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Is It Safe to Combine Topiramate and Alcohol?

By Emily Daw
Updated Mar 03, 2024
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It is not generally considered safe to combine topiramate and alcohol. Topiramate, sold under the brand names Topamax® and Topiragen®, is used to prevent seizures, migraine headaches and certain other neurological conditions. Unlike most migraine medications, it is taken continuously as a preventative rather than on an as-needed basis. It is occasionally prescribed for various psychiatric conditions, although as of 2011 these uses had not been approved by the US Food and Drug Administration (FDA). Combining these two substances is likely to increase the risk of side effects, such as drowsiness, and may decrease the effectiveness of the medication.

Topiramate works by reducing reactions in the nervous system that lead to migraines and seizures. In doing so, it often slows down or depresses other functions of the central nervous system. This may lead to somnolence, or drowsiness, and delayed reaction times. Alcohol, which is also a depressant, can have similar effects on the nervous system. The most likely side effect of mixing topiramate and alcohol is excessive drowsiness due to the combined effect of the two depressants.

In some cases, drinking alcohol while taking topiramate may increase the chances of having a seizure in epileptic patients. This side effect is less common than drowsiness. Still, it may greatly increase the risks of combining topiramate and alcohol for some patients.

The FDA lists the interaction between topiramate and alcohol as "moderate." This means that the combination is not excessively dangerous in and of itself, but should generally be avoided. Patients who combine the two should use extreme caution and should not operate machinery or undertake other tasks requiring concentration, wakefulness or agility. Those who are taking topiramate for seizures should be especially careful, given the increased chances of having a seizure after consuming alcohol. Patients should tell their doctors about their alcohol consumption habits while taking topiramate.

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Discussion Comments

By anon993035 — On Oct 19, 2015

I have done light drinking (one beer, a glass of champagne, or a single shot at a friend's home) on my very low dosage of topamax (only 25mg) and never experienced any sleepiness or other side effects.

I wouldn't try pushing it by having more than one drink, and I definitely wouldn't try going out or doing anything, just in case, but nothing negative has happened to me on my low dosage.

By literally45 — On Mar 07, 2014

I'm on topiramate and I have made the mistake of drinking on it. I do not recommend this to anyone as it was one of the worst experiences. I became very drowsy and confused after a few drinks while on this medication. I lost my motor control. I first started dropping things and running into furniture. I finally became unconscious and landed on the floor of a posh restaurant. They had to take me to the ER because I hit my head in the process.

Was it worth it? Absolutely not. I will never combine topiramate and alcohol again. I wanted to share this here so that others don't make the same mistake. Have a soda and say no to the alcohol when you are taking this drug. In fact, it's a good idea to avoid all alcohol regardless of the medication.

By turquoise — On Mar 07, 2014

@ddljohn-- Unfortunately, the fact that you take your medication in the morning and that you had the drink in the evening doesn't mean anything. The topiramate is in your bloodstream all the time since it's a medication that is taken regularly for long periods of time. So don't fool yourself into think that the interaction between these substances will be any less if you take them at different times of the day. They will interact regardless of when you take them.

By ddljohn — On Mar 06, 2014

I have had an alcoholic drink once despite being on topiramate. The only side effect I experienced was sleepiness. I probably did not have problems because I take my medication in the morning and I had the alcohol in the evening. Plus, it was only one drink and I have not drank again since then. I think that an occasional drink (no hard liquor) while on topiramate might be okay. But it certainly should not become a frequent event.

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