A recent study published in JAMA Psychiatry suggests that topiramate, an FDA-approved drug used to treat epilepsy and migraine headaches, may also be an effective medication for treating cocaine dependence. The study, led by Professor Bankole A. Johnson, Chairman of the Department of Psychiatry at the University of Maryland School of Medicine, is one of the first to explore pharmacological treatments for cocaine addiction, for which there are currently no FDA-approved medications. Cocaine addiction affects millions of users worldwide and is associated with severe health risks.
Professor Johnson, a renowned neuroscientist, and psychopharmacologist, had previously found topiramate to be a safe and effective treatment for alcohol dependence in comparison to a placebo.
The research involved 142 participants, aged 18 or older, seeking treatment for cocaine dependence. They were randomly assigned to either a topiramate group or a placebo group in a double-blinded study. The intent-to-treat analysis showed that topiramate was more effective than the placebo in increasing the participants’ weekly proportion of cocaine nonuse days and in increasing the likelihood of cocaine-free weeks. Additionally, topiramate was associated with reduced craving for cocaine and an improvement in global functioning compared to the placebo. The drug showed few side effects, with mild symptoms such as tingling skin sensations, taste distortions, anorexia, and difficulty concentrating.
Professor Johnson emphasized that while topiramate shows promise as a reliable medicine for cocaine dependence, caution should be exercised due to the risk of glaucoma and potential side effects, especially at higher doses.
The study’s findings build upon previous work from Professor Johnson’s group, which indicated that individuals dependent on cocaine, but not seeking treatment, experienced reduced cravings and preference for cocaine when taking topiramate compared to a placebo. The current study suggests that topiramate may be even more effective for those actively seeking to quit using cocaine.
Professor Johnson noted that the drug’s effects on dual neurotransmitter modulation, enhancing gamma amino butyric acid’s inhibitory action while inhibiting the excitatory effects of glutamate, contribute to its therapeutic effects in reducing cocaine use. These findings offer important insights into the neurobiological basis of addiction in general and may have implications for treating other addictive disorders.
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