Which Heavy Drinkers Benefit Most from Topiramate?

Topiramate can reduce heavy drinking days among patients who aspire to quit drinking. This medication affects glutamate receptors, especially those containing the kainite GluK1 subunit encoded by GRIK1, and a GRIK1 polymorphism has been associated with fewer adverse topiramate effects. In a 12-week, federally funded study, 138 heavy drinkers wishing to reduce drinking to safe levels (62% male; 62% employed full time) were genotyped for C and A alleles at rs2832407 and randomized to topiramate (dosed progressively to 200 mg/day; mean, 173 mg/day) or placebo.

All patients received medical management and brief psychosocial interventions at nine visits. Despite high lifetime prevalence of depression, only eight patients had current diagnoses of …