Topiramate for the Treatment of Methamphetamine Addiction: A Meta-Analysis

Abstract

Methamphetamine (MAP) is one of the most abused recreational drug worldwide and its abuse creates a socioeconomic burden for developed and developing countries alike. It is hypothesized to act on various receptors to facilitate the release of catecholamines such as dopamine to provide a euphoric effect. As of date, there are no pharmacologic interventions approved yet for the treatment of MAP addiction. Topiramate is an anti-epileptic drug that works on multiple pathways to modulate other catecholamines such as gamma-aminobutyric acid (GABA) to decrease the reinforcing effects of stimulants like MAP. Two randomized controlled trials done by Elkashef et al. and Razeai et al. investigated the effectiveness of topiramate in the treatment of MAP addiction. To the authors knowledge, this is the first meta-analysis on topiramate for methamphetamine addiction. This study aims to evaluate the effectiveness of topiramate in the treatment of methamphetamine addiction among diagnoses methamphetamine dependents. Randomized controlled trials were searched through PubMed and other databases. Fixed variant analysis was applied to compare dichotomous outcomes. Two randomized controlled trials comparing maximum topiramate dose tolerated and placebo were included. The primary outcome was negative MAP use using urine test on the 10th week of study. There was no significant difference between the topiramate and placebo groups (RR 1.03, 95% CI [0.85,1.26], p=0.73). There is insufficient evidence to show that topiramate significantly promotes MAP abstinence on MAP abusers compared to placebo. Due to paucity of controlled studies, firm recommendation for its routine use for MAP addiction cannot be established.