Topiramate May Help Alcoholics Stop Drinking, Says Study
FP Expert Cautions Against Unrealistic Expectations
By Barbara Bittner
11/1/2007
Study Overview
Researchers excluded some participants based on certain factors, including
- the presence of a current Axis I psychiatric diagnosis according to criteria in the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition, other than alcohol, nicotine or caffeine dependence;
- a history in the past six months of substance abuse or dependence, excluding dependence on alcohol, nicotine or caffeine;
- a history of more than four unsuccessful formal inpatient treatment attempts to curb alcohol dependence;
- the presence of clinically significant depression;
- a history of suicidal ideation within 30 days of beginning the active phase of the study; and
- a history of having been compelled to receive treatment for alcohol dependence to avoid imprisonment, parole, probation or loss of employment.
In addition, topiramate was associated with a significantly higher rate of achieving 28 or more days of continual nonheavy drinking and 28 or more days of continuous abstinence when either analytic approach was used.
Adverse events reported in more than 10 percent of all participants were paresthesia, headache, taste perversion, fatigue, anorexia, nausea, insomnia, difficulty with concentration and attention, nervousness, difficulty with memory, somnolence, diarrhea, sinusitis, dyspepsia, injury, dizziness, influenza-like symptoms, pruritus, and myalgia. With the exception of headache, nausea, sinusitis, dyspepsia, injury, influenza-like symptoms and myalgia, all occurred more frequently in the treatment than the placebo group.
FP Expert's Opinion
According to Mooney, alcohol dependence is "the country's number one preventable cause of death." The JAMA study, he says, was well-designed and the results are interesting, but the authors' conclusion that topiramate represents "a 'promising treatment' for alcoholism is premature based on such a short-term trial with such small impact on sobriety and a significant incidence of side effects."
Meaningful outcomes in patients with addictive illness take much longer to assess, Mooney adds.
In addition, he notes, "The exclusionary criteria of this trial eliminated many patients with complicated or difficult problems who … would be most in need of physician involvement and possibly medication."
He stresses that pharmaceutical interventions may be useful to help addicted patients reach a point where they could commit to a proven long-term recovery program, such as Alcoholics Anonymous. He believes that a reduction in drinking days such as was shown in the topiramate study could have some benefits, but "it may have little correlation with long-term abstinence, meaningful recovery, improved productivity, enhanced family function, decreased alcoholism mortality and other morbidity recognized to result from addictions."
So what message does Mooney think FPs should take from this study? He says he hopes it will encourage family physicians to identify and help patients in their practices who have this deadly disease. The continuity of care that family physicians provide is unique and can have an important and substantial effect on long-term outcomes for these patients.
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Additional Resource
National Institute on Alcohol Abuse and Alcoholism -- Helping Patients Who Drink Too Much: A Clinician's Guide








