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Research Summary

Topiramate Did Not Increase Abstinence from Methamphetamine but Might Reduce Use

Topiramate has shown promise for the treatment of cocaine dependence. This study randomized 140 methamphetamine-dependent adults from 8 sites to 13 weeks of topiramate (50 mg per day increasing to ≤200 mg per day) or placebo. All subjects received counseling to enhance adherence.

  • Intent-to-treat analyses did not show differences in abstinence during weeks 6 to 12.
  • More subjects in the topiramate (64%) than placebo (42%) group reduced their weekly median quantitative urine methamphetamine levels by ≥25% from baseline (p=0.05) during weeks 6 to 12.
  • More subjects in the topiramate (38%) than placebo (14%) group reported a ≥50% reduction in methamphetamine use from baseline (p=0.003) during weeks 6 to 12.
  • Subjects in the topiramate group experienced improved observer-rated global severity-of-dependence scores and had a trend toward decreased craving.
  • Topiramate was associated with increased paresthesias and dysgeusia but was generally well-tolerated.

Comments:

Discovery of a medication to treat methamphetamine dependence would be a major advance in addiction science. Topiramate did not increase abstinence in this study, but results indicate it might reduce methamphetamine use over time. It appears to take 6 or more weeks to see effects, so a medical-management–type intervention to enhance adherence seems imperative. Perhaps topiramate will be useful for selected patients, but we still await a medication that will be widely effective for abuse of stimulants, especially among the most severely afflicted. Peter D. Friedmann, MD, MPH

Reference:

Elkashef A, Khan R, Yu E, et al. Topiramate for the treatment of methamphetamine addiction: a multicenter placebo-controlled trial. Addiction. 2012;107(7):1297–1306.

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