Topiramate Alcohol

TOPIRAMATE ALCOHOL T sedation Additive sedative effect Warn patients about this effect... 

Alternative carbamazepine or oxcarbazepine or topiramate (alcohol dependence)... 

Johnson BA, Ait-Daoud N, Bowden CL, et al Oral topiramate for rrearment of alcohol dependence a randomised conrrolled trial. Lancet 361 1677—1685, 2003 June HL, Foster KL, McKay PF, er al The reinforcing properties of alcohol are mediared hy GABAj j receptors in rhe venrral pallidum. Neuropsychopharmacology... 

Kampman K.M., Pettinati H., Lynch K.G. et al. A pilot trial of topiramate for the treatment of cocaine dependence. Drug Alcohol Depend. 75 233, 2004. 

Topiramate may affect alcohol, amitriptyline, CNS depressants, lithium, oral contraceptives, digoxin, estrogens, hydantoins, metformin, risperidone, and valproic acid. 

Avoid alcohol and other CNS depressants while on topiramate therapy... 

Topiramate, another antiepileptic drug, may also be helpful in a dose of 400 mg daily, built up gradually. Small quantities of alcohol may suppress essential tremor but only for a short time. Alprazolam (in doses up to 3 mg daily) or gabapentin (100-2400 mg/d) is helpful in some patients. Others are helped by intramuscular injections of botulinum toxin. Thalamic stimulation by an implanted electrode and stimulator is often worthwhile in advanced cases refractory to pharmacotherapy. Diazepam, chlordiazepoxide, mephenesin, and antiparkinsonism agents have been advocated in the past but are generally worthless. Anecdotal reports of benefit from mirtazapine were not confirmed in a double-blind study, which found no effect on the tremor in most patients. 

Preliminary evidence suggests that topiramate, a drug used for partial and generalized tonic-clonic seizures (Chapter 24 Antiseizure Drugs), may be effective in reducing craving in chronic alcoholics. 

Johnson BA, Ait-Daoud N, Bowden CL, et al. Oral topiramate for treatment of alcohol dependence A randomized controlled trial. Lancet 2003 361 1677-1685. 

Topiramate, a drug used for treating seizure disorders, appears useful for treating alcohol dependence. Compared with the placebo group, patients taking topiramate achieved more abstinent days and a lower craving for alcohol. The mechanism of action of topiramate is not well understood but is distinct from that of other drugs used for the treatment... 

Topiramate is an antiepileptic drug that attenuates the rewarding effect of alcohol associated with abuse by inhibiting mesocorticolimbic dopamine release via facilitation of GABA activity and inhibition of glutamate function. It has been demonstrated to reduce both alcohol consumption and craving. 

The anticonvulsant topiramate has also been reported to be effective in reducing binge and purge frequencies in comparison with placebo. However, bothersome side-effects such as paresthesias, impaired cognition, and renal calculi may lessen its usefulness. Naltrexone is a possible adjunct in patients who are refractory to SSRIs, especially those with comorbid alcoholism and/or self-injurious behavior. ... 

There appears to be no pharmacokinetic interaction between pregabalin and carbamazepine, gabapentin, lamotrigine, phenobarbital, phenytoin, topiramate, valproate, alcohol, lorazepam, or oxycodone. However, the impairment of cognitive and gross motor function caused by oxycodone was additive with pregabalin, and pregabalin may potentiate the effects of alcohol and lorazepam. 

Nervous system In a review of several clinical studies of the use of topiramate in different indications (alcohol dependence, essential tremor, binge-eating disorder, bulimia nervosa, migraine, and epilepsy), the percentages of drug-induced nervous system adverse reactions, in particular paresthesia, differed greatly between the different disorders dropouts due to adverse events varied from 2% in those with bulimia nervosa to 29% in those with migraine [289 ]. 

FIGURE 7.5 The total-ion current (HC) chromatograms above demonstrate the thermal decomposition observed during gas chromatographic analysis of topiramate [molecular weight (MW) = 339 p.]. As the injection port tonperature is increased from 170 to 370°C, decomposition to the alcohol daivative (MW = 260 p) is observed. (Masucci and Caldwell, unpublished data). 

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