Use of oral topiramate to promote smoking abstinence among alcohol-dependent smokers a randomized controlled trial

Bankole A. Johnson, Nassima Ait-Daoud, Fatema Z. Akhtar, Martin A Javors

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Abstract

Background: 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. Methods: As a subgroup analysis of a larger double-blind, randomized, controlled, 12-week study comparing topiramate vs placebo as treatment for alcohol dependence, a 12-week clinical trial compared topiramate vs placebo in 94 cigarette-smoking, alcohol-dependent individuals. Of these, 45 were assigned to receive topiramate (escalating dose from 25 to 300 mg/d) and the remaining 49 had placebo as an adjunct to weekly standardized medication compliancemanagement.Theprimaryoutcomewassmoking cessation ascertained by self-report and confirmed by the level of serum cotinine (nicotine's major metabolite). Results: Topiramate recipients were significantly more likely than placebo recipients to abstain from smoking (odds ratio, 4.46; 95% confidence interval, 1.08-18.39; P=.04). Using a serum cotinine level of 28 ng/mL or lower to segregate nonsmokers from smokers, we found that the topiramate group had 4.97 times the odds of being nonsmokers (95% confidence interval, 1.1-23.4; P=.04). Smoking cessation rates for topiramate recipients were 19.4% and 16.7% at weeks 9 and 12, respectively, compared with 6.9% at both time points for placebo recipients. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1600-1605
Number of pages6
JournalArchives of Internal Medicine
Volume165
Issue number14
DOIs
StatePublished - Jul 25 2005

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Alcohol Abstinence
Randomized Controlled Trials
Smoking
Placebos
Cotinine
Alcohols
Alcoholism
Confidence Intervals
topiramate
Smoking Cessation
Serum
Nicotine
Self Report
Therapeutics
Odds Ratio
Clinical Trials

ASJC Scopus subject areas

  • Internal Medicine

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Use of oral topiramate to promote smoking abstinence among alcohol-dependent smokers a randomized controlled trial. / Johnson, Bankole A.; Ait-Daoud, Nassima; Akhtar, Fatema Z.; Javors, Martin A.

In: Archives of Internal Medicine, Vol. 165, No. 14, 25.07.2005, p. 1600-1605.

Research output: Contribution to journalArticle

Johnson, Bankole A. ; Ait-Daoud, Nassima ; Akhtar, Fatema Z. ; Javors, Martin A. / Use of oral topiramate to promote smoking abstinence among alcohol-dependent smokers a randomized controlled trial. In: Archives of Internal Medicine. 2005 ; Vol. 165, No. 14. pp. 1600-1605.
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