What is the role of topiramate in the treatment of cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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In a 12-week, double-blind, randomized study involving 142 cocaine-dependent adults, treatment with the anticonvulsant topiramate was found to be significantly more effective than placebo in improving abstinence from cocaine use, reducing the intensity and frequency of cravings for cocaine in a 24-hour period, and improving observer-rated global functioning. [63, 64]

From weeks 6-12, half of the study’s patients received escalating doses of topiramate, starting at 50 mg daily and increasing to the target maintenance dose of 300 mg/day. The reduction from baseline in the number of days per week in which patients did not use cocaine was 13.3% with topiramate, compared with 5.3% with placebo. In addition, the likelihood of achieving urinary cocaine–free weeks increased by 16.6% with topiramate, versus 5.8% with placebo.

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