The antiepileptic drug topiramate not only decreases heavy drinking in patients with alcohol dependence, it also lowers liver enzyme levels, plasma cholesterol, body mass index, and blood pressure, according to an article in the June 9 issue of the Archives of Internal Medicine.

In addition, researchers also found that topiramate decreases certain adverse psychosocial effects caused by alcohol dependence compared with placebo.

"What topiramate offers alcoholic-dependent individuals is a future of improved health and quality of life," said lead author Professor Bankole Johnson, D.Sc., M.D., Ph.D., M.Phil., FRCPsych., chairman of the UVa Department of Psychiatry and Neurobehavioral Sciences. "This medication provides real hope for millions of alcoholics and their families that they can beat their addiction."

The U.S. 14-week trial involved 371 men and women diagnosed with alcohol dependence. Topiramate was more effective 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, an objective marker of heavy drinking.

Topiramate was considerably more effective 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," explained 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.

Additionally, researchers found that 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.