A medication currently used to treat epilepsy and migraines has also been shown to be effective for reducing alcohol consumption and treating cocaine addiction. But topiramate may never receive approval for the treatment of addiction because of economic considerations.
For at least 10 years, research studies have shown that topiramate, marketed as Topamax, is effective in treating alcoholism. In 2003, a study by the Health Science Center's South Texas Addiction Research & Technology (START) Center found that subjects who were still heavy drinkers were six times more likely to remain sober for a month, compared to a placebo group.
Effective for Cutting Down
In a follow-up study a year later, the START Center researchers, led by Dr. Bankole A. Johnson, conducted a "proof-of-concept clinical trial" that concluded that topiramate has a greater effect on drinking than naltrexone and acamprosate, two medications that are approved for the treatment of alcoholism.
More recent studies have shown that topiramate is more effective in reducing the amount that heavy drinkers drink than it is in producing complete abstinence in alcohol-dependent drinkers.
Reducing Overall Consumption
Traditionally, the goal of treatment for alcohol use disorders has been to achieve abstinence, but in recent years there has been more focus on harm reduction, or reducing the amount of alcohol that patients drink or reducing their number of drinking days.
According to research, topiramate has been found to be more effective in reducing overall alcohol consumption than the currently approved medications disulfiram, naltrexone and accamprosate.
Focus on Harm Reduction
A recent study of alcoholism treatment throughout the Veterans Health Administration found that V.A. doctors were prescribing topiramate for their alcohol-dependent patients at a higher rate than naltrexone and acamprosate combined.The use of the drug is not currently monitored by the V.A. because it is not approved for use as a alcohol use disorder treatment, but that has not stopped clinicians from prescribing it when the goal of treatment was reducing the harm of excessive alcohol consumption.
The authors of the V.A. study concluded that the use of topiramate over the other medications demonstrates a shift in the treatment of alcoholism toward reduction in consumption, rather than total abstinence.
Effective for Cocaine Addiction
Even more recently, research found that topiramate is also effective for treating cocaine addiction. A double-blind study at the University of Maryland School of Medicine of 142 adults who were seeking treatment for cocaine dependence found that topiramate increased the number of cocaine nonuse days.
Previously, studies found that topiramate could help reduce use of the drug by users who were not seeking treatment for cocaine addiction. It works by affecting how the brain reacts to cocaine, thereby reducing craving for the drug.
Topiramate is the first drug that has been found effective in treating cocaine addiction, according to the study's authors. Another study has shown it to be effective in smoking cessation.
No Longer Trademark Protected
Although research shows topiramate to be very effective, relatively speaking, in reducing harmful drinking and in treating cocaine addiction, the medication may not be used to its fullest potential. Because it's not approved by the U.S. Food and Drug Administration specifically for addiction treatment, insurance companies may not pay for prescriptions for those uses.
Additionally, because topiramate is no longer protected by trademark, and is therefore open to generic production, it is not economically feasible for pharmaceutical companies to pursue the expensive process necessary to gain FDA approval for the addiction treatment use of the drug.
Any pharmaceutical treatment for alcoholism or addiction would be a less expensive option that entering a residential treatment program, but without insurance participation, topiramate would be more expensive than other FDA-approved medications.Although topiramate is not FDA approved for the treatment of alcoholism and addiction, there is no prohibition against healthcare providers prescribing the drug for those purposes.
Del Re, AC, et al "Prescription of topiramate to treat alcohol use disorders in the Veterans Health Administration." Addiction Science & Clinical Practice 8 July 2013
Fran, J, et al "Pharmacotherapy for Alcohol Dependence: Status of Current Treatments." Current Opinion in Nuerobiology. 23 August 2013.
Johnson, BA, et al, "Topiramate for the Treatment of Cocaine Addiction." JAMA Psychiatry. 16 October 2013.
Johnson, BA, et al, "Oral Topiramate Reduces the Consequences of Drinking and Improves the Quality of Life of Alcohol-Dependent Individuals." JAMA Psychiatry. September 2004.
Kampman KM, et al. "A Double-Blind, Placebo-Controlled Trial of Topiramate for the Treatment of Comorbid Cocaine and Alcohol Dependence." Drug and Alcohol Dependence 1 November 2013.
Oncken C, et al. "Topiramate for Smoking Cessation: A Randomized, Placebo-Controlled, Pilot Study." Nicotine and Tobacco Research 21 September 2013.