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Gabapentin was originally developed and approved by the FDA as an anti-seizure medication. However, it is prescribed off-label for many other conditions, including drug and alcohol withdrawal and alcohol dependence.1 "The demonstration of the efficacy of gabapentin for relapse prevention among alcohol -dependent patients...is a significant development. This well designed and well-powered trial replicates the positive findings of several previous smaller trials...It would thus seem to have potential for widespread use for treatment of alcohol dependence in both specialty and primary care treatment settings."2 Four of the largest trials of gabapentin showed "beneficial effects of gabapentin on at least one alcohol-related outcome measure."3 "Gabapentin used to treat alcohol dependence ws well tolerated with no severe adverse reactions reported in the extant literature...the current literature is promising for gabapentin in the treatment of alcohol."4 Gabapentin significantly improved rates of absitnence and no heavy drinking days in a large 6-year study. Increased dosage, up to 1800mg, resulted in increased effectiveness.5 "Gabapentin's effect on drinking outcomes is at least as large or greater than those of existing FDA approved treatments...plus it's the only medication shown to improve sleep and mood in people who are quitting or reducing their drinking, and it's widely used in primary care."6 "Gabapentin is a well-tolerated medication, with few adverse effects at low to moderate doses, although typical anticonvulsant adverse effects (e.g., sedation, dizziness) may occur at higher doses...It is already widely prescribed for treatment of chronic pain, mood, anxiety and sleep problems, in addition to seizure prophylaxis."7 "Because gabapentin has been used ubiquitously by many primary care [physicians] for many other indications, it is hoped that gabapentin will be readily utilized by primary care physicians for [alcohol use disorders]."8 Gabapentin is not addictive. Gabapentin can be taken while the alcohol-dependent person is still drinking, though the combination may enhance side effects. Gabapentin may be effective in assisting with symptoms of withdrawal Side effects include drowsiness, dizziness, headache, anxiety and constipation. Gabapentin does not have a negative effect on the liver. Drug interactions can be found here: http://www.drugs.com/drug-interactions/gabapentin.html This information was taken directly from the book A Prescription for Alcoholics: Medications for Alcoholism by Linda Burlison. Kindle location 8022-8400 and pages 401-417 in the book. There is a much more comprehensive explanation and list of research in the book. It can be purchased here: It can be purchased at: http://www.amazon.com/gp/product/B01A1E8YKW?keywords=a%20prescription%20for%20alcoholics&qid=1458427110&ref_=sr_1_1&sr=8-1 Website: http://www.aprescriptionforalcoholics.com/ Bibliography 1. Sirven JI. New uses for older drugs: the tales of aspirin, thalidomide, and gabapentin. Mayo Clin Proc. 2010;85( 6): 508-511. doi: 10.4065/ mcp. 2010.0267. 2. Nunes E V. Gabapentin: a new addition to the armamentarium for alcohol dependence? JAMA Intern Med. 2014;174( 1): 78-79. doi: 10.1001/ jamainternmed. 2013.11973. 3. Greutman MD, Gales MA, Gales BJ, Greutman MD, Gales BJ. Gabapentin in Alcohol Dependence. J Pharm Technol. 2015: 8755122515575543. doi: 10.1177/ 8755122515575543. 4. Leung JG, Hall-Flavin D, Nelson S, Schmidt KA, Schak KM. The Role of Gabapentin in the Management of Alcohol Withdrawal and Dependence. Ann Pharmacother. 2015: 1060028015585849. doi: 10.1177/ 1060028015585849. 5. Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence a randomized clinical trial. JAMA Intern Med. 2014;174( 1): 70-77. doi: 10.1001/ jamainternmed. 2013.11950. 6. Unknown A., Clinical Trial Indicates Gabapentin Is Safe and Effective for Treating Alcohol Dependence. Scripps.edu. 2013. www.scripps.edu/ newsandviews/ e_20131111/ mason.html. On May 3, 2015. 7. Nunes E V. Gabapentin: a new addition to the armamentarium for alcohol dependence? JAMA Intern Med. 2014;174( 1): 78-79. doi: 10.1001/ jamainternmed. 2013.11973. 8. Burlison, L., A Prescription for Alcoholics: Medications for Alcoholism. 2016; p. 402.
Topamax (topiramate) is an FDA approved anti-seizure medication that is prescribed off-label for the treatment of alcohol use disorders (AUDs). It is also used for the treatment of migraines and has been shown to be helpful with weight loss. It has not been widely studied as a treatment for AUDs. The fact that it has not been widely studied, and is prescribed off-label, means that physicians don't know about it. However, it may be more effective, particularly for people with certain genetic markers, than the medications that are FDA-approved. Topamax (topiramate) can be taken with naltrexone and campral. It should not be taken with baclofen. "Two trials suggested that topiramate [topamax] is also more efficacious than naltrexone, and one open-label study reported better results for disulfiram than for topiramate."1 "Topiramate, within the dosage range of 75-300mg/day, could be considered as a first line treatment option for the management of AUDs. It's use appears to be safe and well-tolerated, especially in light of very recent findings."2 "Topiramate treatment an be initiated while the alcohol-dependent individual is still drinking."3 There is a moderate interaction between topamax and alcohol which may increase the side effects of the medication. Though most studies find that topamax, particularly at low doses, is safe, there can be side effects. Side effects include: Cognitive impairment Mental slowing Reduced verbal fluency Memory issues Dizziness Weight loss Can contribute to kidney stone formation Rarely, the development of Acute Angle-closure Glaucoma (AACG) can result from topamax. It is serious and possibly irreversible. This information came directly from the book A Prescription for Alcoholics - Medications for Alcoholism written by Linda Burlison. Kindle location 5351-5396 and pages 321-340 in the book. There is a much more comprehensive explanation and further research available in the book. You can purchase it here: http://www.amazon.com/Prescription-Alcoholics-Medications-Alcoholism-ebook/dp/B01A1E8YKW/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1456588006&sr=1-1&keywords=a+prescription+for+alcoholics The website: http://www.aprescriptionforalcoholics.com/ 1. Arbaizar B, Diersen-Sotos T, Gomex-Acebo I, Llorca J. Topiramate in the treatment of alcohol dependence: a meta-analysis. Actas Esp Psiquiatr. 2010; 38(1):8-12. 2. Guglielmo R, Martinotti G, Quatrale M, et al. Topiramate in Alcohol Use Disorders: Review and Update. CNS Drugs. 2015; 29(5):383-395. doi:10.1007/s40263-015-0244-0. 3. Johnson, B a, Ait-Daoud N. Topiramate in the new gneration of drugs: efficacy in the treatment of alcoholic patients. Curr Pharm Des. 2010;16(19):2013-2112. doi:10.2174/138161210791516404.