcohol while also helping to reduce the withdrawal symptoms a person experiences if they don’t drink, it could be useful. 

With that said, more research is needed into how this medication affects the brain and why it seems effective as an add-on AUD treatment.

Who Can Use Topiramate?

The FDA lists no contraindications, or situations in which taking topiramate could be very dangerous.[2] Because topiramate has mostly been studied in people also using other FDA-approved medications for alcohol use disorder, it should probably be used this way. 

But some doctors do use topiramate alone in patients who have not had success with or have not otherwise tolerated the other FDA-approved medications for AUD.

How to Take Topiramate

Your doctor will prescribe topiramate and explain how and when to take it. Often, people are instructed to take their medications with food, so the drug doesn’t cause stomach upset. 

Follow your doctor’s instructions carefully. If you miss a dose, take it when you remember. But if it’s close to time for your next dose, skip the missed one. Don’t take two at the same time. 

Take the medication as long as your doctor tells you to. 

Side Effects & Risks 

Topiramate is generally safe and well tolerated but causes side effects, including dizziness and “brain fog.”

Known side effects of topiramate include decreased appetite and some weight loss.

Less common side effects include the following:

• Back, bone and muscle pain
• Changes in the ability to taste
• Changes to menstruation patterns
• Unusual bleeding and bruising
• Constipation
• Dry mouth
• Headache
• Drowsiness
• Numbness, burning or tingling of the hands and feet
• Teary or dry eyes
• Diarrhea
• Weight loss
• Nervousness

Again, topiramate is not FDA-approved for treating AUD. Its use for this purpose still requires more research. However, many clinicians use it frequently for many conditions, including AUD. Current research seems to suggest it is a safe and effective AUD treatment.

Topiramate for AUD FAQs

What is the most effective treatment for alcohol use disorder?

Three FDA-approved treatments for AUD are naltrexone, acamprosate and disulfiram.[7] However, other medications, including topiramate, are often used off label to treat AUD. 

Do most patients with AUD use medications?

Unfortunately, no. While good medications exist to help treat AUD, they are woefully under prescribed. One study reported only about 1.6% of patients with likely AUD use medications.[8] 

Several factors could be responsible for low medication use. Doctors may not screen for AUD or offer medications. Some people may not think to ask for them. 

The fact that so few people receive these approved medications is an urgent issue. More needs to be done to improve patients’ ability to get treatments proven to help them combat AUD.[7]