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Cited by 26Substance Abuse Treatment and OutcomesGambling Behavior and TreatmentsEating Disorders and Behaviors

Use of Topiramate in the Spectrum of Addictive and Eating Disorders: A Systematic Review Comparing Treatment Schemes, Efficacy, and Safety Features

Nourredine, Mikail, Jurek, Lucie, Angerville, Bernard, Longuet, Yannick, de Ternay, Julia, Derveaux, Alain, Rolland, Benjamin·2021·CNS Drugs
DOI 10.1007/s40263-020-00780-y
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Abstract

Background and objective Topiramate has been approved by the US Food and Drug Administration for the treatment of epilepsy since the 1990s, and it has also been used off-label in the treatment of many types of addictive disorders. To date, no systematic review has embraced the entire field of addiction, both substance use and behavioral addictions, including eating disorders, to compare topiramate-based protocols and the related level of evidence in each addictive disorder. Our objective is to fill this gap.Methods A systematic search was conducted using the MEDLINE, PsycINFO, and Cochrane databases without a date or language limit. All trials and meta-analyses assessing the efficacy of topiramate in alcohol use disorder; cocaine use disorder; methamphetamine, nicotine, cannabis, opiate, and benzodiazepine use disorders; binge eating disorder; bulimia; and pathological gambling were analyzed. The quality of the studies was rated using the Cochrane Risk-of-Bias tool for randomized trials (ROB-2), the Risk of Bias In Nonrandomized Studies (ROBINS-I), or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, depending on the study design. Safety features were assessed based on a wider non-systematic review.Results Sixty-two articles were reviewed. Treatment protocols were relatively homogenous across addictive disorders, with slow dose titration schemes and a maximum dose range of 200-400 mg per day. The most supportive evidence for topiramate efficacy was found in alcohol use disorder for drinking reduction parameters only. To a lesser extent, topiramate could be a promising therapeutic option for binge eating disorder and cocaine use disorder. Evidence was weak for other addictive disorders. No major tolerability issues were found, provided that basic safety rules were followed. Adverse drug reactions could lead to early treatment discontinuation.Discussion Though off-label, addiction specialists should consider topiramate as a second-line option for drinking reduction in alcohol use disorder, as well as for binge eating disorder or cocaine use disorder.

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Authors
Nourredine, M., Jurek, L., Angerville, B., Longuet, Y., de Ternay, J., Derveaux, A., & Rolland, B.
Affiliations
  • Lyon 1 Université (FR)
  • Inserm (FR)
  • Centre Hospitalier Le Vinatier (FR)
ORCID
Venue
CNS Drugs
Publisher
Springer Science and Business Media LLC
Published
2021-02
Volume
35
Issue
2
Pages
177-213
ISSN
  • 1172-7047 (ISSN-L)
  • 1179-1934
DOI
10.1007/s40263-020-00780-y
OpenAlex
W3130807650
Cited by
26
References
119
Citations by year
2026: 2 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 5 · 2021: 1
FWCI
0.77
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • CNS Drugs (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
topiramate, addiction, eating disorders, binge eating disorder, bulimia nervosa, gambling addiction, alcoholism, cocaine dependence, substance use disorders, off-label drug use, dose titration, treatment efficacy, drug safety, adverse drug reactions, second-line therapy
MeSH terms
Topiramate, Alcohol Drinking, Alcoholism, Anticonvulsants, Feeding and Eating Disorders, Dose-Response Relationship, Drug, Humans, Randomized Controlled Trials as Topic, Behavior, Addictive, Substance-Related Disorders, Off-Label Use

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