Role of anti-craving drugs baclofen and topiramate in the maintenance of abstinence in alcohol dependence syndrome

Background: Alcohol craving is psychological condition related to motivation. Craving is risk factor for relapse in alcohol dependence syndrome. No gold standard therapy is available; many therapeutic agents are under various evaluation stages. Objectives: To evaluate role of anti-craving drugs baclofen and topiramate in maintenance of abstinence in alcohol dependence syndrome Methods: From March to October 2018, an open-label interventional study with 70 sample size was conducted at Nobel Medical College, following ethical clearance. Age range for inclusion was 20-60, with no history of psychotropic use, whereas history of psychiatric illness and use of substance, excluding nicotine were excluded. After written informed consent patients were admitted for detoxification, and after detoxification, anti-craving therapy was started with topiramate and baclofen and asked for follow-up at two, four, and six weeks. Clinical withdrawal assessment scale was used for withdrawal symptoms and obsessive-compulsive drinking scale (OCDS) for progress in craving. Baclofen at 20 mgs/day, topiramate at 50 mgs/day, were prescribed and increased as required at follow-up. Results: Maximum daily dose of baclofen was 24.29 ± 2.19 mg and topiramate 120 ± 33.21 mg. Baclofen group patients had significant improvement in second week (OCDS T score 16.41± 9.52) while topiramate group showed significant improvement (OCDS T score 17.70 ± 7.57) after four weeks. Major side effects were tremors 8.10% in topiramate group, headache was 5.40% in both groups. Conclusion: Baclofen and topiramate were equally effective at six weeks for controlling cravings. Baclofen started to show significant improvements after two weeks of trial.