Topiramate vs Placebo in Painful Diabetic Neuropathy: Analgesic and Metabolic Effects

Other anticonvulsants that are being used for the treatment of painful diabetic neuropathy -- valproic acid, carbamazepine, gabapentin, and vigabatrin, for example -- have been associated with weight gain and/or impaired glycemic control. This is in contrast to the topiramate experience in this study in which a large number of subjects experienced weight loss. Of note, however, approximately 1 of 4 patients in the topiramate group discontinued treatment because of an adverse event. This may, in part, reflect the target of 400 mg daily, a relatively high dose. As the study authors suggest, a lower target dose may provide comparable efficacy, may be better tolerated, and may thus improve the study-completion rate. They propose that titrating to a dose that provides adequate analgesia may be a better approach.