Killing two birds with one stone is a dream for most of us, particularly when it comes to taking prescription medications. After all, this means taking only the risks associated with a single drug, and enjoying multiple benefits. Topiramate is a promising treatment for alcohol abuse, which has also shown good results on weight loss. Let's first focus on its primary use and then explore the exciting alternative applications.

What is Topiramate?

Topiramate, more commonly known under the brand name Topamax, is an antiepileptic medication that is prescribed to adults and children. It is also used to treat migraines. It was FDA approved for these purposes in 1996, which means it was widely used and observed for almost thirty years. It is taken by mouth and you need a prescription from your physician to buy it.

How does it work?

The short answer is - it reduces bursts of electrical activity in your brain, and therefore the normal balance in the brain is restored.

The longer answer is - it stimulates GABA-A receptor activity and reduces glutamate neurotransmission by inhibiting AMPA and kainate receptors.

GABA is a neurotransmitter in the brain, just like serotonin and dopamine. Neurotransmitters are messengers, they bind to specific receptors and produce effects. GABA is known to produce a calming effect. Glutamate, on the other hand, is an exciting, activating neurotransmitter.

How does Topiramate work for alcohol use disorder?

Let's first talk about dopamine - one of the most important and well-known neurotransmitters or messengers in the brain. It plays many important roles in the body, related to pleasure and pain, movement, motivation and reinforcement. Dopamine levels rise when you do a pleasurable activity. Dopamine is also responsible for giving you motivation to repeat the thing that feels good.

The brain changes in a particular manner when you drink alcohol - dopamine levels rise and the body reacts by lowering the number of dopamine receptors. The parts of the brain that are associated with pleasure are overactivated. In order to sustain the high level of the neurotransmitter, you feel the need to drink more.

Studies show that by stimulating GABA-A receptor activity and reducing glutamate neurotransmission, Topiramate stops the behavioral cycle associated with alcohol abuse. It helps the brain “unlearn” the idea that alcohol is good for the body and its consumption should be reinforced.

Dopamine release is reduced. This decreases the pleasant effect of drinking, as well as the negative effects associated with withdrawal - anxiety, mood instability, and cravings. Abstinence maintenance is also improved.

Studies show that Topiramate is more effective than the drugs, which are approved for alcohol use disorder (Disulfiram, Naltrexone, and Acomprosate) in reducing heavy drinking, preventing relapses and lowering cravings. 

What does off-label use mean?

It is a story, as old as medicine itself. A drug is discovered, used widely for the treatment of a disease, and then practice and clinical trials show the drug is extremely effective in treating a different health problem.

Topiramate is FDA approved for the treatment of epilepsy and migraines. It is still not one of the medications that  are approved for alcohol use disorder.

Topiramate is presently utilized off-label as an alcohol cessation medication due to the promising outcomes in clinical research. This indicates that a condition other than the one the medicine has been licensed  for is being treated with it. The practice of prescribing drugs off-label is accepted and widely used.

How does Topiramate help weight loss?

Clinical trials show that between 6%-17% of people who take Topiramate will experience weight loss. The medication suppresses appetite and boosts your metabolism. This means that not only will you feel hungry less often, but your body will burn calories faster.

Studies have shown that people who have taken Topiramate for weight loss lose about 11 pounds in comparison with placebo groups. The effects of the medicine increase both with the duration and the dosage.

How much Topiramate should you take?

The recommended doses for Topiramate as alcohol cessation therapy range from 75 to 200 mg daily, divided in two doses.

For weight loss, positive results have been obtained with smaller doses - around 50 mg per day. Qsymia is an FDA approved combination of Phentermine and Topiramate. The medication is prescribed for weight loss and is available in extended-release capsules.

Topiramate dosages are titrated, which means you should start with a low dose and progressively increase it over time. If you want to learn more about this treatment, speak with your healthcare professional.

What are the possible side effects?

The most common side effects are nausea, dizziness, tiredness, diarrhea, difficulty with memory and concentration, taste perversion, and loss of appetite. The majority of the reported symptoms are mild or moderate. Topiramate increases the effects of alcohol.

If you take this medication, discuss the adverse effects with your healthcare provider.

Is it really a case of killing two birds with one stone?

Further studies into Topiramate as weight loss and alcohol dependence treatment are definitely needed. From what we know now, it is a very promising alternative to standard medications. It shows better results than them in alcohol cessation and abstinence maintenance. The added benefit of weight loss is extremely important, as alcohol overconsumption is linked to weight gain.

Taking just one medication is easier and fits better in a busy schedule. Also, if you only take Topiramate, you don't need to worry about drug interactions.

The final answer is yes - we are looking at a true possibility of killing two birds with one stone.

The information provided in this article is for educational purposes only. It is not meant to diagnose or prescribe medications. It does not replace the integral role of your physician. Before starting any medical treatments, consult your healthcare provider. For further and more in-depth information on the topic, please read the sources.


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