Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review

Abstract

: Topiramate is a non-benzodiazepine anticonvulsant medication with multi-faceted pharmacologic action. It has emerged as an efficacious pharmacotherapeutic option for the treatment of addiction, especially alcohol use disorder (AUD). We present a broad narrative review of the putative mechanism of action and clinical utility of topiramate with regard to AUD and other substance use disorders. Collective evidence suggests topiramate is an effective treatment option in AUD, with notable efficacy in reducing harmful drinking patterns in AUD. Though not currently approved by the United States Food and Drug Administration for the indication of AUD, topiramate should be considered as a pharmacological treatment option with high utility among AUD patients. Early pharmacogenetic studies raise the intriguing possibility of identifying patients likely to respond to topiramate using genetic testing, and initial studies show that topiramate may also be useful in treating cocaine use disorder, smoking cessation and behavioral addictions. However, further research is needed in all these areas.

<p>Pharmacogenetics of alcohol addiction: current perspectives</p>

“…FDA has approved topiramate for the treatment of seizure disorder, migraine prevention, and chronic weight management (along with phentermine) 61. Although the FDA has not currently approved topiramate for the AUD therapy, this medication is also a useful option for the AUD treatment 71. A randomized, double-blind, placebo-controlled trial revealed the anticraving properties of topiramate 72.…”

Alkoholkonsumstörungen und Suizidalität: Ein narratives Review

“…Vielversprechend ist das Antikonvulsivum Topiramat, welches in randomisierten und kontrollierten Studien auf seine Wirkung gegen Craving und Rückfälligkeit untersucht wurde [60]. Topiramat ist jedoch in Deutschland weder für die Rezidivprophylaxe noch für die Behandlung von affektiven Störungen oder Suizidalität zugelas sen. Eine aktuelle Studie über Topiramat bei komorbider Alkoholab hängigkeit und bipolarer Störung war überdies negativ [61].…”

Influence of Topiramate on the Synaptic Endings of the Temporal Lobe Neocortex in an Experimental Model of Hyperthermia-Induced Seizures: An Ultrastructural Study

“…Topiramate (TPM) is a commonly used antiepileptic and newer-generation drug with multi-faced pharmacological action as well as a low potential of serious side effects [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. It is an effective, broad-spectrum anticonvulsant medication used in the treatment of various types of epilepsy, in both partial and generalized seizures [ 14 , 15 , 17 , 18 , 19 , 21 , 22 ], and in the prevention of recurrent FS [ 16 , 23 ] in migraine prevention [ 24 , 25 ], as well as lately in pharmacotherapy for alcohol abuse and other addictions [ 26 ]. However, it should be emphasized that although neurochemical studies conducted on TPM in various animal models indicate its multidirectional effects on the CNS, mainly through the action on GABA and the inhibition of the excitatory amino acids [ 20 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], its exact mechanism at the ultrastructural level still remains unclear.…”