Treatment with the anti-epilepsy drug Topamax (topiramate) appears to reduce alcohol craving and drinking in alcoholic adults, new research suggests.

Unlike existing drugs for alcohol dependence that are only started when alcohol use stops, Topamax can be given before the patient abstains, Dr. Bankole A. Johnson from the University of Texas Health Science Center at San Antonio noted in a telephone interview with AMN Health.

“Typically, alcoholics must become abstinent before they are placed on medication,” he said. Topamax “can be used to treat alcoholics at a point of crisis while they are still drinking, so this allows people to be treated earlier when it is needed the most.”

Topamax is unique in that it targets two chemical pathways that are believed to underlie alcohol’s rewarding effects, Johnson explains in the medical journal Alcoholism: Clinical and Experimental Research.

In the study, 150 alcohol-dependent adults were treated with Topamax, at various doses, or with an inactive “placebo”. All patients also received brief behavioral therapy. Alcohol use and cravings were assessed by surveying the subjects and by performing a blood test.

Throughout the 12-week study, Topamax was much more effective than placebo in curbing craving and drinking. At the end of the study, the Topamax group had 2.88 fewer drinks per day, 27.6 percent fewer heavy-drinking days, and 26.2 percent more days abstinent compared with the placebo group.

Importantly, Johnson said, Topamax does not appear to have any direct interaction with alcohol. Side effects seen more often with Topamax than placebo included dizziness, weight loss, and memory problems, among others.

Dr. Raye Z. Litten of the National Institute on Alcohol Abuse and Alcoholism, which funded the study, said it appears that Topamax has “a greater effect on drinking than” the anti-alcohol drugs Revia (naltrexone) and Campral (acamprosate).” However Topamax also “appears to have more severe side effects.”

SOURCE: Alcoholism: Clinical and Experimental Research, August 2004.