By Melissa Healy
9:00 AM EST, November 30, 2012
Cocaine dependence is a devilishly difficult addiction to break, owing to the drug's unique chemical ability both to reward users and to disrupt their impulse-control mechanisms. But a surprising drug combination may offer an equally clever way to loosen cocaine's hold on an addict, a new study has found.
The experimental treatment regime used a mix of topiramate -- an anti-seizure drug that has shown promise in breaking dependence on nicotine and alcohol -- and stimulant drugs -- amphetamines -- which, in addition to being widely abused, are used to treat attention deficit and hyperactivity disorder.
Individually, both classes of drug have been tried as a treatment for cocaine dependence. Topiramate has shown some promise, but is slow to take effect; amphetamines have not by themselves proven useful. The drug duo comes at a time when no single drug has been shown effective in treating cocaine dependence.
But in a trial that pitted a sham medication against the topiramate/amphetamine duo for 120 days, cocaine addicts taking the combination drug were roughly twice as likely to string together three consecutive weeks of cocaine abstinence (33% of 39 cocaine-dependent subjects) than were those who got the placebo (7 of 42 subjects, or 16.7%). Subjects in both groups also received psychotherapy aimed at keeping them on their medication regimens and off their street drugs.
Moreover, the medication combo appeared to curb cocaine urges within a few weeks, much faster than the eight-week period it took for topiramate alone to take effect in other studies. And the combination appeared to be most effective in curbing the addiction of the study's most frequent cocaine users -- typically those who are hardest to reach with standard psychotherapeutic approaches.
The combination appears to work to correct several of the chemical imbalances in the brain induced by frequent cocaine use, surmised the authors, all substance-abuse researchers from Columbia University's College of Surgeons and Physicians. Topiramate is commercially marketed as Topamax and most recently became half of an FDA-approved combination drug for obesity, Qsymia.
The present study, which was published this week in the journal Biological Psychiatry and funded by the National Institute on Drug Abuse, was very small. Noting that drug combinations in general -- and this combination specifically -- may be the answer to treating cocaine dependency with medication, its authors called for larger studies.
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