Finally, A Pill for Alcoholism

Topiramate Is Highly Effective in Alcohol Use Disorder

martini glass filled with pills
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Topiramate, an anti-seizure drug usually prescribed for epileptic patients, is highly effective in helping alcohol-dependent individuals stop drinking. It is a derivative of the naturally occurring sugar monosaccharide D-fructose. Long-term studies show relatively few serious problems related to taking this drug for most people.

This is the first medication that has shown to be effective for alcohol abusers who are still drinking.

Other "stop-drinking" drugs are only for those who have already quit drinking.

Drinkers get pleasure from alcohol when it releases the chemical dopamine in the brain. Topiramate works by "washing away" the excess dopamine. In other words, alcoholics no longer get any pleasure from drinking.

Clinical Evidence for the Alcoholism Pill

Since Topiramate was first indicated as a treatment for alcohol abuse, a number of studies have been done to test its effectiveness. Almost every one of these has shown the drug to be effective or promising. However, it is not specifically approved by the FDA for treating alcohol use disorder.

For instance, one study found that heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses. Participants taking the placebo were four times more likely to drink heavily during the clinical trial.

All 150 participants were still drinking heavily before they took Topiramate but were planning to quit.

Additional findings from this clinical study include:

  • After 3 months, 24 percent of the Topiramate group had abstained continuously for one month. Only 4 percent in the placebo group had one month sober.
  • In the Topiramate group, 50 percent did not binge in the final month, compared with 16 percent of those taking the placebo
  • 50 percent of the Topiramate group reported fewer cravings for alcohol, compared to 15 percent in the placebo group.

A more recent study seems to back up these accounts, though not necessarily with the same statistics. This controlled trial included 371 participants, half of which received topiramate and the other half a placebo. Again, topiramate was shown to be more effective by week four of the study with fewer heavy drinking days reported among those who took it.

Benefits of the Alcoholism Pill

Topiramate is innovative because it provides immediate help for alcoholics in crisis. It also opens up new directions for the pharmacological treatment of alcohol use disorder. 

The results of the studies done so far suggest that even low doses of topiramate have the capacity to ameliorate the anxiety and mood instability that quitting drinking causes. It also produced a substantial effect on improving abstinence maintenance and reducing alcohol use

The Side Effects of Topiramate

While Topiramate can help you with your drinking problem, you may experience side effects. It's always important to remember that every person is different and this is not the cure-all for every alcoholic.

Among the most important concerns for alcoholics to look for are suicidal thoughts, increased anxiety or aggression, or other unusual mood changes.

It's similar to the side effects some people experience in the stop-smoking drug, Chantix. This is particularly true for anyone who has a history of depression or other mental health concerns. This warning should be taken seriously and is something you really need to discuss with your doctor.

Other side effects of topiramate are primarily physical:

  • headache
  • uncontrollable eye movements and shaking of a part of your body
  • change in ability to taste food
  • missed menstrual periods and excessive menstrual bleeding
  • drowsiness and weakness

It's also recommended that dosages be increased gradually at first, then slowly decreased before you stop taking it.

It's important to avoid abruptly stopping this medication without your doctor's consent.

Other Alcoholism Medications

Researchers have long sought a medication to treat alcoholism. There are only three medications currently approved by the FDA for treating alcoholics in the U.S. These are Antabuse (disulfiram), naltrexone, and Campral (acamprosate).

Antabuse does not reduce cravings, it merely makes a drinker feel sick if they consume alcohol. Naltrexone and Campral have been shown to reduce cravings in alcoholics who have already quit drinking.

Sources:

Johnson BA, et al. Topiramate for Treating Alcohol Dependence: A Randomized Controlled Trial. JAMA. 2007;298(14):1641-51.

Johnson BA. Pharmacotherapy for Alcohol Use Disorder. UpToDate. 2017.

Swift RM, Aston ER. Pharmacotherapy for Alcohol Use Disorder: Current and Emerging Therapies. Harvard Review of Psychiatry. 2015;23(2):122-133.

U.S. National Library of Medicine. Topiramate. Medline Plus. 2015.

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