Abstract
Topiramate, a sulfamate fructopyranose derivative and an anti-epileptic medication, is also used as an adjunctive mood stabilizer in bipolar disorder [1]. It is also effective in the treatment of alcohol dependence and craving for alcohol [2]. We report the effects of topiramate use in alcohol dependence.
Twenty-two patients (20 male) who qualified for alcohol dependence syndrome (ICD-10) [3] with no physical or cognitive deficits, were recruited for the study with full written informed consent. Baseline assessments on self-reported alcohol consumption (number of drinks per day, period of preoccupation with drink, heavy drinking days and number of abstinent days) and craving (using the Obsessive Compulsive Drinking Scale) [4] were noted.
The study group was initiated on topiramate 25 mg/day and escalated to 250–300 mg/day over 2 weeks. The medication was given free and the compliance was monitored by family members; despite this, six patients (four male) did not complete the study period of 12 weeks due to poor drug compliance. One patient developed symptoms of severe depressive episode after 2 weeks of initiation, and was discontinued. Periodic assessments were performed in the remaining patients, once every 2 weeks. This included serum gamma glutamyl transferase (GGT) levels – considered a sensitive and reliable marker of heavy drinking – at baseline and at 4, 8 and 12 weeks. The study subject reported improvement in self-reported drinking outcomes and Obsessive Compulsive Drinking Scale were corroborated with corresponding decrease in plasma GGT levels.
Three patients showed psychomotor slowing, memory and concentration impairment and increasing difficulty in memory tasks. Two patients reported drowsiness and excess sedation. However, the effects dissipated when the drug was tapered and discontinued after the study period.
Topiramate is an anticonvulsant that inhibits dopamine release through antagonism of glutamate activity and facilitation of gamma-aminobutyric acid (GABA) transmitter in areas of the brain that may be associated with alcohol's reward effects [2]. Among the side-effects, depression has been documented with dosages above 50 mg/day [5]. In our study, one patient reported with depressive symptoms at a dose of 200 mg/day. Topiramate-induced cognitive deficit was consistent with other studies [6], [7]. None of the patients reported weight loss, in contrast to other studies [8]. Our study suggests a potential role for topiramate in the treatment of alcohol dependence. However, large studies with a control group and a longer duration of study are required.