Using Topiramate or Naltrexone for the Treatment of Alcohol‐Dependent Patients

Flórez, Gerardo; García‐Portilla, Paz; Álvarez, Susana Álvarez; Sáiz, Pilar A.; Nogueiras, Luis; Bobes, Julio

doi:10.1111/j.1530-0277.2008.00680.x

Cited by 62 publications

(42 citation statements)

References 52 publications

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“…Topiramate has also been studied in longer prospective designs [94] and, in comparison to other medications approved for alcohol dependence including disulfiram [97] and naltrexone, topiramate demonstrated non-inferiority and even superiority in selected studies [98–100]. Due to topiramate's high side effect burden at higher doses, it is critical to determine the optimal dose range for balancing relapse prevention/harm reduction with decreased risk for adverse effects [101].…”

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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“…Other recent studies comparing TP with naltrexone found that both drugs were similarly efficacious in improving alcohol use parameters. 5,6 Despite considerable interest in TP as a promising drug for alcohol dependence, the mechanisms by which this medication reduces drinking remain to be characterized. Pharmacological strategies for treating alcoholism generally aim at alleviating withdrawal symptoms, reducing craving or the urge to drink, attenuating the pleasurable effects of alcohol ingestion, and intensifying the unpleasant effects of alcohol use.…”

mentioning

confidence: 99%

Modulation of Impulsivity by Topiramate

Rubio¹,

Martínez-Gras²,

Navarrete³

2009

Journal of Clinical Psychopharmacology

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Topiramate (TP), an anticonvulsant drug, has been widely used in the treatment of disorders characterized by impulsivity symptoms, so it goes to reason that it might be useful in addictive disorders. Recently, TP has been used to treat alcohol dependence, but it is still not known whether the effects of TP on alcohol consumption are related with its action on impulsivity. The aim of this preliminary study was to investigate which dimension of behavioral impulsivity is associated with the effects of TP. A 12-week, double-blind, placebo-controlled pilot study of TP for the treatment of alcohol dependence was conducted. Subjects were men recruited from alcoholism treatment units (TP = 31; placebo = 32). Diagnoses were made using the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Behavioral inhibition was assessed using the continuous performance test (CPT) and the stop-signal task. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay-discounting dimension. Alcohol craving and alcohol consumption during the study were evaluated. Patients treated with TP presented lower rates of alcohol consumption in the number of drinks per drinking day (P < 0.05) and the number of heavy drinking days (P < 0.001). Scores on alcohol craving scales decreased significantly, and there was more improvement on the continuous performance test (total omissions and total commissions) and on the stop-signal task in the TP group than in the control group. Improved alcohol consumption behavior was associated with performance on the behavioral inhibition paradigm. The results of this study indicate that TP reduces drinking and that the mechanisms underlying this effect may involve, at least in part, modulation of the behavioral inhibition paradigm.

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“…A total of eight studies reported on the course of employmentrelated difficulties. Five of these studies reported improvement [68], while two studies reported improvement/stability [69,29], The most frequent determinants for positive evolution were treatment interventions (reported by five different studies), including two pharmacotherapies [68,70], and improvement in drinking status (reported by three studies). Treatment in general was considered a positive determinant in three studies [20].…”

Section: R Em Unerative Em P Lo Ym E N T (D850)mentioning

confidence: 94%

Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions

Levola

Kaskela

Holopainen

et al. 2013

Disability and Rehabilitation

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Alcohol dependence profoundly affects the family and social network of the afflicted person. The most frequent difficulties in activities and participation have to do with interpersonal interactions, economic and work life, dealing with aggression and legal problems. Problems with high-risk behaviours and in seeking appropriate treatment are also common. Treatment targeted at reduction or cessation of alcohol use is effective in reducing these psychosocial difficulties. The ICF offers a structure for systematic evaluation of the wide range of difficulties encountered in alcohol dependence.

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Using Topiramate or Naltrexone for the Treatment of Alcohol‐Dependent Patients

Cited by 62 publications

References 52 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

Modulation of Impulsivity by Topiramate

Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions

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