Can I Drink Alcohol with Topiramate?

“Can I drink alcohol while I’m taking this medication?” is one of the most common questions people have when starting a new medication — and it’s a valid one. It generally isn’t recommended to drink alcohol while taking medications because doing so can lead to serious health risks. However, alcohol affects each medication differently. 

Topiramate is a medication used to treat seizures or prevent migraines. And people taking it often wonder if it’s safe for them to have a drink with their friends or at a family gathering. But before mixing alcohol with topiramate, there are some important factors to keep in mind. 

In this article, we’ll discuss how alcohol interacts with topiramate and if it’s safe for you to drink alcohol while taking the medication. 

How does alcohol affect people with conditions treated by topiramate?

Topiramate (Topamax) can be used to treat seizures in people with epilepsy (a condition that causes abnormal brain activity that leads to seizures) or prevent migraines. And alcohol affects each of these conditions differently. 

Seizures

Drinking alcohol in small amounts (one or two drinks per day) usually doesn’t cause people with epilepsy to have more seizures, as long as they don’t have a history of alcohol abuse or alcohol-related seizures. Heavier alcohol use (four or more drinks per day), on the other hand, might be associated with unprovoked seizures (seizures that occur without a clear cause). 

The most serious risk of drinking alcohol for people with epilepsy is alcohol withdrawal, which is what your body experiences after you stop drinking. Alcohol withdrawal makes it more likely for you to have a seizure, especially if you drank a heavy amount or if you’ve drunk consistently for a long time. Seizures occur in about 5% of people who go through alcohol withdrawal, and the majority of them occur within 48 hours after you stop drinking.

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Migraines

Drinking alcohol is commonly linked to migraine headaches. In fact, over one-third of people have reported alcohol as a trigger for their migraine attacks. The way in which alcohol triggers a migraine isn’t fully understood, but it’s believed to contribute in several ways. 

First, alcohol can cause mild dehydration by making you urinate more often, and it also causes inflammation in your body. Both dehydration and inflammation can trigger a headache.

Next, many alcoholic drinks, including whiskey, brandy, and red wine, contain chemicals called congeners, which contribute to their color, odor, and taste. Congeners can trigger migraines. Alcohol also widens the blood vessels in your brain, which can cause a headache. 

Lastly, although alcohol may make you fall asleep faster, your sleep is more disrupted, and you tend to wake up earlier after drinking. This can cause fatigue, which can worsen your migraine. 

Can I take topiramate with alcohol?

Topiramate works by altering chemical signals and slowing down nerve activity in your brain. This can cause side effects like confusion, sleepiness, dizziness, memory problems, and depression. 

Because topiramate can cause mental and psychological side effects, it’s not recommended that you drink alcohol while taking topiramate. Combining topiramate and alcohol can intensify the side effects listed above. 

In fact, if you’re taking the extended-release form of topiramate (Trokendi XR), you should completely avoid drinking 6 hours before or 6 hours after taking your dose. This is because alcohol can alter the levels of the medication in your body.

However, your provider may use topiramate off-label (meaning for a condition it’s not approved for) to help with alcohol dependence. If you’re taking topiramate for this purpose, you’ll want to follow your provider’s directions.

Is having one or two drinks OK?

People often wonder if drinking in moderation is OK while taking medications. Unfortunately, there isn’t any research available on alcohol use with topiramate. 

The general consensus is to avoid all alcohol if possible while taking topiramate. However, if you are going to drink, do so with extreme caution. While it may be possible to have an occasional drink while you’re taking it, check with your healthcare provider before you mix the two. And if you have a drink while taking topiramate, don’t drive or do any activities that require you to focus.

Are certain people more at risk when combining alcohol and topiramate?

Yes. Drinking alcohol with topiramate can be more dangerous for certain people. This typically includes those more strongly affected by alcohol, making the combination riskier.

For example, older adults cannot break down alcohol as easily as younger adults. This causes alcohol to reach higher concentrations in their body, which means it can have stronger effects. 

Similarly, people assigned female at birth may also be more at risk because alcohol can reach higher concentrations in their bloodstream compared to those who are assigned male at birth. This means they need less alcohol to get intoxicated. But we don’t know how this risk specifically affects transgender, non-binary, or intersex people due to lack of studies.

