A pilot trial of topiramate for the treatment of cocaine dependence

Kampman, Kyle M.; Pettinati, Helen M.; Lynch, Kevin G.; Dackis, Charles A.; Sparkman, Thorne; Weigley, Catherine; O’Brien, Charles P.

doi:10.1016/j.drugalcdep.2004.03.008

Cited by 271 publications

(190 citation statements)

References 36 publications

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“…Our data give credence to an experience with which clinicians are quite familiar: there is not one treatment that will fit all, and different patients may respond to the same medication differently, based on their gender, biology, and use pattern (Elkashef and Vocci, 2003;Kampman et al, 2004). The failure of bupropion to have a significant impact on heavy users raises the important question of what pharmacological treatment might be effective for them.…”

Section: Discussionmentioning

confidence: 60%

Bupropion for the Treatment of Methamphetamine Dependence

Elkashef

Rawson

Anderson

et al. 2007

Neuropsychopharmacol

193

188

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Bupropion was tested for efficacy in increasing weeks of abstinence in methamphetamine-dependent patients, compared to placebo. This was a double-blind placebo-controlled study, with 12 weeks of treatment and a 30-day follow-up. Five outpatient substance abuse treatment clinics located west of the Mississippi participated in the study. One hundred and fifty-one treatment-seekers with DSM-IV diagnosis of methamphetamine dependence were consented and enrolled. Seventy-two participants were randomized to placebo and 79 to sustained-release bupropion 150 mg twice daily. Patients were asked to come to the clinic three times per week for assessments, urine drug screens, and 90-min group psychotherapy. The primary outcome was the change in proportion of participants having a methamphetamine-free week. Secondary outcomes included: urine for quantitative methamphetamine, self-report of methamphetamine use, subgroup analyses of balancing factors and comorbid conditions, addiction severity, craving, risk behaviors for HIV, and use of other substances. The generalized estimating equation regression analysis showed that, overall, the difference between bupropion and placebo groups in the probability of a non-use week over the 12-week treatment period was not statistically significant (p ¼ 0.09). Mixed model regression was used to allow adjustment for baseline factors in addition to those measured (site, gender, level of baseline use, and level of symptoms of depression). This subgroup analysis showed that bupropion had a significant effect compared to placebo, among male patients who had a lower level of methamphetamine use at baseline (po0.0001). Comorbid depression and attention-deficit/ hyperactivity disorder did not change the outcome. These data suggest that bupropion, in combination with behavioral group therapy, was effective for increasing the number of weeks of abstinence in participants with low-to-moderate methamphetamine dependence, mainly male patients, regardless of their comorbid condition.

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Section: Discussionmentioning

confidence: 60%

Bupropion for the Treatment of Methamphetamine Dependence

Elkashef

Rawson

Anderson

et al. 2007

Neuropsychopharmacol

193

188

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“…GVG has also been reported to inhibit cocaine-enhanced NAc DA levels (Dewey et al, 1998;Schiffer et al, 2003). Furthermore, clinical trials with the GABA A receptor modulator topiramate, the GABA B receptor agonist baclofen, or the GABA enhancers GVG or tiagabine (a GABA-uptake inhibitor) have shown significant decreases in self-reported cocaine craving and urine-confirmed cocaine use (Kampman et al, 2004;Shoptaw et al, 2003;Johnson, 2005;Brodie et al, 2003;González et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Effects of gabapentin on cocaine self-administration, cocaine-triggered relapse and cocaine-enhanced nucleus accumbens dopamine in rats

Peng

et al. 2008

Drug and Alcohol Dependence

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Gabapentin is a γ-aminobutyric acid (GABA) analogue, with GABAmimetic pharmacological properties. Gabapentin is used for the treatment of seizures, anxiety and neuropathic pain. It has been proposed that gabapentin may be useful in the treatment of cocaine dependence. However, clinical trials with gabapentin have shown conflicting results, while preclinical studies are sparse. In the present study, we investigated the effects of gabapentin on intravenous cocaine self-administration and cocaine-triggered reinstatement of drug-seeking behavior, as well as on cocaine-enhanced dopamine (DA) in the nucleus accumbens (NAc). We found that gabapentin (25-200 mg/kg, i.p., 30 min or 2 h prior to cocaine) failed to inhibit intravenous cocaine (0.5 mg/kg/infusion) selfadministration under a fixed-ratio reinforcement schedule or cocaine-triggered reinstatement of cocaine-seeking behavior. In vivo microdialysis showed that the same doses of gabapentin produced a modest increase (∼50%, p < 0.05) in extracellular NAc GABA levels, but failed to alter either basal or cocaine-enhanced NAc DA. These data suggest that gabapentin is a weak GABA-mimic drug. At the doses tested, it has no effect in the addiction-related animal behavioral models here tested. This

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“…Topiramate, a sulfamate-substituted fructopyranose derivative, has been shown to be efficacious in the treatment of both alcohol (Johnson et al, 2003) and cocaine (Kampman et al, 2004) dependence, and to promote smoking cessation among alcohol-dependent individuals who smoke (Johnson et al, 2005a). These therapeutic effects have been attributed to its hypothesized potential to reduce levels of cortico-mesolimbic dopamine, the primary neurochemical substrate for the acquisition and maintenance of drug-seeking behavior for the majority of abused drugs including alcohol, cocaine, tobacco, and amphetamines (Hemby et al, 1997;Wise, 1998).…”

Section: Introductionmentioning

confidence: 99%

Effects of topiramate on methamphetamine-induced changes in attentional and perceptual-motor skills of cognition in recently abstinent methamphetamine-dependent individuals

Johnson

Roache

Ait-Daoud

et al. 2007

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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Methamphetamine-dependent individuals often cite the need to maintain enhanced cognitive performance and attention as a reason for continuing or relapsing to drug-taking. Further, methamphetamine addicts might not comply with taking a potentially therapeutic medication if it had a profound effect on these cognitive processes. Topiramate, a sulfamate-substituted fructopyranose derivative, has been suggested as a putative therapeutic medication for treating methamphetamine dependence. Examination of topiramate's effects on cognitive performance and attention is a clinically and scientifically important component of understanding its potential therapeutic profile. In 10 male and female individuals who met DSM-IV criteria for methamphetamine dependence, we examined the effects of low (50 mg b.i.d.)-and high (100 mg b.i.d.)-dose topiramate -in both the presence and absence of low (15 mg)-and high (30 mg)-dose intravenous methamphetamine -on cognitive performance, attention, and concentration on the rapid visual information processing task and the digit symbol substitution test. Intravenous methamphetamine enhanced cognitive performance, attention, and concentration among recently withdrawn methamphetamine addicts -an effect that hitherto had not been well characterized. Topiramate's cognitive effects were mixed and rather paradoxical, with a tendency to improve attention and concentration both alone and in the presence of methamphetamine while worsening psychomotor retardation. No deleterious interaction occurred between topiramate and methamphetamine on any of these cognitive processes. While clinical studies with topiramate should Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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A pilot trial of topiramate for the treatment of cocaine dependence

Cited by 271 publications

References 36 publications

Bupropion for the Treatment of Methamphetamine Dependence

Bupropion for the Treatment of Methamphetamine Dependence

Effects of gabapentin on cocaine self-administration, cocaine-triggered relapse and cocaine-enhanced nucleus accumbens dopamine in rats

Effects of topiramate on methamphetamine-induced changes in attentional and perceptual-motor skills of cognition in recently abstinent methamphetamine-dependent individuals

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