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Topiramate could be a promising new treatment for alcohol dependence, say the manufacturers. In their latest clinical trial, the drug helped alcohol dependent adults cut down on heavy drinking and increase their chances of staying dry for at least a month. Topiramate worked significantly better than placebo in three different analyses, and its effects were big enough to be clinically relevant, says an independent editorial (p 1691)1691).
The 371 participants took up to 300 mg/day of topiramate or placebo for 14 weeks. They also had a brief weekly behavioural intervention designed to help them stick with their assigned treatment. All were alcohol dependent and wanted to cut down or stop. But they had no other mental illnesses, including other substance misuse disorders. The authors selected their participants carefully, and they admit that their results may not translate well to more typical populations of alcohol dependent adults.
Like all drug treatments, topiramate has side effects. In this trial, people taking the drug had more paraesthesiae, taste perversion, anorexia, and poor concentration than controls. Using a smaller dose may help, say the authors.