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

CNS Drugs volume 35, pages177–213(2021)Cite this article

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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Affiliations

  1. Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, Pôle MOPHA, 95 Bd Pinel, 69500, Bron, France

    Mikail Nourredine, Yannick Longuet, Julia de Ternay & Benjamin Rolland

  2. Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Hospices Civils de Lyon, Lyon, France

    Mikail Nourredine

  3. Centre d’Évaluation et Diagnostic de l’Autisme, CH Le Vinatier, Bron, France

    Lucie Jurek

  4. HESPER, Health Services and Performance Research EA7425-Université Lyon 1, Lyon, France

    Lucie Jurek

  5. Service de Psychiatrie et Addictologie de liaison, CHU Sud, Amiens Cedex, France

    Bernard Angerville & Alain Derveaux

  6. Université de Picardie Jules Verne, Centre Universitaire de Recherche en Santé, INSERM UMR 1247, Groupe de Recherche sur l’Alcool & les Pharmacodépendances, Amiens, France

    Bernard Angerville & Alain Derveaux

  7. Université de Lyon, UCBL, Centre de Recherche en Neurosciences de Lyon (CRNL), INSERM U1028, CNRS UMR5292, PSYR2, Bron, France

    Benjamin Rolland

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  1. Mikail Nourredine
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  2. Lucie Jurek
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  3. Bernard Angerville
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  4. Yannick Longuet
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  5. Julia de Ternay
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  6. Alain Derveaux
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  7. Benjamin Rolland
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Corresponding author

Correspondence to Mikail Nourredine.

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No sources of funding were used to assist in the preparation of this study.

Conflict of Interest

Mikail Nourredine, Lucie Jurek, Bernard Angerville, Yannick Longuet, Julia de Ternay, Alain Derveaux, and Benjamin Rolland have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

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Author contributions

M.N., L.J., B.A., Y.L., J.T., A.D., and B.R. wrote the manuscript; B.R. designed the research; M.N. and L.J. performed the research and extracted the data; and M.N., B.A., Y.L., and J.T. assessed the risk of bias of each study.

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Nourredine, M., Jurek, L., Angerville, B. et al. Use of Topiramate in the Spectrum of Addictive and Eating Disorders: A Systematic Review Comparing Treatment Schemes, Efficacy, and Safety Features. CNS Drugs 35, 177–213 (2021). https://doi.org/10.1007/s40263-020-00780-y

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