Search   |  Advanced

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.


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


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.