Endocrine Abstracts (2003) 6 DP9

Treatment of metabolic syndrome with topiramate. An open study

G Messina1, R Proietti2 & JV Faroni3

1Obesity and Overweight Management Center; Endocrinological and Metabolism Disorders Operative Unit. Italian Neurotraumatological Institute, Grottaferrata (Rome), Italy.; 2Clinical Psychology and Antistress Center. Italian Neurotraumatological Institute 'White town', Veroli (Frosinone), Italy.; 3Neurological Medicine and Headache Operative Unit. Italian Neurotraumatological Institute, Grottaferrata (Rome), Italy.

Topiramate is an antiepileptic drug, with anoressant effect, known to positively modulate GABA receptors. There are some published data concerning the use of topiramate in mood disorders (expecially BED), while there are not know data on its use in obese patients without BED. This is a preliminary study to explane the effectiveness and tolerability of topiramate in non-Binge Eating Disorder (BED) obese patients with metabolic syndrome. We described the effects of topiramate, without a low-calorie diet, on weight and metabolic control in 8 subjects treated for consecutively 8 months. Local Ethical Committee approval has been obtained. The dosage of topiramate was gradually increased in increments of 25 mg every week from 25 mg twice daily in the first two weeks to the target dosage of 75 mg twice daily at the end of second month of treatment. Topiramate induced significant weight loss. The mean weight loss was 6,8 Kg and was present significativelly descrease of visceral fat. Glycemic control improved in parallel with weight loss, with a significant decreases in fasting plasma glucose (mean 21,6 mg/dl) and in plasma triglycerides (mean 33,4 mg/dl). Topiramate was well tolerated. The most adverse events reported were benign and transient (paresthesias 2 case, fatigue 1 case, somnolence 1 case). Treatment with topiramate had not improved HDL-cholesterol levels. Topiramate at 150 mg daily had not increased diastolic blood pression and pulse rate and may be an suitable option to sibutramine in obese patients with high blood pressure. In conclusion our preliminary data suggests that topiramate may be an well-tolerated agent in the treatment of obese patients, but this is a study with few patients. Other controlled studies need to be performed to evaluate the use of topiramate in patients with metabolic syndrome without BED.

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