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.