Topiramate Might Help a Subgroup of People with Cocaine Use Disorder

Results from studies of medications for treating cocaine use disorder (CUD) have been largely disappointing, but targeting particular subtypes might prove useful. Although topiramate has only very modest efficacy in reducing cocaine use, it reduces impulsivity in several disorders and improves outcomes in others characterized by impulsivity (i.e., alcohol use disorder, binge-eating disorder). To determine how impulsive individuals with CUD would respond to topiramate for relapse prevention, researchers completed a secondary analysis of a double-blind, randomized, placebo-controlled trial of topiramate for CUD in 142 treatment-seeking individuals.

Topiramate was titrated to 300 mg/day as tolerated over 6 weeks and maintained for 6 weeks, and …