title: Effects of topiramate or naltrexone on tobacco use among male alcohol-dependent outpatients.
abstract: BACKGROUND
  A high smoking prevalence has been registered among alcoholics. It has been pointed out that alcoholic smokers may have a more severe course and greater severity of alcoholism. This study aims at comparing smoking and non-smoking alcoholics in terms of treatment outcomes and verifying the efficacy of topiramate and naltrexone to decrease the use of cigarettes among alcoholic smokers.
  
  
  METHODS
  The investigation was a double-blind, placebo-controlled, 12-week study carried out at the University of São Paulo, Brazil. The sample comprised 155 male alcohol-dependent outpatients (52 non-smokers and 103 smokers), 18-60 years of age, with an International Classification of Diseases (ICD-10) diagnosis of alcohol dependence. After a 1-week detoxification period, the patients randomly received placebo, naltrexone (50mg/day) or topiramate (up to 300 mg/day). Only the alcoholic smokers who adhered to the treatment were evaluated with reference to the smoking reduction.
  
  
  RESULTS
  Cox regression analysis revealed that the smoking status among alcoholics increased the odds of relapse into drinking by 65%, independently of the medications prescribed, using the intention-to-treat method. Topiramate showed effectiveness to reduce the number of cigarettes smoked when compared to placebo among adherent patients (mean difference=7.91, p<0.01). There were no significant differences between the naltrexone group and the placebo group.
  
  
  CONCLUSIONS
  The results of this study confirm that the treatment is more challenging for smoking alcoholics than for non-smoking ones and support the efficacy of topiramate in the smoking reduction among male alcoholic smokers who adhered to the treatment.
authors: Department of Psychiatry of the University of São Paulo, Brazil. dbaltieri@uol.com.br
authors: Danilo Antonio
authors: DA
authors: Baltieri
authors: Fabio Ruiz
authors: FR
authors: Daró
authors: Philip Leite
authors: PL
authors: Ribeiro
authors: Arthur Guerra de
authors: AG
authors: Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000523:psychology; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000009:adverse effects / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D010045:Outpatients; D010349:Patient Compliance; D055502:Secondary Prevention; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation; D012959:Socioeconomic Factors; D000077236:Topiramate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D009292:Narcotic Antagonists; D000077236:Topiramate; D005632:Fructose; D009271:Naltrexone