Possible Interaction: Cocaine and Topiramate

“This is because the principal neurochemical effects of topiramate would not only serve to decrease the acute reinforcing effects of alcohol or cocaine , but might also facilitate cessation of their use following a period of long-term use by decreasing neuronal sensitisation.”

“Maintenance on topiramate and phentermine alone significantly decreased cocaine self-administration although these effects were modest in magnitude.”

“ Topiramate … cocaine used (mean reduction = -3.108 g, P < .001), the frequency of cocaine use (mean = -0.784 times per week, P = .005), and the amount … variable did not achieve statistical significance after Bonferroni correction) compared with the placebo during the 12 weeks (or 84 days) of the assessment.”

“ Topiramate pre‐treatment reduced the cocaine‐related craving and monetary value of high‐dose cocaine while increasing the monetary value, euphoria and stimulant effects of low‐dose cocaine.”

“Validated and standardized human experimental methods evaluating the potential for topiramate to alter cocaine's abuse liability suggest that topiramate may reduce the reinforcing effects and craving induced by higher cocaine doses.”

“We tested whether topiramate (100 mg twice daily) would reduce the euphoria, subjective mood, craving and preference for cocaine over money induced by low and high doses (0.325 and 0.65 mg/kg i.v.,”

“ConclusionsThese findings suggest that topiramate increases the rewarding properties of cocaine , at least in part, by regulating dopaminergic signaling in the mesolimbic circuit.”

“…•Topiramate increases … of cocaine in CPP• Topiramate alters dopaminergic signaling in the mesolimbic circuit• Topiramate delays the extinction of cocaine-induced CPP• TH and DAT gene … the VTA decreases with topiramate and/or with cocaine• Results show that it should limit the use of topiramate in cocaine-dependent subjects”

“Several medications have been reported to reduce cocaine use in double-blind, placebo-controlled clinical trials, namely baclofen, modafinil, tiagabine, and topiramate.”