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Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions

A Narrative Review

Manhapra, Ajay, MD; Chakraborty, Anirban, MBBS; Arias, Albert J., MD, MS

doi: 10.1097/ADM.0000000000000443

Topiramate is a non-benzodiazepine anticonvulsant medication with multi-faceted pharmacologic action. It has emerged as an efficacious pharmacotherapeutic option for the treatment of addiction, especially alcohol use disorder (AUD). We present a broad narrative review of the putative mechanism of action and clinical utility of topiramate with regard to AUD and other substance use disorders. Collective evidence suggests topiramate is an effective treatment option in AUD, with notable efficacy in reducing harmful drinking patterns in AUD. Though not currently approved by the United States Food and Drug Administration for the indication of AUD, topiramate should be considered as a pharmacological treatment option with high utility among AUD patients. Early pharmacogenetic studies raise the intriguing possibility of identifying patients likely to respond to topiramate using genetic testing, and initial studies show that topiramate may also be useful in treating cocaine use disorder, smoking cessation and behavioral addictions. However, further research is needed in all these areas.

VA Hampton Medical Center, Hampton, VA (AM); VA Connecticut Healthcare System, West Haven (AM, AJA); Department of Psychiatry, Yale School of Medicine, New Haven (AM, AC, AJA); VA New England Mental Illness Research and Education Center, West Haven, CT (AM, AJA).

Send correspondence to Albert J. Arias, MD, MS, 950 Campbell Rd #116A, West Haven, CT 06516. E-mail:

Received 1 March, 2016

Accepted 1 June, 2018

Ajay Manhapra was supported by the VA/OAA Interprofessional Advanced Fellowship in Addiction Treatment, and Research in Addiction Medicine Scholars (RAMS) Program, R25DA033211 from the National Institute on Drug Abuse. VA New England Mental Illness Research and Education Center, West Haven, CT supported this review.

The authors have no financial or other conflicts of interests to report.

© 2019 American Society of Addiction Medicine