Topiramate in opiate withdrawal- comparison with clonidine and with carbamazepine/mianserin.
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.
Zullino
Daniele Fabio
DF
University Department of Adult Psychiatry, Lausanne, Switzerland. Daniele.Zullino@inst.hospvd.ch
Krenz
Sonia
S
Zimmerman
Grégoire
G
Miozzari
Amos
A
Rajeswaran
Rajini
R
Kolly
Stéphane
S
Khazaal
Yasser
Y
D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use*; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D000077236:Topiramate
D000316:Adrenergic alpha-Agonists; D000927:Anticonvulsants; D018687:Antidepressive Agents, Second-Generation; D000077236:Topiramate; D008803:Mianserin; D005632:Fructose; D002220:Carbamazepine; D003000:Clonidine