Drug & supplement interaction

Gamma-hydroxybutyrate (ghb) + Topiramate

Topiramate brand names: Topamax, Trokendi XR, Qudexy XR, Eprontia.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Topiramate falls into 3 drug categories that Gamma-hydroxybutyrate (ghb) can interact with; the most serious is rated major. GHB may increase the risk of serious CNS and respiratory depression.

Read the full interaction report
SeverityMajor
LikelihoodProbable
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Gamma-hydroxybutyrate (ghb) and Topiramate

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Gamma-hydroxybutyrate (ghb) interacts with whole categories of medication. Topiramate falls into 3 of those categories, so it can interact with Gamma-hydroxybutyrate (ghb) in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Major).

Major

CNS DEPRESSANTS

1 of 3

Why this applies to Topiramate

Topiramate falls under CNS DEPRESSANTS — the group Gamma-hydroxybutyrate (ghb) interacts with.

GHB may increase the risk of serious CNS and respiratory depression.
Concomitant use of GHB with CNS depressants may increase the risk of serious CNS and respiratory depression.
Severity Major Likelihood Probable Evidence D

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Let me be upfront here: GHB is not a safe supplement. Outside of the tightly controlled prescription form (sodium oxybate), it's a dangerous, illegal drug that can shut down your breathing on its own. When you put it together with Topiramate, the worry is that both substances calm down the central nervous system, so their sedating effects can stack up.

Topiramate can already make people feel drowsy, foggy, dizzy, or slowed in their thinking. Add GHB, and you raise the risk of deep sedation, dangerously slow or shallow breathing, and even passing out. This combination has a major safety rating, though the evidence is mostly anecdotal. Bottom line: don't combine these, and please talk with your doctor or pharmacist about any concerns.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
Moderate

ANTICONVULSANTS

2 of 3

Topiramate also falls under ANTICONVULSANTS.

Theoretically, GHB may reduce the effects of anticonvulsant medications.
GHB has been reported to cause seizures, and may theoretically reduce the effectiveness of anticonvulsants. Also, concomitant use of GHB with sedative anticonvulsants may increase the risk of serious CNS and respiratory depression.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

First, a real safety note: GHB is not a true supplement. It's a controlled substance and a dangerous CNS depressant, so I'd never recommend pairing it with anything. With Topiramate, there are two concerns here. GHB has been reported to actually trigger seizures, which could work against the very thing topiramate is doing to keep your seizures (or migraines) under control. In plain terms, it may chip away at how well your medication protects you.

The second worry is that both can slow the brain down, so combining them could deepen sedation and, more seriously, suppress your breathing. Keep in mind this interaction is theoretical and based only on anecdotal reports, so it's not firmly proven. Still, please talk with your doctor or pharmacist before mixing these, and don't change your topiramate on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Anon. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-8. DOI
  2. Stomberg MW, Knudsen K, Stomberg H, Skärsäter I. Symptoms and signs in interpreting gamma-hydroxybutyrate (GHB) intoxication - an explorative study. Scand J Trauma Resusc Emerg Med. 2014 Apr 23;22:27. PubMed
  3. Product information for Xyrem. Jazz Pharmaceuticals, Inc. Palo Alto, CA. March 2022.
Moderate

TOPIRAMATE (Topamax)

3 of 3
Topiramate might increase the levels and clinical effects of GHB.
Concomitant use of GHB with topiramate might increase the blood levels and adverse effects of GHB. In one case report, a female regularly taking prescription GHB (sodium oxybate, Xyrem) 4.5 grams twice nightly for nocturnal headaches and insomnia experienced a worsening cluster headache requiring hospitalization after initiating treatment with topiramate 25 mg, 5 hours prior to the GHB dose. Symptoms included confusion, muscle jerking, miosis, and coma, with recovery within a few hours. Plasma levels of GHB were 2.5-fold higher than when GHB was given alone. Potential mechanisms might include decreased GHB breakdown, increased absorption, and/or increased activity.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here the concern runs in one direction: topiramate can push the levels of GHB up, not the other way around. Whether you mean street GHB or the prescription form (sodium oxybate, Xyrem), adding topiramate may slow how your body clears it and let more of it build up. GHB is already a strong nervous system depressant, so higher levels can mean deep sedation, confusion, muscle jerking, slowed or stopped breathing, and even coma.

