Article

Treatment of alcohol dependence with low-dose topiramate: An open-label controlled study

Athens University Medical School, 1st Department of Psychiatry, Eginition Hospital, Athens, Greece.
BMC Psychiatry (Impact Factor: 2.21). 03/2011; 11(1):41. DOI: 10.1186/1471-244X-11-41
Source: PubMed

ABSTRACT

GABAergic anticonvulsants have been recommended for the treatment of alcohol dependence and the prevention of relapse. Several studies have demonstrated topiramate's efficacy in improving drinking behaviour and maintaining abstinence. The objective of the present open-label controlled study was to assess efficacy and tolerability of low-dose topiramate as adjunctive treatment in alcohol dependence during the immediate post-detoxification period and during a 16-week follow-up period after alcohol withdrawal.
Following a 7-10 day inpatient alcohol detoxification protocol, 90 patients were assigned to receive either topiramate (up to 75 mg per day) in addition to psychotherapeutic treatment (n = 30) or psychotherapy alone (n = 60). Symptoms of depression and anxiety, as well as craving, were monitored for 4-6 weeks immediately following detoxification on an inpatient basis. Thereafter, both groups were followed as outpatients at a weekly basis for another 4 months in order to monitor their course and abstinence from alcohol.
A marked improvement in depressive (p < 0.01), anxiety (p < 0.01), and obsessive-compulsive drinking symptoms (p < 0.01) was observed over the consecutive assessments in both study groups. However, individuals on topiramate fared better than controls (p < 0.01) during inpatient treatment. Moreover, during the 4-month follow up period, relapse rate was lower among patients who received topiramate (66.7%) compared to those who received no adjunctive treatment (85.5%), (p = 0.043). Time to relapse in the topiramate augmentation group was significantly longer compared to the control group (log rank test, p = 0.008). Thus, median duration of abstinence was 4 weeks for the non-medicated group whereas it reached 10 weeks for the topiramate group. No serious side effects of topiramate were recorded throughout the study.
Low-dose topiramate as an adjunct to psychotherapeutic treatment is well tolerated and effective in reducing alcohol craving, as well as symptoms of depression and anxiety, present during the early phase of alcohol withdrawal. Furthermore, topiramate considerably helps to abstain from drinking during the first 16-week post-detoxification period.

Download full-text

Full-text

Available from: Dimitris Karaiskos
  • Source
    • "Celle-ci a retrouvé, dans le groupe traité par topiramate, une diminution de 23 % du nombre de jours de consommation massive (p < 0,001) et une augmentation significative du nombre de jours d'abstinence supplémentaires (+2,9 jours, p < 0,001). Un essai monocentrique randomisé, contrôlé versus placebo, en ouvert pendant quatre mois (n = 90) a retrouvé une augmentation significative de la durée moyenne d'abstinence dans le groupe traité par topiramate [10] (tableau I). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Drug treatments used in substance use disorders are not effective in all patients. Objective To assess the effectiveness of topiramate use in the treatment of substance use disorders. Information sources Medline database from January 1966 to December 2013, Cochrane database and clinicaltrials.gov. Selection of studies We used keywords topiramate, addiction, substance abuse, alcohol, tobacco, nicotine, cocaine, methamphetamine, opiate, heroin, benzodiazepine, cannabis, bulimia nervosa, binge eating disorder, gambling. All clinical trials were included. Animal trials, laboratory tests, reviews, answers to writers, case-reports, case series and publications unrelated to the topic were excluded. Twenty-eight articles investigating the efficacy of topiramate in substance use were included. Results In alcohol-related disorder, several trials and a meta-analysis showed a reduction of days of consumption. In a single-center trial on tobacco-related disorder, topiramate was not found effective in reducing the carbon monoxide expired. In cocaine-related disorder, one single-center trial showed a reduction of days of consumption and two single-center trials have found a trend in favour of topiramate. In alcohol and cocaine co-dependency, a single-center trial found a trend in favour of topiramate. In methamphetamine-related disorder, a multicenter trial found a trend in favour of topiramate. In bulimia nervosa, two single-center trials showed a reduction in binge eating and compensatory behaviours. In binge eating disorder, several trials showed a reduction of binge eating and weight. In gambling, one single-center trial did not show any significant results. There were no randomized controlled trials found in opioid-related disorder, benzodiazepines-related disorder, and cannabis-related disorder. Limitations Definition of abstinence and methods to assess the efficacy of topiramate differed between trials. The methodological quality of included trials was variable, especially with no double-blind procedure in eight trials. Conclusion Topiramate showed interest mainly in alcoholism, binge eating disorder and bulimia nervosa. No definitive conclusions can be reached for other substance use disorders such as nicotine dependence, cocaine dependence, amphetamine dependence or cannabis dependence and for gambling.
    Full-text · Article · Sep 2014 · La Presse Médicale
    • "Celle-ci a retrouvé, dans le groupe traité par topiramate, une diminution de 23 % du nombre de jours de consommation massive (p < 0,001) et une augmentation significative du nombre de jours d'abstinence supplémentaires (+2,9 jours, p < 0,001). Un essai monocentrique randomisé, contrôlé versus placebo, en ouvert pendant quatre mois (n = 90) a retrouvé une augmentation significative de la durée moyenne d'abstinence dans le groupe traité par topiramate [10] (tableau I). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Drug treatments used in substance use disorders are not effective in all patients.
    No preview · Article · Jul 2014
  • Source
    • "The study found disulfiram to be superior in abstinence and daily drinks, while topiramate significantly reduced craving compared to disulfiram;95 the lack of blinding and the low dose of topiramate, however, suggests that a more robust design with adequate topiramate dosing is warranted before drawing strong conclusions regarding the superiority of either medication. Topiramate can also be considered an effective adjunctive therapy in lower doses (75 mg daily) when combined with psychotherapy for alcohol dependence.96 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Alcohol use disorders (AUD) continue to be a concerning health issue worldwide. Harmful alcohol use leads to 2.5 million deaths annually worldwide. Multiple options exist for the management of dependence on alcohol, not all of which are approved by drug-regulating agencies. Current practice in treating AUD does not reflect the diversity of pharmacologic options that have potential to provide benefit, and guidance for clinicians is limited. Few medications are approved for treatment of AUD, and these have exhibited small and/or inconsistent effects in broad patient populations with diverse drinking patterns. The need for continued research into the treatment of this disease is evident in order to provide patients with more specific and effective options. This review describes the neurobiological mechanisms of AUD that are amenable to treatment and drug therapies that target pathophysiological conditions of AUD to reduce drinking. In addition, current literature on pharmacologic (both approved and non-approved) treatment options for AUD offered in the United States and elsewhere are reviewed. The aim is to inform clinicians regarding the options for alcohol abuse treatment, keeping in mind that not all treatments are completely successful in reducing craving or heavy drinking or increasing abstinence.
    Full-text · Article · Jan 2014
Show more