Topiramate for the treatment of methamphetamine addiction: a multi‐center placebo‐controlled trial

Abstract

Aims Topiramate has shown efficacy at facilitating abstinence from alcohol and cocaine abuse. This double-blind, placebo-controlled outpatient trial tested topiramate for treating methamphetamine addiction. Design Participants (N=140) were randomized to receive topiramate or placebo (13 weeks) in escalating doses from 50 mg/day to the target maintenance of 200 mg/day in weeks 6–12 (tapered in week 13). Medication was combined with weekly brief behavioral compliance enhancement treatment. Setting The trial was conducted at eight medical centers in the United States. Participants One hundred forty methamphetamine-dependent adults took part in the trial. Measurements The primary outcome was abstinence from methamphetamine during weeks 6 – 12. Secondary outcomes included use reduction versus baseline, as well as psychosocial variables. Findings In the intent-to-treat analysis, topiramate did not increase abstinence from methamphetamine during weeks 6–12. For secondary outcomes, topiramate reduced weekly median urine methamphetamine levels and observer-rated severity of dependence scores significantly. Subjects with negative urine before randomization (N=26) had significantly greater abstinence on topiramate versus placebo during study weeks 6–12. Topiramate was safe and well tolerated. Conclusions Topiramate does not appear to promote abstinence in methamphetamine users but can reduce the amount taken and reduce relapse rates in those who are already abstinent.

Impact of an exercise intervention on methamphetamine use outcomes post residential treatment care

“…Several studies examining drug-use severity, for example, have identified frequency of use at treatment entry to be an important factor that affects treatment response (Simpson et al, 2002;Vaillant, 1988). Recent studies with clinical samples of MAdependent users also support the importance of considering MA-severity when examining posttreatment outcomes, since heavy or daily use is considered to increase one's risk for relapse (Brecht and Herbeck, 2014;Elkashef et al, 2008Elkashef et al, , 2012Heinzerling et al, 2014).…”

The Nucleus Accumbens: Mechanisms of Addiction across Drug Classes Reflect the Importance of Glutamate Homeostasis

“…Topiramate is efficacious for treating smoking addiction in men, but not women (Anthenelli et al, 2008). It has very limited efficacy in treating methamphetamine addiction (Elkashef et al, 2012;Ma et al, 2013). Thus, although the mechanism by which topiramate treats substance use disorders is not entirely clear, it appears to be one of the better clinical tools available for treating addiction.…”

Addiction to Amphetamines and Methamphetamines

“…A multisite outpatient trial of topiramate 200 mg for reducing meth use was negative for the primary outcome. However, there was a positive effect in the subgroup of patients that had negative urines at randomization suggesting a role in relapse prevention (Elkashef et al 2012). Vigabatrin (GVG) was tried in an open-label study of 30 for 9 weeks.…”