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A medication approved to treat epilepsy could help people with alcohol use disorder, according to several research studies.  Topiramate, an anti-seizure drug sold under the brand name Topamax, has been shown to reduce alcohol cravings and heavy drinking — even in people who are unable to stop using alcohol.

One recent study, published in the American Journal of Psychiatry (April 2014), indicates that topiramate helps heavy drinkers cut back their drinking to safer levels.

Topiramate “significantly reduced drinking days and heavy drinking days,” says Dr. Henry R. Kranzler, who led the study and is Director of the Center for Studies of Addiction at the University of Pennsylvania Perelman School of Medicine.

Kranzler says a low-dose regimen of 200 mg of topiramate daily was well-tolerated among the 138 study participants.  By the end of the study, the odds of a heavy drinking day were five times lower in the topiramate than the placebo group, and patients who received topiramate also reported more abstinent days, according to the results.  Topiramate also reduced concentrations of liver enzymes and scores on a measure of alcohol-related problems.

Targeting Genetic Make-Up

The effect of topiramate was significantly greater in patients with a specific gene variant (technically known as a single nucleotide polymorphism), Kranzler says.  This genotype, carried by an estimated 40 percent of European-Americans, has been linked to alcohol dependence and could help doctors predict who will respond well to topiramate treatment in the future.

“The genotype can be run in any genetics lab, but it’s premature to use it to select treatment,” Kranzler says.  “Replication of our findings is essential for that to occur.”

The genotype is associated with certain brain receptors that can trigger alcohol cravings and addiction.  “Our findings suggest that blocking specific kainate (glutamate) receptors reduces drinking,” Kranzler says, “possibly by reducing the salience of alcohol for heavy drinkers (making it less of a focus of their lives) and enhancing their confidence to resist heavy drinking.”

An estimated 17 million American adults — 7.2 percent of the population — have an alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).  This includes 11.2 million men and 5.7 million women who either abuse alcohol at varying levels — despite negative consequences — or are otherwise unable to stop drinking once they start.

Evidence of Success

Topiramate’s potential to help problem drinkers is also confirmed by other clinical trials in the United States and overseas.

American military veterans who had both alcohol dependence and post-traumatic stress disorder (PTSD) improved with a three-month course of topiramate treatment, according to a study in the journal Alcoholism: Clinical & Experimental Research (August 2014).  Topiramate decreased the veterans’ alcohol cravings, alcohol consumption and the severity of their PTSD symptoms (i.e., feeling tense/panic, being easily startled, having trouble sleeping), according to the results.

And topiramate reduced the urge to drink and the number of drinks per day in a landmark study of 371 people diagnosed with alcohol dependence.

“Topiramate proved to be a safe and effective treatment for men and women with alcohol dependence who drank heavily (35+ drinks per week for men; 28+ drinks per week for women),” says Dr. Bankole A. Johnson, who led the study, published in the Journal of the American Medical Association (October 2007).  Dr. Johnson is currently Director of the Clinical Neurobehavioral Center at the University of Maryland School of Medicine.

“Those who can benefit from the administration of topiramate ideally would be a middle-aged patient who currently drinks on a regular and frequent basis,” he says.  “Individuals with impaired liver function may benefit from this drug, because topiramate is not fully metabolized by the liver.”

To make the shift to safer drinking, Johnson advises alcohol-dependent individuals to set a drinking goal — for example, no more than 1 drink per day for women and 2 drinks per day for men.

Side Effects of Topiramate

Like most drugs, there are side effects to using topiramate.  These can include sensations of tingling or “pins and needles,” changes in taste, weight loss, fatigue, confusion, difficulty concentrating and other symptoms.  A lower dose of topiramate may alleviate many of these side effects.

Participants who received topiramate in Kranzler’s study, for example, were given 200 mg per day (a lower dose than in some other studies).  “We found that the lower dosage of topiramate, selected to enhance tolerability, was effective and well tolerated,” he says.

The Way Forward

Addiction experts continue to study topiramate’s potential as a treatment for alcohol dependence.  Currently, NIAAA is funding a study by Kranzler and colleagues focused on patients’ genetic make-up, to predict who will respond best to topiramate.

“We are also using the focus on the kainate receptor gene to test more specific medications for their effects on alcohol consumption,” Kranzler says.  “Our new study is for people who want either to reduce heavy drinking or stop completely.  We will work with them irrespective of which of these goals they have.”

What You Can Do

If you have a problem with alcohol, talk with your doctor about the risks and benefits of using topiramate, and whether off-label use of the drug is right for you.  Discuss all treatment options including stabilization through medical detox if needed, and evidence-based practices such as pharmaceutical therapies and Cognitive Behavioral Therapy to prevent alcohol relapse.

Here are some additional resources to help you reduce or eliminate alcohol use:

  • If you’re seeking professional help for yourself or a loved one, there are more options available today – including research-based treatments for alcohol use disorders.

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