How to Treat Addiction & Abuse with Topiramate

Topiramate is an anticonvulsant drug that is typically used to treat epilepsy in both adults and children. However, off-label it has been used to treat alcoholism because, although it is not clear exactly how it works, it has shown promise in terms of reducing alcohol cravings and supporting abstinence.

Topiramate is most effective for the treatment of alcoholism when administered during a programme of detoxification. Low doses of topiramate at the start of an alcohol detox can help to curb cravings. It is also effective at reducing the symptoms of anxiety and depression that commonly occur during alcohol detox.

What Addictions is Topiramate Used to Treat?

Medications for Abuse and Addiction

When it comes to alcohol addiction, abstinence is the key to recovery. To achieve permanent sobriety, a programme of alcohol detoxification and alcohol rehabilitation must be completed. Moreover, it will be necessary to follow up with aftercare and ongoing maintenance sobriety. Within such a comprehensive recovery programme, there might be scope for certain medications to be used. However, this will depend on the substance being abused and the needs of the individual in question.

If you are being treated for any type of substance addiction, there is a possibility that medication may be prescribed. It could be that your treatment provider believes that medication could be useful during the detox process as it could help to prevent certain symptoms from occurring or lessen the severity of those that do.

Medication might also be used to help you maintain your sobriety. There are specific medications that can reduce cravings or that can cause unpleasant side effects should you return to the substance you were once addicted to.

If you are dealing with an addiction and a mental health disorder such as depression or anxiety concurrently, you may be prescribed medication to treat the symptoms associated with this illness.

How to Choose the Right Medication

If it has been determined that medication is to be used as part of your treatment programme, your doctor or other medical professional will decide on the right one for you. He or she will assess your situation and medical history and will probably perform an examination to ensure that whatever medication is chosen is suitable. Your doctor will need to know if you have had any serious medical issues in the past and whether you are taking any medications at present. Knowing your full medical history and current situation will ensure that you do not have any interactions with any medication during a detox or rehabilitation.

What is Topiramate?

Topiramate is an anticonvulsant drug that is used to treat many different conditions. It has been approved for use in a treatment for epilepsy and weight loss, when used in combination with phentermine. It is regularly used to treat Lennox-Gastaut syndrome (a seizure disorder) and to prevent and treat migraine headaches. Off-label, it is used in the treatment of bipolar disorder, borderline personality disorder, obesity, and alcoholism. Research is ongoing into its efficacy for a host of other conditions.

Brand Names for Topiramate



Trokendi XR

Qudexy XR

History of Topiramate

While trying to develop an antidiabetic medication in 1979, Dr Bruce Maryanoff, a scientist at Ortho-McNeil, discovered the chemical structure that eventually became Topiramate. He discovered that the substance he had inadvertently synthesised had very strong anticonvulsant properties.

Clinical trials then started to determine its efficacy and safety in the treatment of epilepsy, and commercial use of the drug began in 1996. In 2006, a generic version of the drug was made available for sale.

Is Topiramate Addictive?

The potential for abuse with topiramate is quite low and it is not considered to be habit-forming or addictive.

What is the Mechanism of Action?

The exact mechanism of action of topiramate, when used in the treatment of alcohol addiction, is unknown. However, scientists believe that it inhibits the production of glutamate while stimulating the production of GABA at the same time. GABA is the brain’s natural calming agent while glutamate is the brain’s natural exciting agent. By stabilising production of both these neurotransmitters, topiramate is believed to restore the chemical imbalance in the brain that may be caused by alcohol abuse.

By inhibiting the production of glutamate, topiramate is responsible for suppressing alcohol-induced dopamine. This subsequently blocks the reinforcing effect of alcohol.

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How Long Does It Take for Topiramate to Work?

The therapeutic effects of topiramate can take up to three weeks to be noticed. It is typically taken during a detox, but even in those who are still drinking alcohol, it can be fairly effective.

What are the Side Effects of Topiramate?

  • Confusion
  • Drowsiness
  • Fatigue
  • Diarrhoea
  • Depression
  • Nausea
  • Anxiety
  • Weight loss
  • Nervousness
  • Memory problems
  • Confusion

Facts/Statistics on Topiramate

Fact #1

Topiramate is one of very few medications approved for the prevention of migraines.

Fact #2

It can lower blood pressure and has minimal interactions with other medications.

Fact #3

Topiramate is available in tablet form in 25mg, 50mg, 100mg and 200mg doses.

Studies Done on Topiramate
The BMC Psychiatry Journal published the results of a study on the treatment of alcohol dependence with low-dose topiramate in March 2011. The open-label controlled study saw 90 patients treated with a combination of topiramate and psychotherapy or psychotherapy alone after a 7-10-day detoxification.
Researchers were monitoring symptoms of anxiety and depression as well as cravings for a period of 4-6 weeks during inpatient treatment. Patients were further monitored for four months on a weekly basis as they completed outpatient programmes.

The results showed that although the symptoms of depression, anxiety, and obsessive-compulsive drinking improved in both groups, those taking topiramate fared better. The relapse rate was also lower in the group taking the topiramate along with psychotherapy.

It was concluded that ‘low-dose topiramate as an adjunct to psychotherapeutic treatment is well tolerated and effective in reducing alcohol craving, as well as symptoms of depression and anxiety, present during the early phase of alcohol withdrawal’.