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    Important JAMA article on topa

    Howdy folks. I've been lurking for a while, will be posting my story soon, but in the meantime....

    There's an important study on the effectiveness of Topamirate for alcoholism just published in the Journal of the American Medical Association (JAMA) -- this is the origin of the recent mainstream press attention, NPR, etc. It was a large clinical study, properly designed and showing a strong effect, and published in one of the most prestigious medical journals. If your doctor has been reluctant to prescribe topa "off-label", or you've been reluctant to ask, this study might convince him. You can read or download the paper free, but it's rather technical. I'm a biological scientist (yes, this damn disease can get anyone), so I thought I'd parse it for the rest of y'all:

    This study was done by the same researchers who did the earlier Lancet (2003) study. The main difference is the study size -- over twice as many participants -- and the attempt to test lower doses as well as the 300 mg they had used earlier (which didn't really work out for them, see below). There were also some minor changes in the selection criteria, the choice of variables to measure, and so forth.

    Experimental design: 371 alcoholics who wanted to quit were enrolled. Half received topa, half a placebo, for 14 weeks. The topa schedule ramped up to 300 mg over the first five weeks for about half of the topa group, or leveled off at a lower dose for the rest. Participants kept a log of their drinks each day.

    Results: Those taking topa reduced their percentage of heavy drinking days (5+ drinks for men, 4+ for women) from 82% prior to the study, to 44% of days (if you assume all those who dropped out before completing the study relapsed to heavy drinking), or ~25% (if you only count people who completed the study). Those taking placebo reduced their percentage of heavy drinking days from 82% to about 52%. So the placebo group had some success, but the topa group had significantly more. Several other measures were also significant -- the one that caught my eye was the fraction of participants that achieved 28 continuous days of abstinence, about three times as many for the topa group as the placebo group. Likewise about twice as many achieved 28 continuous days without a heavy drinking day. They didn't find a difference within the topa group according to the dosage that they were leveled off at. They might have just not had enough participants at the lower dosages. Hard to say, but it suggests that 300 mg may not be necessary for most people.

    Side effects: 19% of the topa group dropped out before completing the study, probably due to side effects. These included paresthesia (tingling hands and feet) in 51%, taste perversion 23%, loss of appetite 21%, difficulty with attention/concentration 15%, itching 10%. Side effects increased with dosage.

    Bottom line: Within this group of alcoholics who wanted to quit, topa helped them have more success than a placebo. It works, and this study proves it fairly convincingly. Whether it's worth the side effects, well, that's up to you....

    peace,
    lilnev
    Q: How do I become the person I want to be?
    A: Practice, of course.

    #2
    Important JAMA article on topa

    links not permitted until I have at least two posts....
    Q: How do I become the person I want to be?
    A: Practice, of course.

    Comment


      #3
      Important JAMA article on topa

      Here's the link: JAMA_study

      peace,
      lilnev
      Q: How do I become the person I want to be?
      A: Practice, of course.

      Comment


        #4
        Important JAMA article on topa

        Lilnev,

        Awesome and thank you!!

        I personally loved your condensation for us.

        :welcome: and I hope you can achieve your goal, whatever it may be.

        Cindi
        AF April 9, 2016

        Comment


          #5
          Important JAMA article on topa

          lilnev, also a biologist, although different fauna, mine have wings ;-) - thanks for the weekend reading.

          Comment


            #6
            Important JAMA article on topa

            I'm just starting a topamax treatment program, along with supplements and such. This is quite good news, as I'm pretty sure I'm committing slow suicide by drinking. Thank you.
            "uch: When you kick youreslf in the butt, all you get is a sore butt and a tired foot"

            Comment


              #7
              Important JAMA article on topa

              Thanks for posting! Glad they reported the p values for significance tests of side effects -- if you read of all reported side effects, you'd be too scared to try the stuff, without realizing that control group participants report side effects too!

              One question I'd like input on (anyone?) is weight and dosage -- were all subjects on 300mgs regardless of weight/size? (I am 5'1" and 100# -- up to 100 mg and hoping not to have to go up to 300 mgs...)

              Comment


                #8
                Important JAMA article on topa

                I have a similar question. My p-doc used a quicker dosage escalation. He prescribed 50 mg tabs - 50 mg the first week, 100 the second, 150 the 3rd, 200 the 4th, and 300 the 5th. Is this because I'm 6'4" and weigh 220?
                "uch: When you kick youreslf in the butt, all you get is a sore butt and a tired foot"

                Comment


                  #9
                  Important JAMA article on topa

                  You are wonderful. I am just contemplating starting the MWO program but was considering the CDs and supplements witholding the Topamax. May I ask what method you tried?

                  Comment


                    #10
                    Important JAMA article on topa

                    I haven't tried topa myself, just read the article. In the article, they didn't set dosage according to body weight: about half the topa group ramped up to 300 mg, the rest to lower levels, randomly assigned. They did mention that women reported more side effects than men at the same dosage, probably due to lower mass, and people on higher dosages reported more side effects. It would very much make sense that both it's effectiveness and the side effects would depend on body mass. It seems to me that "your milage may vary". Talk to your doctor, bring in the article to show him, and you may need to experiment to find a dose that works for you.

                    peace,
                    lilnev
                    Q: How do I become the person I want to be?
                    A: Practice, of course.

                    Comment


                      #11
                      Important JAMA article on topa

                      Quick question for anyone on Topa: I was using Topa purchased online and working my way up 25 mg every 5-6 days. Good results, no side effects other than fatigue which dissipated after 4 days. I decided to go to a doctor for a prescrip and she told me to go ahead and bump up 50 mg to 225. I didn't. I still only increased 25 mg. each 5-6 days. and now am at 225 mg. The problem is this. Since I started taking the pharmacy Topa instead of the online purchased Topa, my kidneys burn. They just burn all the time. I have read up online and have decreased my protein and uppped my Vitamin C and carbs. I will call the doctor on Monday (don't exactly trust her yet, but will call still), but was wondering if anyone else has experienced this side effect. Did it dissipate with time? Has anyone stopped Topa abruptly? Thanks for any input!

                      Comment


                        #12
                        Important JAMA article on topa

                        Nerak,

                        I did not suffer that side effect. However, topa requires LOTS of water. LOTS of water.

                        Make sure you increase the water you are drinking -- not soda, not coffee, not caffeinated teas.

                        DO NOT STOP THE TOPA ABRUPTLY. It is dangerous.

                        Good luck!!
                        Cindi
                        AF April 9, 2016

                        Comment


                          #13
                          Important JAMA article on topa

                          thanks for replying. I do not drink much water, only one cup of coffee, one tea, one water and that's it! for the day...so, I will NOT stop abruptly, will drink lots of water today and will call doctor. thanks again!

                          Comment


                            #14
                            Important JAMA article on topa

                            I think this test sounds very encouraging and truly convinced me to try the topa. My one and only big question is what about the long term benifits. This test talks about 28 days? What happened after 28 days? What happens after 28 weeks?

                            Comment

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