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Addiction. 2016 Aug;111(8):1337-46. doi: 10.1111/add.13328. Epub 2016 Apr 1.

Topiramate for cocaine dependence: a systematic review and meta-analysis of randomized controlled trials.

Singh M1,2, Keer D1,3, Klimas J1,4,5, Wood E4,6, Werb D4,7.

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St Paul's Hospital, University of British Columbia, Vancouver, Canada.
Department of Psychiatry, University of British Columbia, Vancouver, Canada.
Department of Family Practice, University of British Columbia, Vancouver, Canada.
Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.
School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Department of Medicine, University of British Columbia, Vancouver, Canada.
Division of Global Public Health, University of California San Diego, La Jolla, CA, USA.



To assess the efficacy of topiramate in treating cocaine use disorder (i.e. retention, efficacy, safety and craving reduction) through a systematic review and meta-analysis.


We searched six scientific databases from inception to 23 December 2014 with no date limits. Data were reviewed, extracted and analysed systematically. Studies were included if they were peer-reviewed randomized control trials with participants meeting diagnostic criteria for cocaine dependence or cocaine use disorder, with the treatment arm involving topiramate with or without psychosocial intervention, and the control arm involving no intervention or psychosocial intervention with or without placebo. A random-effects meta-analytical model was computed.


Five studies met inclusion criteria (n = 518). Topiramate was compared with placebo (four studies) and no medication (one study). In a meta-analysis, we observed no significant differences between topiramate and placebo in improving treatment retention risk ratio (RR) = 0.85; 95% confidence interval (CI) = 0.60-1.22, P = 0.38. However, compared with a placebo, use of topiramate was associated with increased continuous abstinence in two of five studies (RR = 2.43; 95% CI = 1.31-4.53, P = 0.005). No differences were observed in frequency of adverse effects reported between topiramate and placebo (RR = 1.06; 95% CI = 0.91-1.23, P = 0.48). Topiramate was associated significantly (P < 0.05) with a reduction in craving in only one of five studies.


Evidence does not currently support the use of topiramate to improve treatment retention for cocaine use disorder, although it may extend cocaine abstinence with a similar risk of adverse events compared with placebo.


Cocaine abuse; cocaine addiction; cocaine dependence; cocaine use disorder; meta-analysis; review; topiramate

[Indexed for MEDLINE]

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