Topiramate Has Lasting Benefits in Alcohol Treatment, Study Finds

A seizure medication called topiramate that addiction specialists and other health professionals sometimes prescribe as a treatment for alcohol use disorder has lasting positive effects on heavy drinking-related harm, new research finds.

In a study published in January 2015 in the journal Alcoholism: Clinical & Experimental Research, researchers from several U.S. institutions gauged the continuing impact of topiramate use up to six months after the end of enrollment in an alcohol program. No one knows for sure how long people who go through alcohol treatment can expect to experience benefits from the use of this medication.

Topiramate

In the U.S., topiramate is available in generic form, as well as under the brand name Topamax. Originally, the medication was intended solely as a treatment for the uncontrolled electrical cascades inside the brain that characterize the seizure disorder known as epilepsy, as well as for a non-epilepsy-related, seizure-producing condition called Lennox-Gastaut syndrome. Doctors subsequently widened use of topiramate to include the prevention of migraine headaches, as well as weight loss. Whatever its treatment context, the medication largely produces its beneficial effects by reducing the rate of excessive interaction between the brain’s primary nerve cells.

Topiramate comes in tablet form, as well as in the form of a capsule designed to be broken open and sprinkled. The medication has a range of potential side effects, including such things as a confused or agitated mental state, a reduced ability to concentrate, a “down” or depressed mood, a fluctuating mood, an irritable mood, disrupted language production, loss of muscle coordination, uncontrolled muscle movement, sleepiness, memory disruptions, muscle aches and tinnitus (a ringing sound in the ears). More severe potential side effects include unusual changes in heart rate, vision problems and pain in the chest or abdomen.

Use in Alcohol Treatment

Unlike three other medications—acamprosate (Campral), naltrexone (Vivitrol) and disulfiram (Antabuse)—topiramate is not specifically approved by the U.S. Food and Drug Administration as a treatment for diagnosable drinking problems. However, current medical thinking recognizes the value of the medication for people affected by alcohol dependence. In cases of alcohol dependence, the underlying mechanism of topiramate’s effectiveness is apparently the same as in other medical contexts (namely, the ability to correct overactivity inside the brain’s nerve networks). Consumption of the medication can lead to substantial reduction in the number of days during which a person with alcoholism drinks heavily. In addition, consumption of the medication can lead to a substantial increase in the number of days during which a person with alcoholism avoids consuming alcohol.

Are There Lasting Benefits?

In the study published in Alcoholism: Clinical & Experimental Research, researchers from the University of Pennsylvania’s Perelman School of Medicine, the Yale University School of Medicine, the University of Connecticut School of Medicine and three other institutions used a project involving 138 excessive alcohol consumers to gauge the longer-term effects of topiramate use after active enrollment in an alcohol program comes to an end. Half of the study participants received topiramate during three months of alcohol treatment, while the other half received a placebo. Three months and half a year after the conclusion of this treatment, the researchers interviewed the participants in both groups and assessed their drinking-related outcomes. Measurements used during these assessments included the percentage of days during which each individual drank heavily, the percentage of days during which each individual abstained from alcohol use, the presence of any significant problems related to alcohol consumption and blood levels of a specific biomarker for alcohol problems.

The researchers concluded that, at the time of the two follow-up interviews, the prior recipients of topiramate no longer drank alcohol on fewer days than their counterparts who did not receive the medication during active treatment. In addition, the topiramate recipients no longer maintained alcohol abstinence on a greater number of days. Despite these facts, the researchers found that, during each follow-up, the topiramate recipients still experienced a significantly smaller number of alcohol-related problems than their counterparts who did not receive the medication. In addition, they found that a subgroup of Caucasian topiramate recipients with a specific genetic variation had substantially higher chances of maintaining a reduced number of heavy drinking days when use of the medication came to an end.

Posted on June 23rd, 2015

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