June 5, 2008 – Alcoholism is a devastating disease in part because of the 'symptom' of heavy drinking, but more so because of the extensive harm it causes physical organs, such as the heart and liver, as well as significant damage to one's quality of life.
In a landmark study, addiction experts led by a University of Virginia Health System team have found that topiramate, an effective therapeutic medication, not only decreases heavy drinking, but it also lowers all liver enzymes, plasma cholesterol, body mass index, and systolic and diastolic blood pressure – all of which tend to increase with heavy drinking and pose such serious health risks as heart disease and cirrhosis.
Researchers also found that topiramate, compared with placebo, decreases certain adverse psychosocial effects caused by alcohol dependence.
"What topiramate offers alcoholic-dependent individuals is a future of improved health and quality of life," says lead author Bankole Johnson, professor and chairman of the U.Va. Department of Psychiatry and Neurobehavioral Sciences. "This medication provides real hope for millions of alcoholics and their families that they can beat their addiction."
Results from the nationwide 14-week trial involving 371 male and female diagnosed alcoholics are published in the June 9 issue of the Archives of Internal Medicine. The study indicates that topiramate was more efficacious than placebo in decreasing body mass index by a mean difference of 1.08 and all liver enzymes, including the log plasma γ-glutamyl-transferase ratio, which is the objective marker of heavy drinking.
Topiramate was considerably more efficacious than placebo in reducing both systolic and diastolic blood pressure by a mean difference of 9.70 mm Hg and 6.74 mm Hg, respectively. Topiramate also significantly lowered plasma cholesterol levels by an average of 16.4 mg/dL compared with a reduction of 5.7 mg/dL with placebo. Notably, these combined effects suggest that topiramate may decrease the risk of heart disease in alcohol-dependent individuals.
"Many alcoholics have hypertension, and some receive anti-hypertensive medication, which can complicate their treatment for alcoholism," said Johnson. "Because topiramate can reduce drinking substantially and decrease blood pressure significantly, this allows one medication to be given instead of several."
By decreasing liver enzymes and cholesterol levels, topiramate also may reduce the risk of fatty liver disease, which leads to cirrhosis, a common consequence to end-stage liver disease leading to death in alcoholics.
Additionally, topiramate significantly contributed to a decline in obsessive thoughts and compulsions about using alcohol. Topiramate also had a greater quality of life improvement than placebo in general activities, leisure activities and household duties, as well as a reduction in sleep disturbances.
The Food and Drug Administration has approved topiramate for seizures and migraine headaches, but it is not currently approved for treating alcohol dependence. Ortho-McNeil Neurologics, Inc., manufactures topiramate and provided study funding.
For information about topiramate and Johnson's study, visit www.uvaaddictiontrials.com/about_topiramate.cfm.