Topiramate reduced heavy drinking and helped to boost abstinence, study finds
TUESDAY, Oct. 9 (HealthDay News) -- An drug used to treat epileptic seizures could be added to the short list of medications prescribed to help alcoholics control their addiction, a new study suggests.
The drug topiramate proved measurably better than a placebo at helping alcoholics stay away from heavy drinking, the study authors said.
"Not only is there an effective new treatment, but there's a medication that you can take at the time of crisis. You can start immediately when you need help," said study author Dr. Bankole Johnson, chairman of the University of Virginia's Department of Psychiatry and Neurobehavioral Sciences.
For many alcoholics, treatment is no different than it was 50 or 60 years ago: They must rely on their own willpower, often with the help of groups like Alcoholics Anonymous. But some -- about 3 percent to 4 percent, Johnson estimates -- try to quit drinking with the help of prescription medications.
In the new study, conducted between 2004 and 2006, Johnson and his colleagues recruited 371 alcoholics between the ages of 18 and 65. The subjects, both male and female, received daily doses of topiramate -- up to 300 milligrams -- or a placebo along with a brief weekly visit with a counselor.
Both treatments seemed to help patients. Over 14 weeks, the percentage of heavy-drinking days per week dropped from 81.9 percent to 43.8 percent among those who took topiramate and from 82 percent to 51.8 percent among those who took a placebo.
Topiramate also led to a higher rate of achieving 28 or more days of continuous non-heavy drinking and 28 or more days of continuous abstinence, the researchers said.
The drug appears to work by cutting the craving for alcohol, according to Johnson.
The findings are published in the Oct. 10 issue of the Journal of the American Medical Association.
There are side effects with topiramate, Johnson said. The drug "can make you dizzy, give you headaches and the feeling of pins and needles in your fingers. Some people have difficulty naming words, which goes away after about a week."
The drug isn't cheap -- it costs about $1,000 for three months, according to Johnson. And, patients don't see benefits for two to four weeks. Still, topiramate holds promise, he said.
"We're talking about a drug that will be many times better than what is currently available," he said. "And it doesn't require you to go to rehab."
Dr. J.C. Garbutt, professor of psychiatry at the University of North Carolina at Chapel Hill, said the new research on topiramate will give doctors another option when they treat alcoholism. Since the drug is already approved for use, doctors can prescribe it immediately.
Garbutt said it's still difficult for doctors to figure out which medication to prescribe to alcoholics. But "this gives you another one you can work with," he said.
Meanwhile, Johnson said, the next step is to study whether people can safely take topiramate for long periods of time.
Meanwhile, the group Public Citizen on Tuesday sent a letter to U.S. Food and Drug Administration Commissioner Andrew von Eschenbach claiming that a questionnaire that accompanied a press kit on the study violated FDA regulations that prohibit the promotion of the off-label use of a medication. Ortho-McNeil Janssen makes topiramate and funded the study.
For more on alcoholism and treatment, visit the National Institute on Alcohol Abuse and Alcoholism.
SOURCES: Bankole Johnson, M.D., Ph.D., chairman, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville; J.C. Garbutt, M.D., professor of psychiatry, University of North Carolina at Chapel Hill; Oct. 10, 2007, Journal of the American Medical Association
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