topiramate is an anticonvulsant medication that has been approved by food and drug administration ( fda ) for the various types of seizure disorder and for prophylaxis of migraine headache . it is , however , also used for a variety of other indications , including alcohol dependence to reduce craving , obesity , bipolar disorder and other psychiatric disorders . though benign , it is a very troublesome side effect and often leads to drug discontinuation . though a variety of cutaneous adverse effects have been reported with topiramate , pruritus as an isolated side effect has only been rarely reported . we hereby report a case of a male of alcohol dependence , who developed pruritus while taking topiramate . a 44-year - old male was diagnosed as a case of alcohol dependence syndrome as per icd 10 criteria . all his blood investigations were normal except for mild elevation of transaminases ( elevated around three times the normal range ) . he was initially detoxified with chlordiazepoxide which was started at a dose of 70 mg / day and was gradually tapered over a period of 2 weeks . he was also prescribed multivitamin injectables on alternate day for a total period of 10 days . he was followed up after a period of 1 month , wherein he was abstinent from alcohol and was now taking only multivitamin in capsule form . he was started on topiramate 25 mg / day increased to 50 mg after 1 week . after 2 days of 50 mg topiramate , the patient reported itching all over the body . he thought it to be drug related and consequently stopped medications on his own . itching improved in 3 days duration without any treatment . other than topiramate , the patient was taking multivitamin capsule which he had continued without any adverse effect . all his investigations , including liver function tests , bile pigments and other tests , were normal . he is currently maintaining well on disulfiram therapy without any relapse of alcohol consumption or any other problem . our case was diagnosed as topiramate induced pruritus . because of temporal correlation , the side effect occurred twice while the drug was re - started and subsided with drug discontinuation . the use of naranjo adverse drug probability scale revealed a score of 9 suggestive of definitive relationship between pruritus and topiramate . side effects frequently caused by topiramate include cognitive impairment , word - finding difficulties , and bodyweight loss , and less commonly renal calculi , hepatotoxicity , and ocular pathology such as glaucoma . regarding cutaneous side effects , topiramate can cause acneiform eruptions , alopecia , drug - induced pigmentation , exanthematous reaction , hyperhidrosis , hypertrichosis , hair texture change , lichenoid eruption , photosensitivity , and fixed drug eruptions . pruritus as a side effect has been reported commonly with antimalarials , plasma volume expanders , opioids , penicillin ace inhibitors and others . we could find only one report wherein four patients with epilepsy developed pruritus after the addition of topiramate to their anticonvulsant regimens . these patients had history of previous drug allergies and this could have had a bearing on pruritus associated with topiramate . the possible mechanisms behind pruritus involve either an allergic reaction or secondary to skin lesions . possible other hypothesized mechanisms for drug - induced pruritus are cholestatic liver injury , xerosis of the skin , deposits of drugs or their metabolites in the skin , phototoxicity , or neurological alterations . often , the underlying mechanism is not known . our case was that of  pure  drug - induced pruritus as there were no other skin lesions associated with it . drug - induced pruritus without associated skin lesions is in itself rare , occurring at a frequency of around 12% of all drug reactions . previous reports suggest that toprimate 's side effects , especially cutaneous side effects , occur when used with other medications . it is possible that the combinations of topiramate with antipsychotic and anticonvulsant medications further alter neural thresholds in such a fashion as to effect the sensation of itch . the neural effects of topiramate might account for its efficacy in treating psoriasis , a disease in which the importance of neural function continues to be defined . however , our case was not on any other medication that could have potentiated the action of topiramate . to conclude , one should be vigilant for such benign side effects as these are very troublesome for the patient . more studies to understand the pathogenesis and to identify the risk factors for cutaneous side effects of topiramate are warranted .
topiramate is an antiepileptic medication frequently used for the management of alcohol dependence and in other psychiatric disorders . 
 though cutaneous side effects are known to occur with it , isolated pure pruritus is rarely reported with topiramate in the literature . 
 we wish to report a case of pruritus associated with topiramate use in a male with alcohol dependence syndrome .