Keywords
Topimarate
Alcohol misuse
Drinking behaviour
Abstract
Alcohol dependence is a complex and multi-faceted problem, with alcohol misuse costing the NHS an estimated £3.5 billion annually. Appropriate pharmacological treatment, alongside behavioural therapy, is essential to the proper management of dependent individuals. NICE recommended pharmacotherapies are still relatively under prescribed, despite their relatively low number-needed-to-treat (NNT), perhaps owing to mixed evidence across the literature. Topiramate (currently licensed for migraine prophylaxis and epilepsy) has been proposed as one drug with potential efficacy in reducing drinking behaviours. Hence, the aim of this paper is to evaluate the efficacy of topiramate in promoting and maintaining abstinence in alcohol dependence, through a review of the current literature.
Seven papers are reported after a systematic database search (PubMed, Medline, Embase, Web of Science); statistical manipulation of results has been performed to present findings in a common format. Results were consistent and showed the effectiveness of topiramate in all outcome measures evaluated: heavy drinking days (HDDs), plasma gamma-glutamyl transferase (GGT) concentration and abstinence rate. These differences over placebo reached statistical significance in all seven studies.
This paper supports the efficacy of topiramate in treating alcohol dependence. There are several recommendations for further research, including comparisons to currently licensed alcohol dependence medications (namely naltrexone) and the pharmacogenetic influence of a GRIK1 polymorphism on the efficacy of topiramate. Further research into the tolerability of topiramate is required, although evaluation of adverse events within this paper has been positive.
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