Topiramate is an anti-seizure medication that some addiction specialists have adapted to the treatment of withdrawal symptoms in recovering alcoholics. Typically, doctors only prescribe this medication to people who have completely stopped drinking and want to remain abstinent from alcohol use. However, according to the results of a study published in February 2014 in The American Journal of Psychiatry, use of topiramate can also potentially help heavy alcohol consumers reduce their intake to safer levels outside of the context of complete alcohol abstinence.
Heavy drinkers are people who regularly consume enough alcohol to seriously elevate their chances of developing the symptoms of alcohol use disorder, a comprehensive alcohol-related illness that includes both non-addicted alcohol abuse and alcoholism. Men elevate their alcohol use disorder risks when they consume more than 14 drinks a week or four drinks a day. Women elevate their risks for the disorder when they consume more than seven drinks a week or three drinks a day. The specific chances for developing symptoms of alcohol abuse or alcoholism vary with the frequency of a person’s participation in heavy drinking. For example, an individual who drinks heavily once a month has an approximately 20 percent chance of eventually qualifying for an alcohol use disorder diagnosis. The chance increases to 33 percent in an individual who drinks heavily once a week. A person who drinks heavily more than once a week has a roughly 50 percent chance of developing alcohol use disorder. As a rule, people already diagnosed with the disorder also qualify as heavy drinkers.
Topiramate was originally developed as a treatment for people affected by serious seizure disorders such as Lennox-Gastaut syndrome and various forms of epilepsy. In this context, it produces benefits by reducing the rate of cell communication inside the brain. The U.S. Food and Drug Administration has only approved topiramate as an anti-seizure medication. However, current research shows that it has other potential uses, and addiction specialists have noted topiramate’s ability to ease the severity of the withdrawal symptoms that typically appear in alcoholics who stop drinking or steeply reduce their alcohol intake. In line with these research findings, some doctors prescribe the medication as an “off-label” treatment for people recovering from alcoholism. Off-label is the term doctors use to describe medications prescribed for reasons other than their FDA-approved purpose.
Effectiveness in Reducing Heavy Drinking
In the study published in The American Journal of Psychiatry, researchers from the University of Pennsylvania’s Perelman School of Medicine investigated the usefulness of topiramate in helping heavy drinkers reduce the amount of alcohol they consume on a regular basis. All told, 138 heavy-drinking adults participated in the project. Half of these individuals received up to 200 mg of topiramate each day for 12 weeks; the other half received an inactive placebo medication designed to look like topiramate. Participants in each of these groups also received brief advice on ways to keep their alcohol intake low. During the second half of the treatment period, the researchers gave periodic Breathalyzer tests to all of the people enrolled in the study in order to objectively determine their level of involvement in alcohol use.
The vast majority of the study participants completed 12 full weeks of treatment. After comparing the results in the two groups, the researchers concluded that topiramate use does successfully help heavy drinkers curb their alcohol intake and reduce the number of days on which they consume excessive amounts of alcohol. In fact, by the end of the treatment period, the participants who only received a placebo medication were roughly 400 percent more likely to drink heavily on any given day than the participants who received topiramate.
Significance and Considerations
The authors of the study published in The American Journal of Psychiatry used a genetic analysis to determine how well heavy drinkers from various ethnic/racial groups respond to topiramate. After completing this analysis, they concluded that the only study participants who clearly benefitted from the medication were a subset of people of European descent with a specific variation of a single gene. Roughly 40 percent of all individuals with European ancestry have this genetic variation. This finding means that the usefulness of topiramate as tool for reducing heavy alcohol consumption may be limited. However, it also means that heavy drinkers with the indicated genetic variation may have a strong chance of benefitting from use of the medication.