This is built on a single case report, so the evidence is thin (anecdotal), but the outcome in that case was serious enough to send the person to the hospital. Please don't start, stop, or change either one on your own. Loop in your doctor or pharmacist first so they can watch you closely.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Weiss T, Müller D, Marti I, Happold C, Russmann S. Gamma-hydroxybutyrate (GHB) and topiramate--clinically relevant drug interaction suggested by a case of coma and increased plasma GHB concentration. Eur J Clin Pharmacol. 2013 May;69(5):1193-4. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Gamma-hydroxybutyrate (ghb) Also Interacts With Other Medications

Gamma-hydroxybutyrate (ghb) has 248 major, 21 moderate, 5 minor known drug interactions in our database — the Topiramate one above is among them. If you take anything else, check it against the full list below.

Major 248 Moderate 21 Minor 5 No known interaction 2,556 (incl. Topiramate)
Taking anything else?

Check Another of Your Medications Against Gamma-hydroxybutyrate (ghb)

Covers the 2,830 medications we’ve checked against Gamma-hydroxybutyrate (ghb). Pick one to open its full report.

From our Q&A

Questions About Gamma-hydroxybutyrate (ghb) or Topiramate

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Gamma-hydroxybutyrate (ghb) or Topiramate, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Topiramate

This page covers Gamma-hydroxybutyrate (ghb) only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Topiramate page lists 125 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Beer (major), Kava (major) and L-tryptophan (major).

By severity: 7 major · 101 moderate · 17 minor.

From our pharmacist’s overview on the Topiramate page

“Most people taking topiramate (Topamax, Trokendi XR) are managing seizures or preventing migraines, and the drug is famous for causing fog and drowsiness all on its own. That is why this list of 125 supplements deserves real vigilance.”

Reviewed by 2 · Jul 18, 2026

Open the Topiramate interaction page

How much people look this up

Where Gamma-hydroxybutyrate (ghb) and Topiramate Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Gamma-hydroxybutyrate (ghb)
Steady interest

#1,240 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Topiramate
Steady interest

#1,559 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Gamma-hydroxybutyrate (ghb)

What is Gamma-hydroxybutyrate (ghb)?

  • Narcolepsy (cataplexy and excessive daytime sleepiness)
  • Sleep aid
  • Misused as a recreational 'party drug'
  • Bodybuilding/muscle building (unproven)
  • Alcohol withdrawal (in some countries)

GHB (gamma-hydroxybutyrate) is a powerful central nervous system depressant that is NOT a safe dietary supplement. In the U.S. it is a controlled substance, and only a tightly regulated prescription form (sodium oxybate) is legal for narcolepsy. Non-prescription GHB can cause coma, breathing failure, and death, and it is also a known 'date-rape' drug — it should not be taken outside of medical supervision.

Read the full Gamma-hydroxybutyrate (ghb) monograph & all interactions
Medication

About Topiramate

What Is Topiramate Used For?

Brand names: Topamax, Trokendi XR, Qudexy XR, Eprontia

  • Topiramate is used alone or with other medications to treat certain types of seizures including primary generalized tonic-clonic seizures (formerly known as a grand mal seizure; seizure that involves the entire body) and partial onset seizures (seizures that involve only one part of the brain). Topiramate is also used with other medications to control seizures in people who have Lennox-Gastaut syndrome (a disorder that causes seizures and developmental delays). Topiramate is also used to prevent migraine headaches but not to relieve the pain of migraine headaches when they occur. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.

See full Topiramate drug information
Keep checking

Other Drugs & Gamma-hydroxybutyrate (ghb)

Browse every other medication we’ve checked against Gamma-hydroxybutyrate (ghb) — both the ones with a known interaction and the ones without. Select any drug for the full detail.

248Major
21Moderate
5Minor
2,555No known interaction
248 Major 21 Moderate 5 Minor 2,555 No interaction
Major

248 interactions

Showing 60 of 248 major interactions — see all 248 on the Gamma-hydroxybutyrate (ghb) page.

Moderate

21 interactions

Minor

5 interactions

No interaction 2,555 drugs checked — show the list

We also checked Gamma-hydroxybutyrate (ghb) against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,555 medications checked with no known interaction — see the full Gamma-hydroxybutyrate (ghb) list.

See the full Gamma-hydroxybutyrate (ghb) interactions page
See every supplement checked against Topiramate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Gamma-hydroxybutyrate (ghb) monograph › Uses, safety, and every drug interaction in one place Topiramate supplement interactions › Every supplement checked against Topiramate, ranked by severity Topiramate drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Gamma-hydroxybutyrate (ghb) and Topiramate Together: Common Questions

Can you take Gamma-hydroxybutyrate (ghb) with Topiramate?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for Gamma-hydroxybutyrate (ghb) and Topiramate?
Topiramate belongs to more than one drug category, and Gamma-hydroxybutyrate (ghb) interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Gamma-hydroxybutyrate (ghb) and Topiramate interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.