Here’s a concise, evidence-rated chart of Topamax (topiramate) off-label psychiatric uses you asked about. I’ve kept it practical and pinned each row to load-bearing studies/reviews.
|
Off-label indication |
Evidence level* |
What the data say (very short) |
Typical study doses |
Key sources |
|
Alcohol Use Disorder (AUD) |
Moderate |
Multiple RCTs show heavy-drinking days and abstinence vs placebo; considered a reasonable second-line option. |
Titrated to ~300 mg/day over 68 wks |
JAMA RCTs and follow-ups. |
|
Cocaine Use Disorder |
Mixed / Low岞oderate |
Meta-analyses: no benefit for retention; some signal for continuous abstinence in subsets; results inconsistent. |
50300 mg/day in trials |
Systematic review/meta-analysis; JAMA Psychiatry RCT. |
|
Binge-Eating Disorder (BED) |
Moderate |
Several RCTs show binge frequency and weight loss vs placebo; not FDA-approved. |
Median/mean ~200300 mg/day (ranges 50600 mg) |
RCTs & meta-review. |
|
Bulimia Nervosa |
Low岞oderate |
10-week RCTs show binge/purge and weight vs placebo; small samples; consider SE profile. |
Median 100 mg/day (range 25400 mg) |
RCTs (Hoopes; Hedges). |
|
PTSD |
Low / Preliminary |
Small/underpowered trials: mixed; some symptom improvements but often not statistically significant overall; research ongoing. |
50300 mg/day in trials |
RCT/protocols & recent civilian PTSD study. |
|
Bipolar disorder (acute episodes) |
Negative / Insufficient |
Cochrane: no better than placebo as monotherapy for acute mania/depression; not recommended as first-line. |
|
Cochrane review. |
*Evidence level guide: Moderate = ≥1 well-designed RCT + replication and/or meta-analysis with consistent signal. Low–Moderate / Mixed = some RCT/meta-analytic signal but inconsistent or population-limited. Low/Preliminary = small RCTs/pilots/protocols with inconclusive results. Negative/Insufficient = good evidence of no benefit for the outcome.
Quick clinical notes (off-label context)
- Dosing/tolerability: Slow titration helps (paresthesias, cognitive dulling, weight loss are common; kidney stones risk). For AUD, many protocols target 300 mg/day over ~6–8 weeks.
- Positioning: For AUD and BED/bulimia, topiramate can be considered when first-line options fail or are contraindicated. For PTSD and cocaine use, evidence is not yet robust enough for routine use. For bipolar, guidelines generally do not recommend it for acute treatment given negative trials.
If you’d like, I can tailor this into a one-page handout with dose-titration examples and contraindication/interaction reminders for each indication.
