Effects of topiramate on cue-induced cigarette craving and the response to a smoked cigarette in briefly abstinent smokers.
BACKGROUND
Clinical studies have shown that topiramate, an anticonvulsant medication, may be effective as a treatment for smoking cessation. However, less is known about topiramate effects on nicotine withdrawal and craving and its interactions with a smoked cigarette.


OBJECTIVE
The objective of this study was to investigate the effects of topiramate treatment on abstinence-related nicotine withdrawal, cue-induced cigarette craving, and the acute effects of a smoked cigarette.


METHODS
Fifteen female and 25 male cigarette smokers were randomly assigned to 9-day treatment with topiramate (final titration dose, 75 mg/day) or placebo. On the last day of treatment, after a 3-h smoke-free abstinence period, participants were evaluated for symptoms of nicotine withdrawal and then underwent cigarette and neutral cue reactivity testing. Thirty minutes after completing cue exposure testing, participants were then evaluated for the acute effects of a smoked cigarette. Cue reactivity and acute smoking measures included subjective ratings of cigarette craving and withdrawal and physiological measures of skin conductance and temperature, heart rate, and blood pressure. In addition, smoking topography was measured using a puff volume apparatus.


RESULTS
Topiramate treatment enhanced subjective ratings of withdrawal after the 3-h abstinence period and reduced pre-cue skin conductance levels. Cigarette cue exposure resulted in a moderate increase in craving, which was unaffected by treatment. Topiramate treatment enhanced the rewarding effects of a smoked cigarette, even while participants smoked less per puff and achieved lower plasma nicotine levels.


CONCLUSIONS
Results suggest that topiramate enhances both nicotine withdrawal and reward. These findings question the utility of topiramate treatment for smoking cessation.
Reid
Malcolm S
MS
Department of Psychiatry, New York University School of Medicine, New York, NY, USA. malcolm.reid@med.nyu.edu
Palamar
Joseph
J
Raghavan
Sumithra
S
Flammino
Frank
F
D000328:Adult; D016739:Behavior, Addictive / Q000188:drug therapy*; D001794:Blood Pressure / Q000187:drug effects; D003463:Cues; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D005731:Ganglionic Stimulants / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D009538:Nicotine / Q000494:pharmacology; D018722:Nicotinic Agonists / Q000494:pharmacology; D012907:Smoking; D016540:Smoking Cessation; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D000077236:Topiramate
D005731:Ganglionic Stimulants; D018696:Neuroprotective Agents; D018722:Nicotinic Agonists; D000077236:Topiramate; D005632:Fructose; D009538:Nicotine