Topiramate, Physical Health, and Psychosocial Function in Adults with Alcohol Dependence

Topiramate combined with weekly adherence enhancement counseling can decrease alcohol use in selected alcohol dependent individuals. To assess whether topiramate also improves physical health and psychosocial function, researchers analyzed data from a multisite, double-blind trial of 364 alcohol dependent individuals randomized to topiramate (up to 300 mg/day) or placebo. Sixty-three percent (112 of 179 patients) receiving topiramate completed the trial with 19% (34 patients) withdrawing due to side effects. Seventy-eight percent (144 of 185 patients) receiving placebo completed the trial with 3% (6 patients) withdrawing due to side effects.

• Compared with placebo, individuals who received topiramate had significantly greater decreases in liver enzymes, cholesterol, body mass index, blood pressure, obsessional thoughts about alcohol, and harmful consequences of drinking. These findings were similar whether the analyses excluded or used multiple imputation for noncompleters.

• Compared with placebo, individuals who received topiramate were significantly more likely to reach the 90th percentile (high function) on a measure of general activities, leisure-time activities, and household duties,* although the absolute number of individuals who reached this level was not clear.

Comments:

These findings suggest topiramate can improve some measures of physical health and psychosocial function in individuals with alcohol dependence. Some of the physical health improvements may be due to decreased alcohol use but may also be due to the weight loss associated with topiramate. Although the results are encouraging, the effectiveness of topiramate in practice settings is uncertain because the study eligibility criteria were very selective, and nearly 40% of the topiramate group did not finish the trial despite weekly adherence enhancement counseling.

Kevin L. Kraemer, MD, MSc

Reference:

Johnson BA, Rosenthal N, Capece J, et al. Improvement of physical health and quality of life of alcohol dependent individuals with topiramate treatment: US multisite randomized controlled trial. Arch Intern Med. 2008;168(11):1188–1199.