Topamax and Alcohol: What You Should Know

Continuing our theme of shedding light on lesser-known treatment methods for alcoholism, this article will focus on the relationship between Topamax and alcohol. Topamax is an anticonvulsant and anti-epileptic medication that has powerful neuro-protective properties.

The generic form of Topamax is called topirimate, but since most people know this drug as Topamax, we will refer to it as Topamax in this article.

Topamax has been traditionally prescribed to treat:

• Epilepsy
• Seizures
• Migraines
• Prescribed by doctors for other off-label purposes (especially chemical addictions)

More doctors are becoming aware of the relationship between Topamax and alcohol. As a result, thousands of people have been able to quit or cut down on drinking. We will now proceed to review the mechanisms underlying the use of Topamax for alcohol addiction.

Topamax And Alcohol: Overview of Topamax

Topamax has shown to be effective at aiding alcohol recovery in the following ways:

• Reducing the severity of alcohol withdrawal and cravings
• Reducing the motivation to drink alcohol (i.e., mitigating the reinforcing mechanisms)

Topamax is very similar in structure to acetazolamide, which has anti-convulsant effects. Once inside of the brain, Topamax does the following:

• Stimulates GABA receptors
• Blocks glutamate receptors
• Reduces the amount of dopamine that is released by drinking

Alcohol is a depressant that mimics GABA (the brain’s primary “calming” chemical), and alcohol addiction causes the brain to decrease its long-term GABA production because it has learned to rely on alcohol for the same effect.

Alcohol also suppresses glutamate (a “stress” chemical), and in response the alcoholic brain ramps up its production of glutamate when drinking stops. In the absence of alcohol to calm down the brain, the alcoholic feels hyperactive, hypersensitive, and panicked.

When an alcoholic stops drinking suddenly, two important things happen:

• Glutamate rebounds to high levels within 3-8 hours
• GABA does not return to normal levels (this can take weeks or months)

Many of the symptoms of alcohol withdrawal are caused by a lack of GABA and an excess of glutamate.

In addition to helping the alcoholic rebalance GABA and glutamate levels, Topamax removes excess dopamine that is released by alcohol. As a result, heavy drinkers who consume both Topamax and alcohol feel compelled to drink significantly less.

While some people have used Topamax for alcohol withdrawal and then tapered off, others have successfully taken long-term Topamax for alcohol cravings.

Continuing to use Topamax after alcohol detox has helped many people drink less or quit drinking altogether. Because Topamax can cause dependence, doses should be tapered down rather than ceased suddenly.

Topamax And Alcohol: How Does Topamax Work?

If you’re new to this site, you may still be wondering – how does Topamax work? It is important to remember that within all of our brains, GABA is a calming chemical, glutamate is a stress chemical, and dopamine is a pleasure chemical that facilitates learning, reward, and motivation.

Basically, Topamax works by exerting a similar effect on GABA and glutamate receptors as alcohol, thereby lessening withdrawal symptoms, while also reducing the dopamine-reinforcement effects of drinking behavior.

Topamax is unique in its ability to help drinkers who are still drinking; the majority of FDA-approved drugs are meant to be used only upon alcohol cessation.

Another exception would be Naltrexone, which can also be used by people who are still drinking. However, heavy drinkers are advised to detox before using Naltrexone for alcohol addiction.

Because of biochemical individuality, some alcoholics may respond better to Topamax while others respond better to Naltrexone. Still others may not respond well to either drug.

Topamax And Alcohol: Topamax Dosage

The following dosage information may be useful if you are considering taking Topamax for alcohol addiction:

• A typical first dose for Topamax is 50 mg/day, with 25 mg taking in the morning and 25 mg taken in the evening.
• Studies on the use of Topamax for alcohol withdrawal indicate that 75 mg/day may be effective for alcohol withdrawal.
• It can take 6-8 weeks to titrate to the typical ceiling dose of 200-300 mg/day, because tolerance to the side effects of Topamax builds slowly. Usually, 50 mg is added to the total daily dose during each successive week until the maximum dose is reached.
• Because Topamax tablets have a very bitter taste, they should not be broken.
• Topamax for alcohol withdrawal should only be taken as long as it is needed to manage symptoms – typically less than a week – to avoid dependence.
• There is no standard dosage of Topamax for alcohol addiction; only a doctor can determine this depending on your situation.
• Only take Topamax under the supervision of a doctor.
• *While Topamax can be taken before quitting drinking as part of a regimen to cut down on alcohol, there are interactions between Topamax and alcohol. Topamax is known to amplify the effects of alcohol and therefore dosage must be determined carefully.

