Topiramate effective for treating alcohol dependence

Medical Tribune August 2008 SFIX
David Brill

A randomized trial has shown that topiramate can improve the physical and mental wellbeing of alcoholics as well as reducing their drinking behaviour.

Patients who took the drug over a 14-week period displayed a greater overall clinical improvement and a reduction in obsessional thoughts and compulsions about using alcohol compared to those who took placebo.

Topiramate was also associated with significant improvements in liver function and reductions in plasma cholesterol, body mass index and blood pressure.

“The research shows quite clearly now that medications add to the beneficial effects of psychotherapy or psychosocial interventions,” said the study’s lead author Professor Bankole Johnson, who is chairman of the department of psychiatric medicine at the University of Virginia, US.

The use of topiramate as a treatment for alcohol dependency is currently off-label in the US and Johnson does not specifically advocate the drug over any other.

“If anyone with alcohol dependence presents to a family practitioner or a general practitioner then it’s important that medication be prescribed, whatever the medication. Otherwise they’re not getting the best effect of treatment,” he said.

He added, however, that topiramate does appear to be more powerful and efficacious than other options such as naltrexone or acamprosate.

The double-blind trial, published in The Archives of Internal Medicine, involved 317 alcohol-dependent patients aged from 18 to 65.

Patients in the topiramate group also reported improvements in some aspects of quality of life such as leisure-time activities and household duties, and displayed a trend towards reduced sleep disturbances. However adverse events – including pins and needles, headache, fatigue, nausea and anorexia – were more common among these patients than those who took placebo.

Topiramate is thought to reduce the rewarding effects of alcohol consumption by working on the corticomesolimbic system – inhibiting glutamate pathways while facilitating γ-aminobutyric acid pathways.

Previous studies had shown that the drug reduced alcohol consumption and promoted abstinence, but had not addressed the physical and psychosocial aspects of treatment.

“To have a medicine that can not only reduce the alcohol drinking but can also help improve these other problems is very important,” said Johnson, adding that topiramate can be prescribed for patients who are still drinking and not just those who are abstinent.

“And I think there’s an important public health message,” he added. “We need to find ways to treat this disease that are effective and easy to deliver because it’s number five on the World Health Organization’s global impact of disease list, and we really need treatments that all doctors can deliver and not just specialists.

“In the US we’re now getting a slight increase in the number of doctors prescribing medicine for alcohol dependence and I’m hoping that that trend will continue,” he said.