Does Topa rewire only at 300 mg

[Guest]

Is it necessary to increase the Topa all the way to 300 mg to "rewire" the brain? Or do we simply stay at whatever dose controls our cravings, then reach 12 weeks and try to reduce back down to a minimum dose, or nothing at all? My doctor is very supportive, but unsure.

[Guest]

Does Topa rewire only at 300 mg

Sobermom,

You many need not dose up to the full 300 mg. Here is an earlier response to a similar question from a patient who was doing well at 150 mg but noted side effects (tingling) after titrating up. It may be helpful to you.

We encourage everyone to carefully review existing posts to see if their questions have already been answered...you'll get your information much more quickly, as I'm often traveling and unable to respond immediately.

--Dr. Garcia


...I think it would be fine to hold at your current level or even decrease to a lower dose, particularly given your weight, and see how you feel. Topamax does have a variety of symptoms that we try to minimize while you get the benefit of receptor control so the cravings can be held in check.

Are you working all elements of the program: hypnotherapy tapes as advised, exercise, kudzu, avoiding sugar? Topamax provides a strong, basic foundation to give that extra control in balancing the glutamate and GABA in the brain. However, I have noticed that some of my patients de-emphasize the critical core and put too much focus on Topamax titration. It is not necessary to achieve the full 300 mg. dosing, particularly if you are experiencing ill effects, so long as the other elements of the program are adhered to.

About the 12 week study: you are probably aware that Topamax does not cure this disease and I advise those who believe that to be true to rethink their relationship with alcohol. I also encourage both patients and physicians to review Chapter Six of the My Way Out book regarding long term maintenance. I also stated in the foreword that my mother, who battled alcohol addiction, forgot late in life who her daughter was, but she never lost the desire for that "little drink". This is a lifelong program.

Also keep in mind that Topamax is not the only drug known for its effectiveness in the medical treatment of alcohol dependence. Naltrexone is available in oral form and in a one-month injection with or without Acamprosate (Campral). If you find the side effects of topiramate too harsh, you may wish to substitute with one of the other meds.

Thanks for the questions and good luck to you.

--Dr. Garcia