A drug currently used to treat epilepsy and migraines has also been shown to be effective in reducing alcohol consumption and treating cocaine addiction. However, for economic reasons, topiramate may never be approved for the treatment of addiction.
Research studies have shown for at least 10 years that topiramate, marketed as Topamax, is effective in treating alcoholism. In 2003, a study by the Health Science Center’s South Texas Addiction Research & Technology (START) center found that subjects who drank heavily were six times more likely to fasted for a month than a placebo group.
Effective for reducing
In a follow-up study a year later, the START Center researchers led by Dr. Bankole A. Johnson conducted a proof-of-concept study that found that topiramate had a greater effect on drinking than naltrexone and acamprosate. two drugs approved for the treatment of alcoholism.
Recent studies have shown that topiramate is more effective in reducing the amount that heavy drinkers drink than complete abstinence in alcoholic drinkers.
Reduction in overall consumption
Traditionally, the goal of treating alcohol use disorders has been to achieve abstinence. However, in recent years there has been more emphasis on harm reduction or reducing the amount of alcohol that patients drink, or on reducing the number of drinking days. Research has shown that topiramate has been shown to be more effective at reducing overall alcohol consumption than the currently approved drugs disulfiram, naltrexone, and acamprosate.
Focus on damage reduction
A recent study of the treatment of alcoholism by the Veterans Health Administration found that V.A. Doctors prescribed topiramate to their alcoholic patients at a higher rate than naltrexone and acamprosate combined.
The use of the drug is currently approved by the V.A. because it’s not approved for the treatment of alcohol disorders, but that didn’t stop doctors from prescribing it when the goal of treatment was to lessen the harm from excessive alcohol use.
The authors of the V.A. The study concluded that the use of topiramate over the other drugs shows a shift in the treatment of alcoholism towards a reduction in consumption rather than total abstinence.
Topiramate effective in cocaine addiction
Even more recently, research found that topiramate was also effective in treating cocaine addiction. A double-blind study at the University of Maryland School of Medicine of 142 adults seeking treatment for cocaine addiction found that topiramate increased the number of days without cocaine use.
Previously, studies found that topiramate can help reduce drug use by users who were not seeking treatment for cocaine addiction. It affects the brain’s response to cocaine, thereby reducing drug cravings.
According to the study’s authors, topiramate is the first drug shown to be effective in treating cocaine addiction. Another study showed it was effective in giving up smoking.
Topiramate is no longer trademarked
Although research shows that topiramate is relatively effective at reducing harmful drinking and treating cocaine addiction, the drug may not be used to its full extent. Because it isn’t specifically approved by the U.S. Food and Drug Administration for use as an addiction treatment, insurance companies may not pay for prescriptions for these purposes.
With topiramate no longer trademarked and therefore open to generic manufacturing, it is not economically feasible for pharmaceutical companies to continue the expensive process required to gain FDA approval for the drug’s addiction treatment.
Any pharmaceutical treatment for alcoholism or addiction would be a less expensive option than enrollment in an inpatient treatment program. However, without insurance coverage, topiramate would be more expensive than other FDA-approved drugs.
Although topiramate is not FDA approved for the treatment of alcoholism and addiction, there is no ban on healthcare providers prescribing the drug for these purposes.
Del Re, AC, et al. “Prescribing Topiramate for the Treatment of Alcohol Use Disorders in the Veterans Health Administration.” Addiction Science & Clinical Practice July 8, 2013
Fran, J, et al. “Pharmacotherapy for Alcohol Dependence: Status of Current Treatments.” Current opinion in neurobiology. 23rd August 2013.
Johnson, BA, et al., “Topiramate for the Treatment of Cocaine Addiction”. JAMA psychiatry. October 16, 2013.
Kampman KM et al. “A double-blind, placebo-controlled study of topiramate for the treatment of addiction to comorbid cocaine and alcohol.” Drug and alcohol addiction 1. November 2013.
Oncken C et al. “Topiramate for Smoking Cessation: A Randomized, Placebo-Controlled Pilot Study.” Nicotine and Tobacco Research 21st September 2013.