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 co-morbid 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 300mg/day 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 to 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.