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Frequently Asked Questions

Is there evidence that topiramate (Topamax, Topamac) is useful in the treatment of alcohol dependence?

Short Answer

Yes, there have been a number of controlled clinical studies completed with positive results and many more studies are in progress.

Long Answer

Some of the anticonvulsants such as topiramate (toe-PEER-uh-mate; also toe-PYRE-uh-mate) have been used in controlled studies to treat alcohol dependence but topiramate (Topamax, Topamac) has received the most attention.

It is thought that the way topiramate (Topamax, Topamac) works is by reducing the amount of dopamine released in the brain.

In 2007 a study of 183 subjects who used up to 300mg of topiramate (Topamax, Topamac) per day showed significant positive results as compared to a control group that did not use topiramate (Topamax, Topamac). Behaviour modification support was not used in any significant way.

About 10% of the participants reported some of the following side effects: parathesia (prickly feeling), anorexia (loss of appetite), pruritis (itching), and some difficulty in concentrating. Fatigue and confusion have sometimes been associated with topiramate (Topamax, Topamac).

The normal dose of topiramate (Topamax, Topamac) is from 25mg up to 300mg. The dose should be gradually increased until the effective dose is reached and if a decision is made to stop therapy then the dose should be gradually decreased. Do not stop "cold turkey".

Additional Information

Pharmacy Practice February/March 2009 Vol. 25 No. 1
Sections of our answer have been based on this reference.
ClinicalTrials.gov: An Efficacy and Safety Study of Topiramate in the Treatment of Alcohol Dependence
The impact of alcoholism can be reduced through effective treatments, which may include medical, psychological, and social interventions. The main goals of alcohol-dependence treatment are to assist patients in avoiding alcohol, developing better strategies for managing stress, and improving self-esteem and quality of life. Studies have demonstrated that treatments for alcohol use disorders can be effective, but their effectiveness is often limited.
ClinicalTrials.gov: New Medications to Treat Alcohol Dependence
In the last decade, there has been an explosion of new knowledge of the neuroscientific basis of alcohol-seeking behavior. Briefly, medications that modulate mesolimbic dopamine pathways by facilitating gamma amino butyric function and inhibiting the action of excitatory amino acids should reliably diminish alcohol's rewarding effects. Topiramate (a sulfamate-substituted fructo-pyranose derivative) has these characteristics. In support of this concept, we have shown in a phase-II-type medications clinical trial that topiramate is significantly superior to placebo at improving drinking outcomes and decreasing craving among (N = 150) alcohol-dependent individuals. Using the carefully controlled environment of the human laboratory, we are submitting a revised application containing a set of systematic studies to assess directly the mechanistic neuropharmacological processes that are associated with topiramate's anti-drinking effects. This will provide a more comprehensive understanding of the neurobiology of alcohol-seeking behavior and aid in the development of even more effective compounds for the treatment of alcohol dependence. Thus, the specific aims of the project are to: 1) determine the dose-relationship of acute effects of topiramate to reduce alcohol effects related to its abuse and addiction potential. We hypothesize that topiramate will reduce alcohol-induced craving, reward, and euphoria; 2) determine whether chronic treatment with an acutely effective dose of topiramate produces substantial reductions in alcohol-related cue-induced craving, thereby decreasing the potential for treatment relapse. We hypothesize that chronic topiramate administration will desensitize (reduce) alcohol craving produced by alcohol-related sensory cues; and 3) determine whether topiramate interactions with and without alcohol are associated with neurocognitive impairment. Clinical studies including ours have suggested that topiramate use may be associated with neurocognitive effects such as loss of concentration and memory impairment. In our own study, these effects were mild and not associated with reduced treatment compliance. Since alcohol's ability to produce neurocognitive impairment may be mediated through similar ionic mechanisms to that of topiramate, the proposed human laboratory setting affords us the unique opportunity to more clearly delineate topiramate's neurocognitive effects in both the presence and absence of alcohol. This study supports NIAAA's goal to develop effective medications for treating alcoholism and to understand the basic underpinnings of the disease.