L efficacia del topiramato a basso dosaggio in pazienti alcolisti in fase di post-disintossicazione

[Autom. eng. transl.] Introduction: Topiramate increases GABA inhibitory activity on GABA A receptors, antagonizes AMPA and kainate receptors for glutamate, reducing the release of dopamine in the nucleus accumbens induced by alcohol intake. Our study aimed to evaluate the efficacy of low-dose topiramate as maintenance therapy in alcoholic patients in post-detoxification phase. Methods: Twenty-eight patients diagnosed with alcohol addiction (DSMIV) detoxified were randomized into two groups: 15 received 100 mg / day of topiramate, 13 received 250 mg / day of metadoxine (placebo). Scales for the evaluation of craving (VAS; OCDS), withdrawal symptoms (AWRS), quality of life (QL-INDEX-74), and global clinical improvement (CGI) were administered. Results: In the group treated with topiramate, 46.7% had no relapses, while in the metadoxine group only 31% of patients remained alcohol free. The drug acted with statistically significant efficacy on the obsessive and total component of craving, while the compulsive component was reduced significantly, but not significantly as for the withdrawal symptoms, the desire to drink, the clinical severity and the quality of life. Discussion: Topiramate presented a better outcome than placebo in terms of total abstention from alcohol and the number of relapses, despite the low dosage used in this study. Furthermore, it has proved to be generally effective, compared to placebo, in reducing and attenuating abstinence symptoms, the desire to take the substance, the compulsion linked to potus, the severity of the global psychopathological situation and the quality of life.