DOC News March 1, 2007
Volume 4 Number 3 p. 11
© 2007 American Diabetes Association
Topiramate/Metformin Combo Safe to Treat Diabetes
Although metformin has long been used as a first-line oral agent to treat
diabetes, evidence suggests that topiramate may have some therapeutic effect
for these patients as well. Topiramate, indicated for the treatment of seizure
disorders and to prevent migraines, appears to exert a beneficial effect on
glucose control.
In a recent issue of International Journal of Obesity, researchers
reported a randomized, double-blind, placebo-controlled study that found
topiramate was safe and effective in combination with metformin in obese
patients with type 2 diabetes.
The study included 646 participants followed at 68 medical centers in
Canada, Europe, and South Africa. Participants were 18–75 years old,
with a body mass index (BMI) of 27–50, and had been on metformin therapy
for at least 4 months before the trial. All participants engaged in an
exercise and behavior modification program and followed a diet intended to
reduce daily energy intake by 600 kcal. One group of participants was
prescribed 96 mg of topiramate per day, while another took 192 mg of
topiramate daily, and another group received placebo.
After 24 weeks of therapy, participants taking topiramate lost
significantly more weight, had lower glycated hemoglobin (A1C) levels, and had
lower systolic blood pressure than those receiving placebo. There was a
dose-response relationship, with a greater weight loss and A1C reduction among
participants prescribed the higher dose of topiramate.
Adverse events from topiramate therapy were uncommon, mostly involving
paresthesias and central nervous system symptoms. The drug appears safe and
effective for the treatment of obese patients with type 2 diabetes, but more
research is warranted, the researchers conclude.
Toplak H, Hamann A, Moore A, et al.: Efficacy and safety of
topiramate in combination with metformin in the treatment of obese subjects
with type 2 diabetes: A randomized, double-blind, placebo-controlled study.
Int J Obes 31:138–146, 2007
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