Migraine drug may aid alcoholics

A migraine drug, combined with a little emotional support, helped heavy drinkers sharply reduce their alcohol consumption without undergoing detox, a new study that included San Antonio patients found.

The drug, topiramate, given over 14 weeks along with weekly 15-minute counseling sessions, cut the percentage of "heavy drinking days" — days in which men had five or more drinks a day, and women four or more — by a higher percentage than those who had counseling sessions alone, said Dr. Bankole Johnson, chairman of psychiatry and neurobehavioral sciences at the University of Virginia.

"They went from about a bottle and a half of wine per day, to about 31/2 glasses of wine in the treatment group," Johnson said. "The other group had about six glasses of wine a day."

The study, which began when Johnson was at the University of Texas Health Science Center, appears in today's Journal of the American Medical Association.

Johnson said that unlike other drugs for alcoholism — naltrexone, for example — topiramate can be given while patients are still drinking, before they go through detoxification or quit altogether.

Johnson compared it to high blood pressure pills that don't require first achieving normal blood pressure before they can be taken.

The study involved 371 male and female alcoholics ages 18 to 65, including about 30 in San Antonio, at 17 sites across the country, Johnson said.

One randomly selected group was given up to 300 milligrams per day of topiramate, along with short weekly sessions with a trained nurse to encourage them to stick with treatment. The other group was given a placebo pill and the sessions.

After 14 weeks, the topiramate group saw a reduction in heavy drinking days, from 82 percent to 44 percent of days. The placebo group had dropped to 52 percent. Some stopped drinking altogether — 27 in the topiramate group went at least 28 days without a drink, compared with six in the placebo group.

Side effects, including dizziness, tingling and numbness, fatigue, insomnia, nervousness and diarrhea, caused 34 of the 183 in the topiramate group to drop out of the study, compared with six in the placebo group.

Johnson said the drug works by altering the levels of several chemical messengers in the brain, including dopamine, glutamate and GABA.

"It's a bit like a child's seesaw, where you're trying to get a kind of balance, restore the balance of the brain."

Ortho-McNeil Neurologics, which paid for the study, markets the drug as Topamax. It is currently approved by the Food and Drug Administration for the treatment of migraine headaches and seizures.

It is not approved for alcoholism, and Johnson said he is not advocating off-label use.

"One of our next steps is to directly study topiramate's efficacy in treating alcoholics within community practice settings."

Dr. Mark Willenbring, director of treatment and recovery research with the National Institute on Alcohol Abuse and Alcoholism, noted that topiramate "produced significant and meaningful improvement in a wide variety of drinking outcomes."

"At the end of the 14-week trial, differences between topiramate and placebo were still increasing, suggesting that even more improvement may occur with longer administration," Willenbring wrote. "In contrast to other medications, patients were not required to stop drinking prior to study entry."

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