Oral topiramate effective for alcoholism
The Journal of Family Practice. 2003 September;52(9):664-688
September 1, 2003|Family Medicine
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- BACKGROUND: Alcohol dependence is a fairly common problem seen in family practice. To date, there have been few, if any, effective medications that help patients control or reduce their drinking behavior.
- POPULATION STUDIED: These researchers enrolled 150 patients with alcohol dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), into the study. They randomly assigned subjects to treatment or placebo groups.
- STUDY DESIGN AND VALIDITY: Patients were randomly assigned to receive escalating doses of either topiramate (maximum of 300 mg/d) or placebo for a period of 12 weeks. Subjects, clinicians, and those assessing treatment outcomes were blind to group assignment; however, it is unclear whether allocation to the groups was concealed.
- OUTCOMES MEASURED: The investigators measured 6 primary outcomes on a weekly basis throughout the 12 weeks of the study. They assessed the number of drinks per day, drinks per drinking day, heavy drinking days (defined as 5 or more drinks for men or 4 or more drinks for women), and number of days abstinent.
- RESULTS: Patients taking topiramate had an average of 1 fewer drink per day, both on drinking days and on a daily basis, 15% fewer days of heavy drinking, and approximately 12% more days of abstinence compared with the placebo group. The numbers were even more significant at the end of the study, showing a trend in increasing efficacy over the 12 weeks of follow up. The anticraving effects were also more significant at the end than when averaged over the length of the study. Plasma GGT levels had a statistically significant drop during the study and obsessive-compulsive drinking scale factor scores decreased significantly. All 150 subjects completed the study, and they reported no adverse events.
PRACTICE RECOMMENDATIONS
Oral topiramate is effective in the treatment of alcohol dependence. Patients taking topiramate consumed less alcohol, had fewer heavy drinking days, and had more days abstinent within a 12-week period. This medication adds a significant adjunct to our current treatment of alcoholism and can be considered for use in treating those alcoholics who desire sobriety.
