I was thinking about Topiramate as an adjunct to an anti-tolerance stack. This case report (
Topiramate use in alprazolam addiction, page 265) provides some interesting insights:
"Topiramate is considered to enhance GABAergic activity,
antagonize AMPA/kainite-type glutamate receptors
and inhibit sodium channels, L- and N-type calcium
channels as well as CA-III and CA-IV isoenzymes of
carbonic anhydrase (Chengappa et al. 2001)."
In this case report, alprazolam dose was reduced from 6mg to 1.5. Each 25mg of Topiramate (added each 10 days) was able to reduce alprazolam dosage by 0.5mg increments.
This (
study) discusses the use of anticonvulsant drugs in substance abuse and withdrawal.
Other interesting studies on Topiramate and addiction:
Topiramate for the treatment of methamphetamine addiction: a multi-center placebo-controlled trial.
"CONCLUSIONS:
Topiramate does not appear to promote abstinence in methamphetamine users but can reduce the amount taken and reduce relapse rates in those who are already abstinent."
How to treat cocaine dependance? With amphetamine, of course! -
Extended-release mixed amphetamine salts and topiramate for cocaine dependence: a randomized controlled trial.
RESULTS:
The overall proportion of participants who achieved 3 consecutive weeks of abstinence was larger in the extended-release mixed amphetamine salts and topiramate group (33.3%) than in placebo group (16.7%). There was a significant moderating effect of baseline total number of cocaine use days (Wald χ(2) = 3.75, df = 1, p = .05) on outcome, suggesting that the combination treatment was most effective for participants with a high baseline frequency of cocaine use.
Not so positive review study -
Topiramate in the treatment of substance-related disorders: a critical review of the literature.
Topiramate is efficacious for the treatment of alcohol dependence, but side effects may limit widespread use. While topiramate's unique pharmacodynamic profile offers a promising theoretical rationale for use across multiple substance-related disorders, heterogeneity both across and within these disorders limits topiramate's broad applicability in treating substance-related disorders. Recommendations for future research include exploration of genetic variants for more targeted pharmacotherapies.
Effects of topiramate on methamphetamine-induced changes in attentional and perceptual-motor skills of cognition in recently abstinent methamphetamine-dependent individuals.
Topiramate's cognitive effects were mixed and rather paradoxical, with a tendency to improve attention and concentration both alone and in the presence of methamphetamine while worsening psychomotor retardation. No deleterious interaction occurred between topiramate and methamphetamine on any of these cognitive processes. While clinical studies with topiramate should prepare participants for possible psychomotor retardation, the cognitive effects profile observed would not likely present an important obstacle to compliance in motivated patients. Topiramate's complicated cognitive effects among methamphetamine addicts need more comprehensive examination. Hmmmmm....
Now, this is interesting -
Effects of acute topiramate dosing on methamphetamine-induced subjective mood.
...topiramate appeared to accentuate the appreciation of methamphetamine-induced stimulation and euphoria significantly, but not craving or reinforcement. The experimental combination of topiramate and methamphetamine appeared to be safe and well tolerated, with few adverse events. Acute dosing with up to 200 mg topiramate appears to enhance, rather than attenuate, the positive subjective effects of methamphetamine.
So, definitely useful as an anti-addiction and euphoria/stimulation enhancing for METH.
Does it automatically mean tolerance/neurotoxicity reducing? Whaddya think?
--
