Abstract: Introduction: Several controlled clinical trials have studied the efficacy of topiramate in the treatment of alcoholism. In this paper, we have performed a meta-analysis of those trials in which topiramate was compared with placebo and then we reviewed its efficacy in trials in which it was compared with other drugs. Method: A quantitative synthesis of data was performed using inverse variance weighting in a random effects model. Results: Based on three placebo-controlled trials, topiramate is more efficacious than placebo in reducing the percentage of heavy drinking days (23.2%, 95% confidence interval [CI]: 15.7 to 34.4), increasing the number of days of abstinence (mean difference: 2.9 days, 95% CI: 2.5 to 3.3), and lowering the logarithm of ?-GT levels (mean difference: 0.075 95% CI: 0.048 to 0.118). Two trials suggested that topiramate is also more efficacious than naltrexone, and one open-label study reported better results for disulfiram than for topiramate. Conclusion: Topiramate can be used in alcohol dependence. Adverse effects such as paresthesia or insomnia should be taken into account when prescribing topiramate. Its optimal dosage requires further research.

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