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Original Article
September 2004

Oral Topiramate Reduces the Consequences of Drinking and Improves theQuality of Life of Alcohol-Dependent Individuals: A Randomized Controlled Trial

Author Affiliations

From the Department of Psychiatry, The University of Texas Health ScienceCenter at San Antonio (Drs Johnson, Ait-Daoud, and Ma and Ms Akhtar).

Arch Gen Psychiatry. 2004;61(9):905-912. doi:10.1001/archpsyc.61.9.905

Background  Topiramate, a fructopyranose derivative, was superior to placebo at improving the drinking outcomes of alcohol-dependent individuals.

Objectives  To determine whether topiramate, compared with placebo, improves psychosocial functioning in alcohol-dependent individuals and to discover how this improvement is related to heavy drinking behavior.

Design  Double-blind, randomized, controlled, 12-week clinical trial comparing topiramate vs placebo for treating alcohol dependence (1998-2001).

Participants  One hundred fifty alcohol-dependent individuals, diagnosed using the DSM-IV.

Interventions  Seventy-five participants received topiramate (escalating dose of 25 mg/d to 300 mg/d), and 75 had placebo and weekly standardized medication compliance management.

Main Outcome Measures  Three elements of psychosocial functioning were measured: clinical ratings of overall well-being and alcohol-dependence severity, quality of life, and harmful drinking consequences. Overall well-being and dependence severity and quality of life were analyzed as binary responses with a generalized estimating equation approach; harmful drinking consequences were analyzed as a continuous response using a mixed-effects, repeated-measures model.

Results  Averaged over the course of double-blind treatment, topiramate, compared with placebo, improved the odds of overall well-being (odds ratio [OR] = 2.17; 95% confidence interval [CI], 1.16-2.60; P = .01); reported abstinence and not seeking alcohol (OR = 2.63; 95% CI, 1.52-4.53; P = .001); overall life satisfaction (OR = 2.28; 95% CI, 1.21-4.29; P = .01); and reduced harmful drinking consequences (OR = –0.07; 95% CI, –0.12 to –0.02, P = .01). There was a significant shift from higher to lower drinking quartiles on percentage of heavy drinking days, which was associated with improvements on all measures of psychosocial functioning.

Conclusions  As an adjunct to medication compliance enhancement treatment, topiramate (up to 300 mg/d) was superior to placebo at not only improving drinking outcomes but increasing overall well-being and quality of life and lessening dependence severity and its harmful consequences.