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Topiramate for the Treatment of Alcohol Dependence

A novel anticonvulsant medication may have efficacy in reducing drinking behaviors.

Few medications have been shown to reduce drinking behavior in patients with alcohol dependence, and thus medications have played a limited role in alcoholism treatment. Preclinical data have suggested that the novel anticonvulsant topiramate might blunt the alcohol-induced increases in mesolimbic dopamine that reinforce alcohol dependence; thus, topiramate might decrease the chronic changes in glutamate receptor sensitivity that possibly facilitate these dopamine increases. In a partially manufacturer-supported study on the efficacy of topiramate for alcoholism, researchers randomized 150 alcohol-dependent patients (average daily intake, approximately 9 drinks) to receive topiramate (doses escalated to 300 mg daily) or placebo. All patients had weekly clinic visits to enhance medication compliance and to assess drinking behavior.

At the study's end, compared with placebo recipients, topiramate recipients had 2.9 fewer mean drinks per day, 3.1 fewer mean drinks per drinking day, 28% fewer days with heavy drinking, 26% more abstinent days, and reductions in serum -glutamyl transpeptidase levels and craving. Significant effects began at 6 to 8 weeks and were equivalent in early- and later-onset alcoholism. Topiramate was not associated with serious adverse events; the most common events were dizziness, memory and concentration impairment, psychomotor slowing, and weight loss.

Comment: These results suggest that topiramate is one of the very few effective medications for treating alcohol dependence; others include disulfiram, naltrexone, and acamprosate (this last drug has not received FDA approval). Unlike the researchers in this study, most clinicians combine medications with behavioral or psychological treatments for alcoholism; thus, the generalizability of these results and the clinical utility of topiramate are unclear. Researchers have compared the efficacy of naltrexone and acamprosate, alone and in combination; similar studies of topiramate would clarify its place in the medical management of alcoholism.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry July 24, 2003

Citation(s):

Johnson BA et al. Oral topiramate for treatment of alcohol dependence: A randomised controlled trial. Lancet 2003 May 17; 361:1677-85.

• Medline abstract (Free)