People who take higher doses of topiramate are also more at risk because they may be more likely to experience mental and psychological side effects. 

How does alcohol interact with topiramate?

Topiramate calms down the nerve activity in your brain. Similarly, alcohol affects several chemical signals in your brain, which leads to the common intoxication symptoms like slurred speech, dizziness, memory loss, and sleepiness. Combining the two can have an additive effect that may result in people experiencing more intense and dangerous side effects from topiramate.

What are the typical side effects?

There is potential for side effects with all medications. But drinking alcohol with most medications may worsen the side effects you experience. This is especially true when combining alcohol and topiramate. 

The most common side effects of topiramate include:

• Tingling, prickling, or “pins-and-needles” feeling in your arms, hands, legs, and feet

• Loss of appetite

• Weight loss

• Fatigue

• Changes in your taste

• Problems with your speech

• Memory problems

• Dizziness

• Sleepiness

Are there any serious side effects or risks?

Yes. Topiramate can cause serious side effects, many of which involve your brain. 

These serious effects can include:

• Problems with cognition (e.g., confusion, slowed reactions, difficulty concentrating or paying attention, memory problems, speech problems)

• Changes in your mood

• Aggressive behavior

• Depression

It can also raise your risk of suicidal thoughts or behavior. Similarly, alcohol can potentially make you feel sleepy, affect your mood, and worsen your memory. Therefore, combining the two — which may amplify these effects — can be dangerous. 

When should I get medical attention?

Combining alcohol with topiramate can worsen the side effects of the medication. Notify your healthcare provider right away if you experience any of the following:

• Suicidal thoughts or behavior

• New or worsening depression or anxiety

• Restlessness

• Panic attacks

• Irritability

• Aggressive or violent behavior

• Acting on dangerous impulses

• Feelings of extreme happiness

• Any other unusual changes in your mood or behavior

• Changes in your mental or motor skills (confusion, difficulty concentrating, speech or memory problems, sleepiness, dizziness)

There are also serious risks associated with taking topiramate. Symptoms that you should get medical help for right away include:

• Eye problems (blurred vision, loss of vision, eye pain)

• Signs of high acid levels in your body (fatigue, loss of appetite, irregular heartbeat, difficulty thinking clearly, kidney stones)

• Signs of high ammonia levels in your body (fatigue, feeling less alert, vomiting)

• Fever and inability to sweat, especially in hot weather

When can I start drinking after I’ve stopped taking topiramate?

Because alcohol can raise your risk of seizures and trigger migraines, it’s best to talk to your healthcare provider before drinking, even if you’ve stopped topiramate.

Regardless of what you’re taking topiramate for, you shouldn’t stop taking the medication suddenly because it can raise your risk of seizures and may cause more frequent seizures. If you’ve been taking topiramate for a long period of time, your provider will gradually lower your dose over the course of 2 to 8 weeks. It’s still not recommended to drink alcohol while you’re weaning off of topiramate.

How long does topiramate stay in your system?

Topiramate stays in your system for approximately 4 to 6 days after you take your last dose, but this may differ depending on your age, the dose you were taking, and your medical history. Because of this, talk to your provider about if it’s safe for you to drink after you’ve stopped taking topiramate.

Are there are any seizure or migraine medications that aren’t affected by alcohol?

Anti-seizure medications and alcohol both affect chemical signaling in your brain and act as depressants on your brain. Because of this, there are no seizure medications that are completely safe to take while drinking alcohol. 

A variety of other medications are used to prevent migraines, like blood pressure medications, antidepressants, and a newer category of medications called monoclonal antibodies. 

It generally isn’t recommended to drink alcohol with blood pressure medications. The same holds true for antidepressants. There aren’t specific warnings against alcohol use with the monoclonal antibodies, such as erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti), used for migraine prevention. 

However, because alcohol use on its own can trigger migraines, talk to your healthcare provider about if it’s safe to have a drink while taking these medications. 

Why trust our experts?

Written by:

Ashley Wong, PharmD

Ashley Wong, PharmD, is a licensed pharmacist in California. She has over 6 years of experience providing drug information.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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If you or someone you know struggles with alcohol dependency, you can get help by calling the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357).