Topiramate in opiate withdrawal- comparison with clonidine and with carbamazepine/mianserin

Subst Abus. 2004 Dec;25(4):27-33. doi: 10.1300/j465v25n04_04.

Abstract

There are some rationales for developing anticonvulsants for the treatment of substance abuse. The blockade of the AMPA/kainate subtype of glutamate receptor by topiramate may be of particular interest, as preclinical studies of withdrawal from opioids suggest that whilst AMPA-receptor antagonists may not be able to prevent tolerance or dependence from developing, they may ameliorate both physical and emotional consequences of withdrawal.

Methods: Ten consecutively admitted patients treated with topiramate were compared in a retrospective naturalistic drug utilization observation study with 10 consecutively admitted patients treated with clonidine and with 10 consecutively admitted patients treated with a carbamazepine/ mianserin combination.

Results: In 9 cases of the clonidine group and in 7 carbamazepine/mianserin treated patients the dose had been reduced, whereas this occurred in only 2 topiramate treated patients (p < 0.01). Patients in the topiramate group received less p.r.n. myorelaxant medication than the two other groups, and there was a significant difference between the three groups with regard to p.r.n. analgesics (p < 0.05), topiramate and clonidine treated patients receiving fewer analgesics than the carbamazepine/mianserin group.

Conclusions: Compared to clonidine and carbamazepine/mianserin, a detoxification scheme using high initial and then decreasing doses of topiramate appeared to be appropriate for most patients and as associated with less analgesic and myorelaxant comedication, indicating a more promising efficacy at the used doses.

Publication types

  • Comparative Study

MeSH terms

  • Adrenergic alpha-Agonists / adverse effects
  • Adrenergic alpha-Agonists / therapeutic use*
  • Adult
  • Anticonvulsants / adverse effects
  • Anticonvulsants / therapeutic use*
  • Antidepressive Agents, Second-Generation / adverse effects
  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Carbamazepine / adverse effects
  • Carbamazepine / therapeutic use*
  • Clonidine / adverse effects
  • Clonidine / therapeutic use*
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Fructose / adverse effects
  • Fructose / analogs & derivatives*
  • Fructose / therapeutic use
  • Humans
  • Male
  • Mianserin / adverse effects
  • Mianserin / therapeutic use*
  • Opioid-Related Disorders / rehabilitation*
  • Retrospective Studies
  • Substance Withdrawal Syndrome / drug therapy*
  • Topiramate

Substances

  • Adrenergic alpha-Agonists
  • Anticonvulsants
  • Antidepressive Agents, Second-Generation
  • Topiramate
  • Mianserin
  • Fructose
  • Carbamazepine
  • Clonidine