title: Topiramate treatment of alcohol use disorder in veterans with posttraumatic stress disorder: a randomized controlled pilot trial.
abstract: BACKGROUND
  The course of posttraumatic stress disorder (PTSD) is frequently and severely complicated by co-occurring alcohol use disorder (AUD), yet there are few reports of pharmacologic treatments for these comorbid conditions. The objective of this pilot study was to obtain a preliminary assessment of the efficacy and safety of topiramate in reducing alcohol use and PTSD symptoms in veterans with both disorders.
  
  
  METHODS
  This was a prospective 12-week, randomized, double-blind, placebo-controlled pilot trial of flexible-dose topiramate up to 300 mg/d in 30 veterans with PTSD and AUD. The primary outcome measure was frequency of drinking. Secondary outcomes consisted of other measures of alcohol use and PTSD symptom severity.
  
  
  RESULTS
  Within-group analyses showed that topiramate treatment was associated with significant reductions in frequency and amount of alcohol use and alcohol craving from baseline through week 12. Between-group analyses showed that topiramate reduced frequency of alcohol use and alcohol craving significantly more than placebo and tended to reduce drinking amount. Topiramate treatment was also associated with decreased PTSD symptom severity and tended to reduce hyperarousal symptoms compared with placebo. Topiramate transiently impaired learning and memory, with significant recovery by the end of treatment.
  
  
  CONCLUSIONS
  These preliminary results indicate that in veterans with co-occurring PTSD and AUD, topiramate may be effective in reducing alcohol consumption, alcohol craving, and PTSD symptom severity-particularly hyperarousal symptoms. Topiramate was associated with transient cognitive impairment but was otherwise well tolerated.
authors.affiliation: San Francisco, California; San Francisco Veterans Affairs Medical Center, San Francisco, California; Addiction Research Program, Northern California Institute for Research and Education (NCIRE), San Francisco, California; Department of Psychiatry, University of California, San Francisco, California.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Batki
authors.forename: David L
authors.initials: DL
authors.lastname: Pennington
authors.forename: Brooke
authors.initials: B
authors.lastname: Lasher
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.forename: Thomas
authors.initials: T
authors.lastname: Metzler
authors.forename: Angela
authors.initials: A
authors.lastname: Waldrop
authors.forename: Kevin
authors.initials: K
authors.lastname: Delucchi
authors.forename: Ellen
authors.initials: E
authors.lastname: Herbst
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000188:drug therapy*; D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D003072:Cognition Disorders / Q000139:chemically induced / Q000150:complications; D066249:Craving / Q000187:drug effects; D017831:Diagnosis, Dual (Psychiatry); D004311:Double-Blind Method; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010865:Pilot Projects; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D000077236:Topiramate; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*
chemical_list: D000077236:Topiramate; D005632:Fructose
keywords: Alcohol Use Disorder; Clinical Trial; Cognition; Posttraumatic Stress Disorder; Topiramate
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