A Quick Study item in the Sept. 14 Health section incorrectly said that Cymbalta has been approved by the Food and Drug Administration as a treatment for epilepsy. The drug has been approved for treatment of major depression in adults and for diabetic peripheral neuropathic pain. (Published 9/15/2004)
Outlook seems to improve with anti-epilepsy drug.
* THE QUESTION People addicted to alcohol often find that their dependency affects their work and social relationships. Might the drug topiramate (Topamax), an anti-epilepsy drug, help control cravings for alcohol and, ultimately, improve a person's quality of life?
* THIS STUDY randomly assigned 150 people diagnosed with alcohol dependency to take either topiramate or a placebo. Participants took escalating doses up to 300 milligrams a day. After 12 weeks, based on blood tests and standard assessment scales, those who took the drug had 27 percent fewer days of heavy drinking, were 2.6 times more likely to have abstained from alcohol and were more than twice as likely to feel satisfied with their lives.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with moderate alcohol dependency. At the start of the study, female participants averaged 21 or more alcoholic drinks a week and men averaged 25 or more drinks week.
* CAVEATS All participants received weekly counseling aimed at ensuring they took the drug regularly; whether taking topiramate without counseling would yield the same results was not determined. Long-term effects of the drug were not evaluated. People with more severe alcoholism may not see the same results. Those who took topiramate reported more side effects, including some dizziness, memory loss and weight loss. Ortho-McNeil Pharmaceutical, which makes Topamax, provided the drugs and partially funded the research.
* BOTTOM LINE People with moderate alcoholism may want to ask their doctor about topiramate combined with counseling.
* FIND THIS STUDY September issue of Archives of General Psychiatry; abstract available online at www.archgenpsychiatry.com.
* LEARN MORE ABOUT alcoholism at www.niaaa.nih.gov and www.mayoclinic.com.
Long-term medication appears safe but may not cut death risk.
* THE QUESTION Calcium channel blockers have become a preferred treatment for the occasional chest pain of angina, which results when plaque clogs the arteries and restricts blood flow to the heart. But can such drugs be used safely for a long period of time?
* THIS STUDY randomly assigned 7,665 people experiencing angina as a result of heart disease to add to their current drug regimen either 60 milligrams daily of nifedipine (sold as Adalat or Procardia) or a placebo. An extended-release form of nifedipine, designed to have less effect on the gastrointestinal system, was used. After an average of five years, about the same number of people in both groups had died. However, people taking the drug had 11 percent fewer heart problems requiring medical intervention than did the placebo-takers.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People who experience angina, a common symptom of heart disease.
* CAVEATS The drug was deemed safe for long-term use, but it did not improve life expectancy .
* BOTTOM LINE People with heart disease who suffer chest pains may want to ask their doctor about nifedipine.
* FIND THIS STUDY Sept. 4 issue of The Lancet; abstract available online at www.thelancet.com (click on INTERHEART).
* LEARN MORE ABOUT angina at www.nhlbi.nih.gov and www.americanheart.org.
Antidepressant may help women with muscle pain.
* THE QUESTION No one knows precisely what causes the widespread muscle pain, tenderness and fatigue that characterizes fibromyalgia. But one theory links it to abnormalities in brain chemicals associated with depression. Might an antidepressant offer relief?
* THIS STUDY randomly assigned 207 adults with fibromyalgia -- 89 percent of them women and 38 percent diagnosed with major depression -- to take 60 milligrams of duloxetine (Cymbalta) or a placebo twice a day. After 12 weeks, medical exams and questionnaires revealed that overall pain had dropped by 50 percent or more in 28 percent of those taking duloxetine and 17 percent of those on the placebo. People taking the drug also were less tired and had fewer tender points on their bodies. The results were similar overall for people who were and those who were not depressed. However, men in the study did not register improvement with the drug.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Women with fibromyalgia. The disorder affects about 1 in 50 Americans, about 90 percent of them women.
* CAVEATS People taking duloxetine had more side effects -- including dry mouth, insomnia and constipation, all moderate -- than those on the placebo. Because the study included only 23 men, the findings on men may not be valid. During the study, 44 percent of the duloxetine group and 36 percent of the placebo group withdrew, for various reasons. The study was funded by Eli Lily, which makes Cymbalta. Three of the seven authors worked for the company and two others had received consulting fees from it. The Food and Drug Administration has approved Cymbalta for epilepsy but not fibromyalgia.
* BOTTOM LINE Women with fibromyalgia may want to talk with their doctor about duloxetine.
* FIND THIS STUDY September issue of Arthritis and Rheumatism; abstract available online at www3.interscience.wiley.com (click "Medicine," then "Rheumatology").
* LEARN MORE ABOUT fibromyalgia at http://fmaware.org and www.niams.nih.gov (under "Health Information").
-- Linda Searing