title: Effects of topiramate on urge to drink and the subjective effects of alcohol: a preliminary laboratory study.
abstract: BACKGROUND
  Topiramate was recently reported to be efficacious in reducing drinking rates and craving among individuals with alcohol dependence in a randomized controlled trial, but dose effects could not be determined. This laboratory study systematically examined the dose-dependent effects of topiramate on cue-elicited craving and other putative mechanisms of its pharmacotherapeutic effects on drinking.
  
  
  METHODS
  Male and female heavy drinkers (n = 61) were randomized to 1 of 3 medication conditions (200 mg/d; 300 mg/d; placebo) in a double-blind study. Participants reached the target dose after a 32-day titration period, then were stabilized for approximately 1 week. All then participated in a laboratory assessment of alcohol cue reactivity and of the subjective effects of a moderate dose of alcohol.
  
  
  RESULTS
  Both doses of topiramate reduced the frequency of heavy drinking during the titration period as compared to placebo. However, topiramate did not affect self-reported craving for alcohol during the titration period, during the cue reactivity protocol, or in response to the alcohol challenge procedure. Topiramate reduced the stimulating effects of alcohol ingestion compared to placebo, but only in the 200 mg group.
  
  
  CONCLUSIONS
  The results of this study support previous findings that topiramate reduces drinking, but the behavioral mechanism underlying this effect does not appear to be attenuation of craving for alcohol as measured using the approaches employed in this study. Rather, the results tentatively suggest that topiramate may exert its beneficial effects by altering the subjective experiences of alcohol consumption. Limitations of the current study are discussed and complementary methods are recommended for future studies, such as the use of behavioral economic paradigms and ecological momentary assessment.
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island 02912, USA. miranda_jr@brown.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Miranda
authors.forename: James
authors.initials: J
authors.lastname: MacKillop
authors.forename: Peter M
authors.initials: PM
authors.lastname: Monti
authors.forename: Damaris J
authors.initials: DJ
authors.lastname: Rohsenow
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tidey
authors.forename: Chad
authors.initials: C
authors.lastname: Gwaltney
authors.forename: Robert
authors.initials: R
authors.lastname: Swift
authors.forename: Lara
authors.initials: L
authors.lastname: Ray
authors.forename: John
authors.initials: J
authors.lastname: McGeary
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000188:drug therapy* / Q000523:psychology*; D016739:Behavior, Addictive / Q000188:drug therapy* / Q000523:psychology*; D004311:Double-Blind Method; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077236:Topiramate
chemical_list: D000077236:Topiramate; D005632:Fructose; D000431:Ethanol