Low-Dose Topiramate in Alcohol Dependence: A Single-Blind, Placebo-Controlled Study

Introduction: Topiramate and anticonvulsants in general are considered safe and effectivedrugs for the treatment of alcohol dependence, even though topiramate-induced adverseevents are quite common, especially for high initial doses or if titration to 300 mg/day istoo rapid. The aim of the present study was to assess the efficacy and tolerability profile oflow-dose topiramate for relapse prevention.Methods: Following detoxification, 52 patients were randomised into two groups: 26patients received 100 mg of topiramate (per os, bid, daily), titrated over two weeks, and 26patients received placebo. Both groups underwent rehabilitation, twice a week.Results: After 6 weeks of treatment, compared to the placebo group, patients receivingtopiramate showed: 1) fewer drinking days (p<0.05); 2) less daily alcohol consumption(p<0.05); 3) more days of treatment (p<0.05); 4) reduced levels of craving (OCDS) andwithdrawal symptoms (CIWA-Ar); 5) improvement of anxiety, depression and obsessivecompulsivesymptom severity (SCL-90-R).Conclusion: Despite the small sample size and the short follow-up period, the present placebo-controlled study demonstrated the potential usefulness of topiramate, even whenadministered at a dose of 100 mg/day, for the treatment of detoxified alcohol-dependent subjects, confirming results from previous studies testing higher doses of topiramate.