A double-blind, placebo-controlled trial of topiramate for the treatment of
comorbid cocaine and alcohol dependence.
Author(s): Kampman KM(1), Pettinati HM, Lynch KG, Spratt K, Wierzbicki MR, O'Brien CP.
Affiliation(s): Author information:
(1)Department of Psychiatry, Perelman School of Medicine, University of
Pennsylvania, 3900 Chestnut Street, Philadelphia, PA 19104, USA. Electronic
address: kampman@upenn.edu.
Publication date & source: 2013, Drug Alcohol Depend. , 133(1):94-9
BACKGROUND: Topiramate increases GABAergic activity and antagonizes the
AMPA/kainate subtype of glutamate receptors. Through these mechanisms of action,
topiramate may reduce alcohol and cocaine reward and may reduce alcohol and
cocaine craving. Topiramate has been shown to reduce drinking in persons with
alcohol dependence, and reduce relapse in stimulant-dependent patients. The
current trial was intended to test the ability of topiramate to promote cocaine
and alcohol abstinence among patients addicted to both drugs.
METHODS: The study was a double-blind, placebo-controlled, 13-week trial
involving 170 cocaine and alcohol dependent subjects. After achieving a period of
cocaine and alcohol abstinence, subjects were randomized to topiramate, 300 mg
daily, or identical placebo capsules. In addition, subjects received weekly
individual psychotherapy. Primary outcome measures included self-reported alcohol
and cocaine use, and thrice weekly urine drug screens. Secondary outcome measures
included cocaine and alcohol craving, Addiction Severity Index results, cocaine
withdrawal symptoms, and clinical global improvement ratings.
RESULTS: Topiramate was not better than placebo in reducing cocaine use on the a
priori primary outcome measure, or in reducing alcohol use. Topiramate was not
better than placebo in reducing cocaine craving. Topiramate-treated subjects,
compared to placebo-treated subjects, were more likely to be retained in
treatment and more likely to be abstinent from cocaine during the last three
weeks of the trial. Subjects who entered treatment with more severe cocaine
withdrawal symptoms responded better to topiramate.
DISCUSSION: Topiramate plus cognitive behavioral therapy may reduce cocaine use
for some patients with comorbid cocaine and alcohol dependence.
|