Before taking Topamax for alcohol addiction, make sure to review the following:

• Overview
• Side effects
• Interactions

Topamax And Alcohol: Research Studies

A large number of studies support the use of Topamax for alcohol withdrawal and cravings:

• Detoxing alcoholics who received up to 75 mg of Topamax had fewer alcohol withdrawal symptoms in the 7-10 days following drinking cessation, and significantly fewer relapses in the 4 weeks following treatment, than patients who received only therapy (source)
• Topamax is as effective as diazepam in treating alcohol withdrawal symptoms, including tonic-clonic seizures (source)
• Low dose Topamax reduces alcohol cravings, anxiety, and depression during acute withdrawal (source)
• Clinical trials with Topamax in doses of 200 to 300 mg/day have been shown to drastically reduce the percentage of heavy-drinking days (Johnson et al. 2008)
• Topamax is more effective than placebo, and is not distinguishable from diazepam, when used for the treatment of alcohol withdrawal symptoms (Krupitsky et al. 2007)
• In a 4-week study with 371 participants, half receiving placebo and the other half receiving Topamax, the Topamax group had significantly fewer drinking days (source)
• Topamax is generally well tolerated, although some serious side effects can occur (source)

It’s worth noting that Topamax will likely never receive FDA approval for alcohol addiction.

The patent for Topamax expired, and there is no financial incentive for drug companies to pursue approval to market Topamax for alcohol addiction.

Topamax And Alcohol: Alternatives to Topamax

Not everyone can obtain Topamax, since it must be prescribed by a doctor. It can sometimes be difficult to find a doctor who is open to prescribing Topamax for alcohol addiction.

Besides benzodiazepines, which are the most commonly prescribed drugs for short-term alcohol detox, there are a few other alternatives to Topamax for alcohol addiction.

You can read some other articles on prescription medications for alcohol dependence here:

• Naltrexone
• Gabapentin
• Acamprosate

Further Considerations – Nutritional Repair

After getting through acute alcohol withdrawal, it’s important to determine what lifestyle changes will reduce alcohol cravings and repair their bodies.

Nutrition is one of the most neglected pillars of alcohol recovery. After excising toxic ethanol from your life, you can maximize your sense of well-being by optimizing what you put into your body. This includes eating well and taking supplements to repair nutritional deficiencies.

Check Fit Recovery’s list of supplements that work best for supporting the brain-body system through alcohol recovery.

As your body-brain system heals, you will discover that drinking alcohol is a barrier, not an enhancement, to experiencing life in full, vivid, color – and that life without alcohol does NOT have to be a life of bleak deprivation.

Topamax And Alcohol: Conclusion

The relationship between Topamax and alcohol is well established, despite the fact that Topamax is not approved by the FDA for alcohol addiction. People with alcohol disorders deserve to know about all of their options for changing their lives for the better, including pharmacological methods like Topamax.

While not everyone responds well to Topamax, greater awareness of Topamax and alcohol addiction can improve recovery odds for many people.

If you have any questions about the relationship between Topamax and alcohol, please leave them in the comment box below.

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Dr. Ken Starr is board certified in both Addiction Medicine and Emergency Medicine, and diplomate of the American Board of Addiction Medicine. In addition to his work as the Addiction Medicine Director for Fit Recovery, he operates Ken Starr MD Wellness Group in Arroyo Grande, CA. His clinic offers advanced drug and alcohol detox methods, long term recovery facilitation, and IV nutritional programs including NAD+ therapy.