Side effects reported in studies on alcohol dependence include tingling in the extremities, memory and thinking problems, weight loss, fatigue, insomnia, diarrhea, changes in the ability to taste food, and itching. Here are some additional risks and suggestions about how to minimize them:
Decreased sweating. Topiramate can make it more difficult for your body to cool down when it gets very hot. Avoid exposure to heat, drink plenty of fluids, and tell your doctor if you have decreased sweating or increased body temperature.
Eye problems. In rare cases, nearsightedness and glaucoma—a blockage of fluid that causes increased pressure in the eye—were also reported but resolved with discontinuation of the drug. Tell your doctor if you've ever had glaucoma, and report any sudden decrease in vision, eye pain, or redness while taking the drug.
Confusion, difficulty concentrating, dizziness, and drowsiness. Don't drive a car or operate machinery until you know how it affects you.
Drug interactions. Topiramate interacts with many drugs and can decrease the effectiveness of birth-control pills. Tell your doctor what prescription and over-the-counter medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
Kidney stones. Drink six to eight glasses of water a day to reduce your chances of getting these, which can be excruciatingly painful.
Too much acid in the blood (acidosis). This is more likely if you have kidney disease, respiratory problems, or diarrhea, or if you consume a high-fat, low-carbohydrate diet. Tell your doctor if you have any of those conditions before or during treatment, and don't follow a high-fat, low-carb diet while taking the medication. Your doctor should do a blood test before treatment and then periodically during treatment to monitor your body's acid balance.
Suicide. Topiramate might increase the risk of becoming suicidal. Call your doctor right away if you experience panic attacks, anxiety, depression, sleep problems, aggression, preoccupying thoughts about death, or any other unusual changes in behavior or mood.
In addition to the conditions specified above, tell your doctor if you've ever had liver problems, osteoporosis, or mood disorders, or if you are pregnant, planning to become pregnant, or breast-feeding.
Don't stop taking topiramate without first talking to a doctor. Suddenly discontinuing the drug can cause serious problems.
Bottom line. Topiramate is one of several drugs currently recommended in national and international guidelines for the treatment of alcohol dependence. But further studies are needed to determine its long-term safety, efficacy, and potential role in the treatment of alcoholism. Our advice: Talk with your doctor about all available treatments for your condition, including counseling, 12-step programs, the management of withdrawal symptoms, and medication for dependence. If approved medications aren’t effective or you can’t tolerate them, or if you are unable to abstain from alcohol during treatment, consider topiramate after its risks and benefits have been thoroughly explained to you. The NIAAA publishes a useful guide to each of the medications. You should know, too, that you might respond better to one type of treatment than another.
For referrals to treatment specialists and programs, contact: