Anti-Seizure Medication Topamax Offers Promise in Treatment of Alcoholism

By Hugh C. McBride
Two university studies involving the anti-seizure drug topiramate indicate that the medication may offer unprecedented effectiveness in the treatment of alcohol dependency.
In 2003, researchers with The University of Texas Health Science Center at San Antonio discovered that topiramate can greatly reduce a patient’s desire for alcohol. Five years later, a study at the University of Virginia Health System documented the drug’s ability to eliminate some of the physical and psychological harm caused by alcoholism. Both studies were led by Bankole A. Johnson, M.D., Ph.D.
The drug, which is marketed by Johnson & Johnson under the brand name Topamax, is currently approved by the U.S. Food and Drug Administration for use in preventing seizures and migraine headaches.
In a press release that accompanied the UTHSC study, Johnson said that topiramate had a dramatic effect on the alcohol-dependent individuals to whom it was given: 
“All 150 patients were enrolled into this clinical trial while they were still drinking heavily (defined as more than five standard drinks a day for men and more than four for women). …Patients who took topiramate were six times more likely than those who received placebo to be continuously abstinent [from alcohol] for at least one month during the three-month trial.  Over the same period, those taking the placebo were four times more likely to drink heavily for an entire month during the trial.”
Following the UVA study, which was published in the June 9, 2008 edition of the Journal of Internal Medicine¸ Johnson told the ScienceDaily news service that topiramate’s efficacy could reduce the amounts and types of medication that some recovering alcoholics are required to take:
“Many alcoholics have hypertension, and some receive anti-hypertensive medication, which can complicate their treatment for alcoholism. Because topiramate can reduce drinking substantially and decrease blood pressure significantly, this allows one medication to be given instead of several.”
Three medications are currently approved by the FDA for treating alcoholism:

  • Acamprosate, which is marketed in the United States as Campral, is believed to restore a proper balance of brain chemicals in alcohol-addicted individuals. When used in conjunction with counseling and other social support programs, the drug has been effective in helping to reduce a person’s desire to drink.
  • Disulfram, which is marketed in the U.S. under the brand name Antabuse, does not affect cravings, but instead causes severe negative reactions to alcohol. Symptoms experienced by individuals who drink while taking disulfram may include extreme nausea and vomiting, blurred vision, pounding headache, chest pains, and difficulty breathing.
  • Naltrexone, which is marketed as Revia and Vivitrol, can reduce cravings for alcohol but the drug can only be administered to individuals who have been abstinent from alcohol for at least seven days.

Much of the enthusiasm surrounding the results of the topiramate tests is based on the fact that the drug appears to effectively reduce cravings for alcohol even in individuals who have not yet quit drinking. Johnson told the Medscapemedical news service that some of the alcohol-addicted individuals who were given topiramate experienced a dramatic reduction in their cravings for a drink. “Patients say that it’s almost like the alcohol isn’t there,” he said.
According to the U.S. National Library of Medicine, topiramate’s effectiveness in treating alcoholism is believed to be associated with its impact on neurotransmitters such as gamma-aminobutyric acid, which can cause abnormal excitement in the brain.
The second factor that has sparked such enthusiasm about topiramate is the fact that the drug appears to be effective in treating the damage that alcoholism inflicts on the body. The study published in the Journal of Internal Medicine noted that, in addition to decreasing patients’ desire to drink, topiramate also had the following physical effects:

  • Reduced blood pressure
  • Reduced body mass index
  • Lowered plasma cholesterol levels

“It’s encouraging that topiramate not only reduces drinking but may reduce the risk of hypertension, heart disease, and liver cirrhosis in alcohol-dependent individuals,” Johnson told Medscape.
It is results like this that prompted Mark Willenbring, director of the National Institute on Alcohol Abuse and Alcoholism’s Division of Treatment and Recovery Research, to tell U.S. News & World Report that he believes topiramate may one day affect alcohol addiction treatment in the same way Prozac impacted the treatment of depression.
Though the promise of topiramate appears to be significant, the medication is not without adverse side effects. Medscape has reported that at least one in 10 study subjects experienced fatigue, nausea, headache, difficulty concentrating, and paresthesia (the “pins and needles” feeling most commonly associated with having one’s foot “fall asleep”).
The online drug database RxList lists drowsiness, confusion, and depression as possible effects experienced by individuals who take the drug for anticonvulsant purposes (though it must be noted that individuals who are prescribed topiramate to stop seizures usually take larger doses than studies have indicated are necessary when the drug is being used to treat alcohol dependency).
As indicated by an October 2007 news release issued by the National Institute on Alcohol Abuse and Alcoholism, though topiramate may not be a perfect drug for every alcohol-dependent individual, test results have given experts reason to be optimistic.
If additional studies support the results of recent research on topiramate, incorporating the drug into the existing list of treatments for alcoholism, the NIAAA notes, will have the benefit of “expanding the range of effective treatments [and] will maximize patient choice and outcomes, since no single approach is universally successful or appealing to patients.”