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Finally, A Pill for Alcoholism?

Topiramate Found Highly Effective in Breakthrough Study

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Updated May 17, 2003

In what is being called a major scientific advance and a landmark discovery which could change the direction of alcoholism treatment, scientists have found that an anti-seizure drug usually prescribed for epileptic patients is highly effective in helping alcohol-dependent individuals stop drinking.

Researchers at The University of Texas Health Science Center at San Antonio reported that heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses.

The drug is topiramate, marketed as Topamax by Johnson & Johnson, which has been used for many years as an anti-seizure medication and is already approved for use by the Food and Drug Administration for that purpose. Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Long-term studies have shown no serious problems related to topiramate.

Reported in the The Lancet, this study conducted by Professor Bankole A. Johnson, M.D., Ph.D., and colleagues was carried out at the Health Science Center's dynamic South Texas Addiction Research & Technology (START) Center, where more than 100 professionals develop new medications for treating alcohol and drug dependence.

"Remarkably, all 150 patients were enrolled into this clinical trial while they were still drinking heavily (defined as more than five standard drinks a day for men and more than four for women)," Professor Johnson said in a news release. "Next, these patients were randomized to receive either oral topiramate (up to 300 milligrams a day) or the placebo for three months along with a minimum intervention behavioral treatment.

"Patients who took topiramate were six times more likely than those who received placebo to be continuously abstinent for at least one month during the three-month trial. Over the same period, those taking the placebo were four times more likely to drink heavily for an entire month during the trial."

The study involved 103 alcoholics over a three month period. Of the 103 heavy drinkers, 55 were given topiramate, while 48 were given a placebo. Both groups received counseling throughout the trial. The results of the study included:

  • After 3 months, 13 out of the 55 in the topiramate group, or 24 percent, had abstained continuously for a month. Only two out of 48 in the placebo group, or 4 percent, had a month sober.
  • In the topiramate group, 28 out of 55, or 50 percent, did not binge in the final month, compared with eight out of 48, or 16 percent, of those taking the placebo. Those taking the drug were nearly four times less likely to binge.
  • Half of the topiramate group reported less craving for alcohol, compared to a 15 percent in the placebo group.
Researchers have long sought a medication to treat alcoholism. Only two medications are currently approved for treating alcoholics in the U.S. -- disulfiram (Antabuse) and naltrexone. Antabuse does not reduce cravings, it merely makes a drinker feel sick if they consume alcohol. Naltrexone has been shown to reduce cravings in alcoholics who have already quit drinking.

Another medication, acamprosate has proven to be more effective than naltrexone, but it has yet to be approved for use in the United States, although it has been used for years in Europe. Acamprosate is also designed to reduce cravings after the person has stopped drinking.

Topiramate is the first medication that has been shown to be effective for persons who are still drinking. Drinkers get pleasure from alcohol when it releases the chemical dopamine in the brain, researchers say. Topiramate works by "washing away" the excess dopamine. In other words, alcoholics no longer get any pleasure from drinking.

Part Two: Leading Researchers Praise Topiramate Study.

Source: University of Texas Health Science Center at San Antonio.

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