Low-Dose Topiramate in Alcohol Dependence

Martinotti, Giovanni; Nicola, Marco Di; Vita, O. De; Hatzigiakoumis, Daniele Stavros; Guglielmo, Riccardo; Santucci, Barbara A.; Aliotta, F; Romanelli, Roberto Giulio; Verrastro, Valeria; Petruccelli, Filippo; Giannantonio, Massimo Di; Janiri, Luigi

doi:10.1097/jcp.0000000000000228

Cited by 46 publications

(12 citation statements)

References 49 publications

(59 reference statements)

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“…This open-label study has been followed by a 6-week randomized placebo-controlled trial of low-dose topiramate (300 mg/day) for relapse prevention in 52 subjects with alcohol dependence post-detoxification [104]. Martinotti and colleagues [104] found that after 6 weeks of treatment, compared to placebo, those who received low-dose topiramate had fewer drinking days, less alcohol consumption, more days in treatment, reduced alcohol withdrawal and alcohol cravings, and reductions in mood and anxiety symptoms.…”

Section: Anticonvulsants For the Treatment Of Harmful Drinking Pattmentioning

confidence: 99%

Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders

et al. 2015

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Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin's ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

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Section: Anticonvulsants For the Treatment Of Harmful Drinking Pattmentioning

confidence: 99%

Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders

et al. 2015

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“…Today, Phenytoin is not used for HPPD treatment due to its troubled side effect profile. Medications such as Valproic Acid (200–600 mg/day), Carbamazepine (200–600 mg/day), Oxcarbamazepine (300 mg/day), Gabapentin (300–900 mg/day), Topiramate (25–100 mg/day), and Lamotrigine (50–100) may be useful [ 23 ], also because of their efficacy in substance and alcohol use disorders [ 77 , 78 , 79 ]. In a single case of HPPD symptoms and electroencephalographic (EEG) abnormalities, compatible with toxic encephalopathy, the visual hallucinations that recurred at any alcohol ingestion improved, but did not disappear with the use of Valproic Acid (1500 mg/day) [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives

et al. 2018

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Hallucinogen Persisting Perception Disorder (HPPD) is a rare, and therefore, poorly understood condition linked to hallucinogenic drugs consumption. The prevalence of this disorder is low; the condition is more often diagnosed in individuals with a history of previous psychological issues or substance misuse, but it can arise in anyone, even after a single exposure to triggering drugs. The aims of the present study are to review all the original studies about HPPD in order to evaluate the following: (1) the possible suggested etiologies; (2) the possible hallucinogens involved in HPPD induction; (3) the clinical features of both HPPD I and II; (4) the possible psychiatric comorbidities; and (5) the available and potential therapeutic strategies. We searched PubMed to identify original studies about psychedelics and Hallucinogen Persisting Perception Disorder (HPPD). Our research yielded a total of 45 papers, which have been analyzed and tabled to provide readers with the most updated and comprehensive literature review about the clinical features and treatment options for HPPD.

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“…In addition, the faster titration schedule (eg, 5 weeks) of topiramate may have increased side effect burden and thus, the subsequent impact of adverse effects. 9 Prior studies have reported a greater frequency of adverse events with increased dosing of topiramate suggesting that adopting a slower titration schedule (eg, 8 weeks) may be ideal. 10 …”

Section: Discussionmentioning

confidence: 99%

“…9,10 Given that we did not evaluate craving typology in this study, it is possible that we included participants in this study who were less likely to benefit from treatment with topiramate. Another limitation pertains to the interpretation of study data.…”

Section: Discussionmentioning

confidence: 99%

A randomized, placebo-controlled proof-of-concept trial of adjunctive topiramate for alcohol use disorders in bipolar disorder

et al. 2016

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Background and Objectives Topiramate is effective for alcohol use disorders (AUDs) among non-psychiatric patients. We examined topiramate for treating comorbid AUDs in bipolar disorder (BD). Methods Twelve participants were randomized to topiramate or placebo for 12 weeks. Results The topiramate group, with two out of five participants (40%) completing treatment, experienced less improvement in drinking patterns than the placebo group, with five out of seven participants (71%) completing treatment. Discussion and Conclusions Topiramate did not improve drinking behavior and was not well-tolerated. This study failed to recruit adequately. Problems surrounding high attrition, a small study sample, and missing data preclude interpretation of study findings. Scientific Significance This is the first randomized, placebo-controlled trial of topiramate for AUDs in BD.

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Low-Dose Topiramate in Alcohol Dependence

Cited by 46 publications

References 49 publications

Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders

Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders

Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives

A randomized, placebo-controlled proof-of-concept trial of adjunctive topiramate for alcohol use disorders in bipolar disorder

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