Topiramate Reduces Drinking in Adults With Alcohol Dependence
Topiramate may decrease alcohol consumption among people with alcohol dependence by reducing the release of dopamine. To determine topiramate’s efficacy for reducing drinking, researchers randomized 371 patients with alcohol dependence from 17 sites across the U.S. to receive topiramate (up to 300 mg per day) or placebo for 14 weeks. Only subjects without comorbid conditions (e.g., other substance use, depression) who wanted to quit or reduce drinking were eligible to enroll. All subjects received weekly, manual-guided adherence enhancement counseling.
- In analyses that considered all dropouts as having relapsed to baseline measures, topiramate recipients had greater reductions in the percentage of drinking days (from a mean of 82% to 44% compared with 82% to 52% for placebo recipients) and in liver enzymes. They also had greater increases in abstinent days (from a mean of 10% to 38% compared with 9% to 29% for placebo recipients).
- In analyses that considered dropouts as missing rather than as relapses, the differences between the topiramate and placebo groups were even greater.
- With both analytic approaches, topiramate recipients achieved ≥28 days of both continuous abstinence and continuous nonheavy drinking faster than placebo recipients did.
Topiramate is a promising treatment for alcohol dependence. Both analytic approaches suggest that broadening the use of topiramate to treat alcohol dependence among adults who want to reduce their drinking is warranted. However, because this randomized controlled trial had strict eligibility criteria to ensure that safety and efficacy could be measured, the generalizability of these findings to patients with comorbid illnesses, such as other substance disorders or psychiatric disease, may be limited.Julia H. Arnsten, MD, MPH
Johnson BA, Rosenthal N, Capece JA, et al. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA. 2007;298(14):1641–1651.