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Research Summary

Low-dose Topiramate for Alcohol Dependence

Topiramate 150–300 mg per day can reduce alcohol craving and relapse in patients with alcohol dependence, but adverse effects at these dosages lead to frequent discontinuation. In this paper, researchers randomized 90 alcohol-dependent patients who completed a 7–10 day inpatient detoxification protocol to open-label low-dose topiramate (up to 75 mg per day) (n=30) or to no medication (n=60). All participants received 4–6 weeks of inpatient cognitive behavioral therapy following detoxification. Participants were assessed 3 times during inpatient treatment and provided self-reported alcohol use weekly for 16 weeks after discharge.

  • Depression, anxiety, and obsessive-compulsive drinking scores were significantly lower in the topiramate group than in the control group at the second and third inpatient assessments.
  • Relapse to any drinking 16 weeks after discharge was lower in the topiramate group (67%) than in the control group (86%) (hazard ratio, 0.52; p=0.014).
  • The most common adverse effects in the topiramate group were dizziness (20%), somnolence (23%), psychomotor slowness (13%), and nausea (17%). Only somnolence differed significantly from the control group.

Comments:

Low-dose topiramate appeared to decrease mood symptoms and alcohol relapse over a short timeframe in this small nonblinded trial set within a rather intensive treatment program. Although low-dose topiramate has potential for treating alcohol dependence, larger blinded trials in the outpatient setting, with longer follow-up and comparisons to other agents, are needed. Kevin L. Kraemer, MD, MSc

Reference:

Paparrigopoulos T, Tzavellas E, Karaiskos D, et al. Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study. BMC Psychiatry. 2011 March 14;11:41.

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