Adjunctive Topiramate for Treatment of Alcohol Dependence in Patients With Bipolar Disorder

NCT ID: NCT00572117

Last Updated: 2017-01-09

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 12 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2007-08-31
• Study Completion Date: 2014-07-31

Brief Summary

The purpose of this study is determine whether the use of topiramate is effective in the treatment of alcohol dependence (i.e. decreases drinking) in patients with bipolar disorder.

Detailed Description

Alcohol and substance use disorders are more common in bipolar disorder bipolar disorder than in any other DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) Axis I disorder, estimated to occur in up to 60% of patients with bipolar disorder. Alcohol use is associated with poor outcome in bipolar disorder, and yet these co-occurring conditions are understudied. To date, there is only one published placebo-controlled trial of an agent for the treatment of alcohol dependence alcohol dependence in bipolar disorder. The purpose of the proposed study is to evaluate the efficacy of a topiramate as a treatment for alcohol dependence in patients with bipolar disorder. This is a 12-week, randomized, placebo-controlled study of the efficacy of topiramate adjunctive to standard treatment for bipolar disorder in patients with alcohol dependence and bipolar disorder. Additional aims of the study are to document the safety and tolerability of topiramate in this population, and to evaluate to effect of decreased drinking on mood symptoms. The study involves the enrollment of a total of 80 patients with co-occurring alcohol dependence and bipolar disorder over the course of 40 months at the Massachusetts General Hospital (MGH) Bipolar Clinic and Research Program (BCRP) (www.manicdepressive.org). With a conservative estimate of a 30% dropout rate, approximately 56 of the 80 patients with these two comorbid conditions will complete 12 weeks treatment with either topiramate or placebo.

Conditions

Bipolar Disorder; Alcoholism; Alcohol Dependence

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Placebo (inert pill) Arm

Half the participants will receive topiramate and half will receive placebo. Neither participants nor study staff will know who is receiving which pills until the end of the study. Subjects will receive placebo pills identical to the active pills (pills that contain the study drug, topiramate) for the 12 treatment weeks of the study and will have the pills discontinued over the next four weeks of the study. All subjects will be re-evaluated at 26 and 52 weeks.

Group Type: PLACEBO_COMPARATOR

Topiramate

Intervention Type: DRUG

Medication will be slowly increased over 5 weeks from 25 mg a day to 150 mg twice a day in an effort to minimize side effects that might enable participants and raters to guess whether they are on active drug or placebo. Subjects will continue on 150 mg twice a for Weeks 6-12 of the study.

Topiramate

Half the participants will receive topiramate and half will receive placebo. Neither participants nor study staff will know who is receiving which pills until the end of the study. The pills will be slowly increased over 5 weeks from 25 mg a day to 150 mg twice a day in an effort to minimize side effects that might enable participants and raters to guess whether they are on active drug or placebo. Subjects will continue on 150 mg twice a for Weeks 6-12 of the study.

Group Type: EXPERIMENTAL

Topiramate

Intervention Type: DRUG

Medication will be slowly increased over 5 weeks from 25 mg a day to 150 mg twice a day in an effort to minimize side effects that might enable participants and raters to guess whether they are on active drug or placebo. Subjects will continue on 150 mg twice a for Weeks 6-12 of the study.

Interventions

Topiramate

Medication will be slowly increased over 5 weeks from 25 mg a day to 150 mg twice a day in an effort to minimize side effects that might enable participants and raters to guess whether they are on active drug or placebo. Subjects will continue on 150 mg twice a for Weeks 6-12 of the study.

Intervention Type: DRUG

Other Intervention Names

Topamax

Eligibility Criteria

Inclusion Criteria

1. Age 18+

2. Written informed consent.

3. Meet DSM-IV criteria (by SCID) for alcohol dependence.

4. Meet DSM-IV criteria (by SCID) for bipolar disorder I or II disorder.

5. ≥ 8 heavy drinking days (defined as ≥ 5 standard drinks per day for men, ≥ 4 standard drinks per day for women) in the prior 4 weeks.

6. During the baseline visit, patients must be on a stable dose of accepted maintenance treatment for bipolar disorder for the past 4 weeks. If the subject is on more than one agent, at least one agent must be adequately dosed.

7. Antidepressant treatment is permitted if the dose has been stable for the past 4 weeks.

Exclusion Criteria

1. Pregnant women or women of child bearing potential who are not using a medically accepted means of contraception (condom, diaphragm, spermicide, intrauterine device, tubal ligation, or partner with vasectomy). Because of the risk of the lowering of oral contraceptive blood levels with topiramate, women whose sole means of contraception is oral contraceptives or hormonal implants will be asked to use an additional barrier method of birth control during treatment with the study drug.

2. Women who are lactating.

3. Age under 18.

4. Patients who do not have ≥ 8 heavy drinking days in the 4 weeks prior to the baseline visit.

5. Important alcohol withdrawal symptoms (Clinical Institute Withdrawal Assessment for Alcohol-Revised, CIWA-Ar, score > 15)

6. Urine toxicological screen positive for amphetamines or cocaine.

7. Meets DSM-IV criteria for current substance dependence for drugs other than cannabis or nicotine.

8. Currently meets full DSM-IV criteria for manic, hypomanic, or mixed episode.

9. Serious suicide or homicide risk, as assessed by evaluating clinician.

10. Unstable medical illness including cardiovascular, hepatic, renal, respiratory, endocrine, neurological, or hematological disease or uncontrolled seizure disorder.

11. History of nephrolithiasis, or treatment with any drug associated with nephrolithiasis.

12. Current treatment with zonisamide.

13. Current treatment with any carbonic anhydrase inhibitors, including acetazolamide, dorzolamide, and methazolamide.

14. Current treatment with any drug known to decrease drinking.

15. Subjects who have begun a new psychosocial treatment within 12 weeks of study enrollment. Subjects receiving psychosocial treatment that has been stable for at least 12 weeks prior to study entry, however, will be permitted to enroll in the study.

16. Any psychotic disorder, including schizoaffective disorder (current or past).

17. Clinical or laboratory evidence of untreated hypothyroidism.

18. Patients with a diagnosis or history of glaucoma

19. Patients requiring excluded medications (see table below for details).

20. Psychotic features in the current episode or a history of a psychotic disorder, as assessed by SCID.

21. Past intolerance to topiramate.

22. Any use of topiramate in the past 12 months.

23. Any investigational psychotropic drug within the last 3 months.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

NIH

Sponsor Role: collaborator

Stanford University

OTHER

Sponsor Role: lead

Responsible Party

Michael Ostacher

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Michael J. Ostacher, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

Stanford/VA Palo Alto Mood Disorder Research Program

Palo Alto, California, United States

Countries

United States

Other Identifiers

K23AA016340

Identifier Type: NIH

Identifier Source: secondary_id

View Link

TIL-NIAAA-016340-01

Identifier Type: -

Identifier Source: org_study_id