When naltrexone or acamprosate is not a fit, two other medicines are sometimes used off-label for alcohol use disorder: gabapentin and topiramate. Neither is FDA-approved for this use, but both have supporting studies.
Gabapentin
Gabapentin may reduce drinking and help with sleep and anxiety in early sobriety, and it can help with mild withdrawal symptoms. Side effects include drowsiness and dizziness. It can be misused, especially with opioids, and combining it with opioids or alcohol can slow breathing, so careful monitoring matters.
Topiramate
Topiramate has some of the strongest evidence among off-label options for reducing heavy drinking. It is started low and increased slowly over weeks. Side effects can include tingling, trouble finding words, slowed thinking, lower appetite and kidney stones. It can cause birth defects, so it is not for pregnancy, and it can make some hormonal birth control less effective. Get care right away for sudden eye pain or blurred vision. Do not stop it suddenly; your provider lowers the dose gradually.
How they fit
Your provider weighs your goals, other conditions and other medicines. These options can be used alone or alongside counseling and support.
Learn more about alcohol use disorder treatment in Charleston.
Help at Hope Addiction Medicine
Our team combines medication with counseling and behavioral therapies, in person at our West Ashley office in Charleston and by telehealth when appropriate. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment or call our office.
This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If someone may be overdosing, call 911 and give naloxone if you have it.
Frequently Asked Questions
Studies suggest gabapentin may reduce drinking and help sleep and anxiety in early sobriety. It is used off-label and needs monitoring because it can be misused.
Yes, off-label. It has some of the strongest evidence among off-label options for reducing heavy drinking, and it is started low and increased slowly.
Tingling, trouble finding words, slowed thinking, lower appetite and kidney stones. It is not used in pregnancy, can weaken some hormonal birth control, and should not be stopped suddenly. Get care right away for sudden eye pain or blurred vision.