Last Updated on March 30, 2021
Alcoholism is on the rise. In fact, it rose by a startling 49 percent during the first decade of the 2000s. One in eight American adults now meets the diagnostic criteria for alcohol use disorder, or AUD. Luckily, there are many science-based options to help people change their relationship with alcohol—including the medication topiramate.
Does Topiramate Reduce Alcohol Consumption?
The FDA originally approved topiramate to prevent migraines and treat epilepsy, but doctors also use it “off-label” to reduce alcohol consumption. For more than a decade, research has shown that it can significantly reduce heavy drinking. Plus, you can still drink while taking it.
One 2011 review of studies on the drug1, by University of Virginia researchers, concluded that “there is now solid clinical evidence to support the efficacy of topiramate for the treatment of alcohol dependence.” And more studies2 since then have pointed to the drug’s efficacy.
Topiramate has been shown to reduce alcohol cravings, as well as symptoms of anxiety and depression. In one key study3, low doses were shown to support those going through alcohol withdrawal. It also helped participants abstain from drinking during the first 16-week detoxification period.
How Does It Work?
Topiramate alters one’s brain chemistry in a way that reduces alcohol cravings in the short-term. It also reduces alcohol withdrawal symptoms, which helps cut back on chronic consumption.
Topiramate is a glutamate antagonist and a GABA agonist. It works by blocking the activity of two subtypes of glutamate receptors while enhancing the action of GABA, a calming agent. Glutamate is an excitatory brain chemical that alcohol suppresses, thereby slowing brain activity while you drink.
Although its mechanisms of action are not fully understood, topiramate appears to target a potential chemical imbalance caused by chronic drinking.
The glutamate system4 plays a major role in the behavioral and neural actions of alcohol, as well as the actions that drive the development of alcoholism. By blocking glutamate receptors, topiramate alters the effects of ethanol.
The drug also indirectly decreases the dopamine-induced pleasurable feeling that typically results from alcohol consumption. Naltrexone, which is FDA-approved for alcoholism and opioid addiction, also suppresses dopamine levels. Some evidence5 suggests, however, that topiramate may work better6 than naltrexone.
What About Topiramate’s Side Effects?
Topiramate is usually well-tolerated. In order to reduce the risk of any adverse effects, though, it is best to slowly increase the dosage over several weeks.
Side effects include dizziness, a tingly or itching feeling in the skin, memory impairment, and weight loss. However, these effects are typically mild and last for a short time. Canada’s Centre for Addiction and Mental Health7, however, notes that about 20 percent of its patients stop using topiramate due to side effects. Still, the drug is not habit-forming and does not cause individuals to become psychologically or physically dependent.
How Does Ria Health Use Topiramate?
Topiramate is one of several medications that Ria Health uses to help its members drink less. On average—with the help of medication, coaching, and in-app drink tracking—our members reduce their drinking by 70 percent within the first six months. And they do that all from the comfort of their own home. There’s no costly rehab center, and no white-knuckling through AA meetings. If you think you might be drinking more than you’d like, take our Alcohol Use Survey, learn more about us, or get started with our program.