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Am Fam Physician. 2005;72(3):510-513

Topiramate (Topamax) has been shown to be effective in reducing alcohol cravings, decreasing heavy drinking, and improving abstinence rates in patients who are alcohol dependent. Despite being an established pharmacotherapy agent for alcohol abstinence, questions about this medication persist. Does topiramate improve drinking outcomes because it improves quality of life, or does it reduce the harmful consequences of alcohol abuse? This question is difficult to answer because alcohol dependence syndrome has a negative impact on social, occupational, and recreational activities. In addition, past studies on topiramate were coupled with psychotherapy. Johnson and colleagues evaluated topiramate alone and its effect on psychosocial functioning in alcohol-dependent patients.

The study was a double-blind, randomized, controlled clinical trial comparing topiramate with placebo in alcohol-dependent patients. Participants were eligible for the study if they were adults, met the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., criteria for alcohol dependence, and had a high score on an alcohol-use disorder test. In addition, participants had to have consumed a specified number of drinks during the previous 90 days (i.e., at least 21 for women, 35 for men). The intervention group received topiramate starting at a dosage of 25 mg per day and increasing to as much as 300 mg per day. The study duration was 12 weeks. Participants received a brief compliance-enhancement procedure at baseline and at weekly intervals. The main outcomes measured included clinical ratings of psychosocial functioning, alcohol-dependence severity, quality of life, and harmful drinking consequences.

A total of 150 patients completed the study. Compared with placebo, topiramate significantly improved overall well-being and life satisfaction. In addition, topiramate significantly improved reported abstinence rates and reduced harmful drinking consequences. The percentage of heavy-drinking days shifted significantly from higher to lower drinking quartiles in the topiramate group. This was associated with improvements in all psychosocial measurements.

The authors conclude that topiramate as an adjuvant to a medication-compliance program was superior to placebo in improving drinking outcomes. In addition, topiramate had a positive impact on the overall well-being and quality of life in patients with alcohol dependence. This intervention also reduced dependence severity and its harmful consequences in these patients.

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