Six randomized, double-blind, controlled clinical trials evaluating the use of
topiramate in patients who were
cocaine dependent were analyzed. The results from the studies indicated that
topiramate, when used in combination with cognitive behavioral therapy, may be effective in reducing short-term
cocaine use and should be considered as a possible treatment option. Other trials suggested that
topiramate was not effective in patients with a dual diagnosis of
opioid and
cocaine dependence. Two trials suggested that short-term abstinence assisted by
pharmacotherapy is a predictor of longer-term (6 months and 1 year, respectively) abstinence.
Cocaine use is dependent on multiple factors; therefore, a reduction in use or craving is not definitively associated with abstinence. However, decreased use reduces potential patient harm and the amount of money spent on illicit
cocaine. The findings of this literature review should be used to encourage the completion of more trials that are appropriately designed.
Topiramate was shown to be effective for increasing
cocaine abstinence, the proportion of
cocaine nonuse days, and the proportion of patients to attain 3 consecutive weeks of
cocaine abstinence and decreasing the abuse liability of
cocaine. Conflicting results in clinical trials do not provide a definitive answer regarding
topiramate's efficacy in managing
cocaine dependence.
CONCLUSION: