Hie reduction of withdrawal seizures was more pronounced with valproate (2.2% vs 4.7% with carbamazepine and 6.1% with placebo). However,

there was also a higher, but not significant, rate of delirium (valproate 4.4%). compared with 2.2% for placebo and none with carbamazepine. The authors also report a better general tolerability of valproate compared with carbamazepine. In conclusion, there Inhibitors,research,lifescience,medical is some evidence for effectiveness not only of carbamazepine, but also of valproate in learn more uncomplicated alcohol withdrawal, but it is obvious that better controlled studies are needed. So far, of all the anticonvulsants only carbamazepine reached such a level of confidence that it has been recommended in guidelines as suitable for the pharmacological management of alcohol withdrawal.35 Newer antiepileptic drugs that, had been tested in opencase series in the indication of alcohol withdrawal have produced conflicting results, eg, gabapentin, vigabatrin and topiramate36-38; however, randomized Inhibitors,research,lifescience,medical studies are missing or negative.39 Valproate and lamotrigine have also been tested in controlled studies in bipolar Inhibitors,research,lifescience,medical patients with comorbid alcohol abuse for their effects on drinking habits. For valproate, a significant reduction in heavy drinking days was found in

a controlled study,40 and also lamotrigine reduced alcohol intake and craving in an open study.41 There are also some case series on carbamazepine and lamotrigine lowering alcohol consumption in comorbid schizophrenia and alcohol dependence.42,43 Cocaine dependence As there is a high comorbidity, especially between bipolar disorder and cocaine dependence, some mood-stabilizing anticonvulsants have been tested in terms Inhibitors,research,lifescience,medical of their utility in limiting drug abuse. Both valproate44 and lamotrigine45 demonstrated mood-stabilizing effects in openlabel

trials, and some positive effects on drug abuse, such as diminished consumption (valproate) and less craving (lamotrigine). In a small placebo-controlled pilot trial, topiramate also proved Inhibitors,research,lifescience,medical effective in attaining at least 3 weeks of continuous abstinence.46 However, more controlled evidence still needs to be collected. Sedatives and tranquilizer MTMR9 abuse A potential role for GABA uptake inhibitors such as tiagabine for benzodiazepine withdrawal has been suggested,47 but never been rigorously tested. Of the older anticonvulsants, valproate has been tested in open case series,48 and has been compared against trazodone and placebo for benzodiazepine withdrawal. Rickels et al49 reported that more patients were free of benzodiazepines after 5 weeks when treated with valproate or trazodone compared with placebo. However, they did not find a significant reduction of somatic symptoms during benzodiazepine tapering. According to a Cochrane meta-analysis of available trials, carbamazepine shows a rather modest benefit in reducing withdrawal severity, but it does significantly improve drug-free outcome.