Topiramate Helps Alcoholics Quit, Cut Back

A medication used primarily for migraines and seizure control has been shown once again to help some alcohol dependent drinkers stop drinking or cut back on heavy drinking. About 15 percent of the study participants who took topiramate, marketed under the name Topamax, were able to maintain abstinence for 28 days during the 14-week trial.

Previous short-term studies also found topiramate to be effective for helping alcoholics quit or cut back on the amount they drink. Unlike other drugs currently approved for treating alcoholism, topiramate can be used before the person stops drinking. Current medications are used to help someone who has already stopped drinking remain abstinent.

The recent study, published in the October 10 issue of JAMA, involved 371 alcohol-dependent people, age 18 to 65, at 17 different sites in the U.S. over a 14-week period. Along with a weekly psychosocial treatment to encourage -- but not require -- them to stop drinking, 183 of the participants received 300 mg of topiramate a day and 188 received a placebo.

Safe and Consistently Effective

Those who received topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo. The participants were drinking an average of 11 drinks a day when the study began, and 15 percent were able to stop drinking during the 14-week program.

"Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important," the authors concluded. "Alcoholism ranks third and fifth on the U.S. and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health.

"Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings," they wrote.

There Are Some Side-Effects

The study did find that some participants dropped out of the trial because of the side-effects they experienced, including itching, tingling, anorexia, dizziness, drowsiness and difficulty concentrating.

Because the trademark protection for Topamax is about to expire, the drug's manufacturer, Ortho-McNeil Janssen, will probably not seek FDA approval to treat alcoholism with the medication. There is no prohibition on physicians prescribing the medication for off-label use, however.

Another drawback is the cost of Topamax, which is about $350 for a month's supply, or about $1,000 for a three-month supply. However, $350 is a lot cheaper than a residential treatment program and if patients can obtain the medication from their family doctor, it could encourage more people to seek help.

Related Information:

• Topiramate for Treating Alcohol Dependence
  
• Finally, A Pill for Alcoholism?
  
• Medications Approved for Alcoholism

^{Source: Johnson, Bankole A., et al. "Topiramate for Treating Alcohol Dependence" JAMA. 2007;298(14):1641-1651.}

^{Photo: Topamax.com}