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Topiramate May Help Alcohol-Dependent Patients Stop Smoking

  • Authors: News Author: Laurie Barclay, MD
    CME Author:
    Désirée Lie, MD, MSEd
  • CME Released: 7/25/2005
  • Valid for credit through: 7/25/2006
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Target Audience and Goal Statement

This article is intended for primary care physicians, psychiatrists, and other specialists who care for patients with alcohol and tobacco dependence.

The goal of this activity is to provide the latest medical news to physicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Identify the action of topiramate in alcohol and tobacco dependence.
  • Describe the effect of topiramate on smoking cessation rates in alcoholic patients.


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  • Laurie Barclay, MD

    Laurie Barclay is a freelance reviewer and writer for Medscape.


    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


  • Gary Vogin, MD

    Senior Medical Editor, Medscape


    Disclosure: Gary Vogin, MD, has disclosed no relevant financial relationships.

CME Author(s)

  • Désirée Lie, MD, MSEd

    Clinical Professor of Family Medicine; Director, Division of Faculty Development, University of California, Irvine School of Medicine, Irvine, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

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Topiramate May Help Alcohol-Dependent Patients Stop Smoking

Authors: News Author: Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEdFaculty and Disclosures

CME Released: 7/25/2005

Valid for credit through: 7/25/2006


July 26, 2005 -- Topiramate is safe and effective for smoking cessation in alcohol-dependent patients, according to the results of a subgroup analysis of a randomized trial reported in the July 25 issue of the Archives of Internal Medicine.

"Despite the proposal that smoking cessation can trigger alcohol relapse among the dually dependent, contemporary studies show that smoking cessation treatment does not cause abstinent alcoholics to relapse and could reduce moderate to heavy drinking among those still consuming alcohol," write Bankole A. Johnson, DSc, MD, PhD, from the University of Virginia in Charlottesville, and colleagues. "Previously, our group has shown that topiramate, a sulfamate-substituted fructopyranose derivative, is an effective treatment for alcohol dependence. Herein, we extend that proof-of-concept study by determining whether cigarette-smoking, alcohol-dependent individuals from the earlier study also experienced improved smoking outcomes."

This subgroup analysis was part of a larger, double-blind, 12-week study comparing topiramate and placebo as treatment for alcohol dependence. Of 94 cigarette-smoking, alcohol-dependent individuals, 45 were randomized to receive topiramate at an escalating dose from 25 to 300 mg per day, and 49 received placebo in addition to weekly standardized medication compliance management. The main outcome was smoking cessation based on self-report and confirmed by the level of serum cotinine, the major metabolite of nicotine.

Compared with patients receiving placebo, those receiving topiramate were at least four times more likely to abstain from smoking (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.08 - 18.39; P = .04). When a serum cotinine level of 28 ng/mL or lower was used to separate nonsmokers from smokers, patients receiving topiramate were nearly five times as likely to be nonsmokers (OR, 4.97; 95% CI, 1.1 - 23.4; P = .04). For topiramate recipients, smoking cessation rates were 19.4% at week 9 and 16.7% at week 12, vs 6.9% at both time points for placebo recipients.

Study limitations include post hoc analysis of smoking behavior, inclusion only of cigarette smokers, lack of follow-up, exclusion of patients with comorbid axis 1 psychiatric disorders, relatively small sample size, and short study duration.

"In this trial, topiramate (up to 300 mg/d) showed potential as a safe and promising medication for the treatment of cigarette smoking in alcohol-dependent individuals," the authors write. "This finding should garner scientific interest because no medication has been established as an effective treatment for comorbid alcohol and nicotine dependence."

Ortho-McNeil Pharmaceutical Inc., maker of Topamax, provided medication and a research grant in partial support of this project, which was also supported by the University of Texas Health Science Center at San Antonio and the National Institute on Alcohol Abuse and Alcoholism.

Arch Intern Med. 2005;165:1600-1605